Ureteral reimplantation in infancy: Evaluation of long-term voiding function

Purpose: The advisability of early ureteral reimplantation in neonates and infants is controversial and to our knowledge long-term results are not ava ilable. We evaluated long-term voiding function after ureteral reimplantati on in infancy. Materials and Methods: Between 1984 and 1993, 32 children underwent uretera l reimplantation in year 1 of life at our institution. Long-term results we re evaluated in regard to surgical outcome, voiding function, urinary tract infection and the need for prophylaxis. Analysis of voiding function inclu ded family interviews, uroflowmetry and post-void residual urine measuremen t. Results: Complete long-term data were available in 14 girls and 7 boys. The diagnosis was primary bilateral and unilateral vesicoureteral reflux, and ureterovesical junction obstruction in 11, 4 and 6 cases, respectively. Of the 26 refluxing renal units overall disease was grade II in 3, III in 6 an d IV to V in 17. Patient age at surgery was 0.6 to 12 months (mean 5.4) and followup was 5 to 13 years (mean 9.5). Tapered reimplantation was performe d in 8 renal units using excisional or infolding in 5 and 3, respectively. There were no complications in 19 patients (94%), while 2 had postoperative reflux for which 1 underwent reoperation. In 13 patients voiding habits we re normal, while 8 reported infrequent voiding (3 or fewer voids daily). In 19 of the 20 patients tested voided volume was appropriate, and the now ra te of 10.8 to 52.7 cc per second (mean 20.9) and post-void residual urine v olume of 0 to 40 cc (mean 11) were considered normal. One patient with norm al uroflowmetry had incomplete vesical emptying. Conclusions: Early reimplantation may result in a high technical success ra te and low postoperative morbidity in infants. After long-term followup inf requent voiding was common but noninvasive assessment of bladder function r evealed no significant abnormality in the majority of patients.