INCIDENCE OF CONTRALATERAL VESICOURETERAL REFLUX FOLLOWING UNILATERALEXTRAVESICAL DETRUSORRHAPHY (URETERONEOCYSTOSTOMY)

Purpose: The development of contralateral vesicoureteral reflux follow ing different types of unilateral antireflux surgery has been reported to be as high as 22%. We review our recent experience with unilateral extravesical detrusorrhaphy in regard to the incidence of postoperati ve contralateral vesicoureteral reflux. Materials and Methods: Between 1990 and 1995, 72 children underwent unilateral extravesical detrusor rhaphy. Of 73 refluxing renal moieties (1 patient had reflux in both m oieties of a completely duplicated kidney) reflux grade was II in 35 ( 48%), III in 25 (34%), IV in 11 (15%) and V in 2 (3%). Common sheath r eimplantation for complete ipsilateral duplication was performed in 16 patients.Results: One patient had grade I postoperative ipsilateral v esicoureteral reflux resulting in a success rate of 98.6%. In 4 patien ts (5.6%) contralateral vesicoureteral reflux developed, and was grade II in 3 and grade I in 1. In all patients contralateral reflux resolv ed at 16, 17, 18 and 31 months of followup. No additional surgery was required in any patient. There was no association between the incidenc e of contralateral vesicoureteral reflux, and patient age, gender, pre operative ipsilateral reflux grade and presence of ipsilateral duplica tion. Conclusions: Unilateral extravesical detrusorrhaphy is a highly successful procedure with a low incidence of postoperative contralater al vesicoureteral reflux. Should reflux develop, it is of low grade wi th a significant rate of spontaneous resolution.