THE MECHANISM OF NEW-ONSET CONTRALATERAL REFLUX FOLLOWING UNILATERAL URETERONEOCYSTOSTOMY

Purpose: We studied a population of patients undergoing unilateral ant ireflux surgery to determine the mechanism of new onset contralateral reflux postoperatively. Materials and Methods: A total of 141 patients underwent unilateral antireflux surgery via the Cohen, Glenn-Anderson or extravesical technique. The 18% of patients who had new onset cont ralateral vesicoureteral reflux were analyzed according to grade of in itial reflux, presence of a Hutch diverticulum or duplex system and su rgical technique. Results: Surgical technique did not influence the de velopment of contralateral reflux. As grade of corrected reflux increa sed, a significant trend toward development of contralateral reflux wa s noted. A Hutch diverticulum was not a risk factor for contralateral reflux but reflux into a duplicated system was a distinct risk factor (26 versus 12% in single system reflux). Conclusions: Our study suppor ts the concept that new onset contralateral reflux may result from eli mination of a pop-off mechanism. Surgical distortion of the contralate ral hemi-trigone appears not to be responsible. Correction of severe ( grade V) reflux and reflux into duplex systems put patients at particu lar risk for development of contralateral reflux postoperatively.