LESSONS LEARNED ABOUT CONTRALATERAL REFLUX AFTER UNILATERAL EXTRAVESICAL URETERAL ADVANCEMENT IN CHILDREN

Purpose: The development of contralateral reflux after unilateral anti reflux surgery has spawned interest and controversy regarding etiology and management issues. We evaluate our experience to understand bette r the issues surrounding contralateral reflux. Materials and Methods: We retrospectively reviewed the records of all children seen in a 7-ye ar period who underwent unilateral extravesical ureteral advancement p erformed by one of us (M. R. Z.) at our institution. Results: A total of 43 children a mean of 50.5 months old underwent unilateral reimplan tation. The male-to-female ratio was 12:31. In 12 children contralater al reflux had resolved preoperatively. Overall contralateral reflux de veloped in 5 patients (11.6%) after unilateral extravesical ureteral a dvancement. In 1 child in whom new onset contralateral reflux develope d on 1 side reflux resolved by 10 months with observation. In 8 of the 12 children (66%) with a history of resolved contralateral reflux the re was no recurrence. In 4 of the 12 children recurrent contralateral reflux completely resolved by 14 months postoperatively with only obse rvation. In these 4 patients initial reflux had been grades II and IV in 2 each. To date all fully evaluable reflux in children with previou s contralateral reflux recurred has resolved. Conclusions: The recurre nce of contralateral reflux after unilateral reimplantation that is ex pected in a small number of children resolves in the majority, if not in all, with conservative management. We believe that children should not be offered bilateral reimplantation for unilateral reflux and a hi story of resolved contralateral reflux. If contralateral reflux recurs , it will most likely resolve with time.