30 YEARS EXPERIENCE WITH THE ANTIREFLUX PLASTY ACCORDING TO POLITANO-LEADBETTER

Our aim was to analyze the incidence of complications after surgical c orrection of vesicorenal reflux with the intravesical technique of Pol itano-Leadbetter. Furthermore, we investigated the pre- and postoperat ive prevalence of renal scars and hypertension. From 1965 to 1996, 666 children with 814 renal units were operated using a standardized tech nique. The mean follow-up was 10.3 (1-31) years. 68.8% of all patients could be controlled in the 10(th) postoperative year. The intra- and postoperative complication rate was 7.8% (52/666). Intraoperative comp lications included minor injuries to the bowel (0.3%, 2/666) as well a s urinary fistulas (0.4%, 3/666) and hematomas (0.3%, 2/666). Th most frequent postoperative complications was persistence of reflux in 5.6% (37/666) which occurred especially in patients with high grade reflux . Obstructions of the upper urinary tract due to ureteral stenosis wer e observed in 1.2% (8/666) of the children and could be successfully c orrected by reimplantation. Late ureteral obstructions were seen in on ly 0.2% (1/666). Renal scars were found in 21.2% (141/666) preoperativ ely. During the observation period, there was an increase in renal sca rring up to 27.7% (127/458). In 8.7% (40/458) of the patients with ren al scars, arterial hypertension occurred between 6 and 17 years postop eratively. 6.1% of all patients (28/ 458) required secondary nephrecto my due to reflux nephropathy. The ureteroneocystostomy according to Po litano-Lead-better was successful in 93.6% of all 814 renal units. Thi s operation is a safe procedure in the operative management of vesicor enal reflux. Hypertension is a complication even of successfully corre cted vesicorenal reflux.