VOIDING DYSFUNCTION AFTER BILATERAL EXTRAVESICAL URETERAL REIMPLANTATION

Purpose: Voiding dysfunction has been reported after bilateral extrave sical ureteral reimplantation. We evaluate the incidence and duration of voiding dysfunction, and the effects of minimizing surgical dissect ion in a cohort of children after bilateral extravesical reimplantatio n. Materials and Methods: A retrospective chart review was performed o n 33 consecutive children who underwent bilateral extravesical uretera l reimplantation for reflux. Preoperative and postoperative radiologic al studies, and postoperative post-void residuals were reviewed. Of th e 33 patients II underwent ureteroneocystostomy using a modified Lich- Gregoir technique with ureteral advancement and 22 underwent a modifie d procedure in which the detrusor dissection was minimized and the obl iterated umbilical artery was preserved. Both groups had similar preop erative characteristics. Postoperative surgical success and signs of v oiding dysfunction were evaluated and compared between groups. Results : The average length of time until patients were able to void at least half of the bladder volume was 5.9 +/- 3.1 days. The average length o f time until successful postoperative Foley catheter or suprapubic tub e removal was 7.4 +/- 4.2 days. All children were able to void adequat ely eventually. Postoperative voiding cystourethrogram demonstrated th at reflux was cured in 97% of the ureters. There was no postoperative vesicoureteral obstruction. There was no significant difference in len gth of time necessary to void, the duration of catheterization or oper ative success between the children who underwent standard versus limit ed detrusor dissection procedures. Conclusions: Extravesical ureteral reimplantation is an effective method for repairing reflux without ure teral obstruction but it can also result in a high rate of transient p ostoperative urinary retention even when detrusor dissection is minimi zed.