SURGICAL VERSUS ENDOSCOPIC CORRECTION OF VESICOURETERAL REFLUX IN CHILDREN WITH NEUROGENIC BLADDER DYSFUNCTION

Purpose: We attempted to compare the efficacy of subureteral polytetra fluoroethylene injection and ureteral reimplantation for treating vesi coureteral reflux in children with neurogenic bladder dysfunction. Mat erials and Methods: We retrospectively studied the records of all chil dren with neurogenic bladder dysfunction and reflux into single collec ting systems treated with cross-trigonal ureteroneocystostomy or subur eteral polytetrafluoroethylene injection. Followup cystography was per formed 2 months postoperatively and ultrasound was done twice yearly t hereafter. Urodynamic data were evaluated when available. Success was defined as complete eradication of reflux. Data were stratified by pro cedure, patient sex, grade and laterality of reflux, and the presence of unilateral or bilateral reflux, and then compared using chi-square analysis. Results: Of 85 patients (118 ureters) identified followup da ta were available in 95%. Subureteral polytetrafluoroethylene injectio n and ureteroneocystostomy were done an 60 and 47 ureters, respectivel y. Both groups were similar in mean patient age, followup and preopera tive degree of reflux. Success rates after ureteroneocystostomy and a single injection were 84.3 versus 56.7%. The cumulative success rate o f subureteral polytetrafluoroethylene injection was 61% after a second injection. The success rate of ureteroneocystostomy was significantly greater than that of injection (p = 0.02). Reflux resolved in all pat ients in whom injection failed and who underwent secondary reimplantat ion. Successful ureteroneocystostomy was unrelated to patient sex, ref lux grade or laterality, or bilateral versus unilateral reflux. Subure teral polytetrafluoroethylene injection was more likely to fail in hig her grades of reflux (p = 0.03) but success was otherwise unrelated to other parameters. Failure to correct reflux was unrelated to urodynam ic findings. Conclusions: Primary open ureteral reimplantation is more effective than subureteral polytetrafluoroethylene injection for corr ecting reflux in children with neurogenic bladder dysfunction. Despite controversy related to the appropriate injectable substance, the rela tive technical simplicity, outpatient nature, rapid recovery and poten tial for successful secondary reimplantation support a role for subure teral polytetrafluoroethylene injection in managing reflux in these di fficult cases.