VOIDING DYSFUNCTION AFTER BILATERAL EXTRAVESICAL DETRUSORRHAPHY

Purpose: Extravesical detrusorrhaphy has been successful for correctin g unilateral vesicoureteral reflux, although its use in bilateral uret eral reimplantation has been questioned because of a reportedly high i ncidence of significant postoperative voiding dysfunction. We reviewed the incidence of voiding dysfunction after bilateral extravesical det rusorrhaphy during the last 5 years. Materials and Methods: From 1990 to 1995, 123 patients with a mean age of 5.8 years (231 refluxing rena l units) underwent bilateral extravesical detrusorrhaphy. Patients req uiring anticholinergic therapy or intermittent catheterization at surg ery were excluded from study, although in 6 who were included voiding dysfunction had previously resolved. Results: Grades I and II vesicour eteral reflux persisted in 1 and 3 renal units, respectively, represen ting a 98.3% success rate. There was no postoperative upper urinary tr act obstruction. Postoperatively voiding dysfunction developed in 8 pa tients (6.5%), including 2 with a history of voiding dysfunction. In 3 cases (2.5%) irritative voiding symptoms controlled with oxybutynin c hloride resolved 2, 4 and 24 months postoperatively, respectively. In 5 patients (4%) temporary incomplete bladder emptying and/or urinary r etention required outpatient Foley catheter drainage or intermittent c atheterization for 2 to 21 days. Conclusions: Bilateral extravesical d etrusorrhaphy is a highly successful procedure with a low incidence of significant voiding dysfunction. Should this condition develop, in ou r experience it is transient and of minimal morbidity. We found an inc reased rate of postoperative voiding dysfunction in younger patients a s well as in those with a history of resolved voiding dysfunction.