COMMON SHEATH REIMPLANTATION YIELDS EXCELLENT RESULTS IN THE TREATMENT OF VESICOURETERAL REFLUX IN DUPLICATED COLLECTING SYSTEMS

Purpose: We evaluated our 10-year experience with the surgical treatme nt of vesicoureteral reflux in uncomplicated duplicated collecting sys tems. Materials and Methods: Between 1984 and 1994, 54 refluxing renal units (8 bilateral) in 37 female and 9 male patients required surgery . Patient age ranged from 7 months to 17 years (average 4.9 at surgery ). Postoperative followup (average 14.2 months) included voiding cysto urethrography and renal sonography or excretory urography. Results: Co mmon sheath ureteral reimplantation via an intravesical approach was p erformed in 48 of the 54 refluxing renal units. Of the remaining 6 ren al units detrussorrhaphy was performed in 4, and ureteroureterostomy c ombined with ureteral reimplantation and partial lower pole nephrectom y were done in 1 each. Two treated renal units had persistent postoper ative vesicoureteral reflux, which resolved after subureteral polytetr afluoroethylene (Teflon) injection. No renal unit had postoperative hy dronephrosis. Contralateral reflux was identified in 1 patient who und erwent unilateral reimplantation. Our overall success rate was 96% for the surgical correction of vesicoureteral reflux in uncomplicated dup licated collecting systems. Common sheath reimplantation had a 98% suc cess rate. Conclusions: Although a duplicated collecting system increa ses the risk for surgical treatment, the presence of a duplication ano maly does not adversely affect surgical outcome. Modifications of proc edures commonly performed in the surgical treatment of single system r eflux to accommodate common sheath reimplantation have excellent surgi cal results with minimal morbidity.