THE USE OF THE DETRUSORRHAPHY FOR VESICOURETERAL REFLUX - THE WAY FORWARD

Objective To assess the outcome of all detrusorrhaphies carried out fo r simple single-system vesico-ureteric reflux (VUR) in children at one institution over a 4-year period. Patients and methods Twenty-nine pa tients (11 boys, 18 girls, 43 renal units; mean age at presentation 23 months; range, antenatal to 72 months) were analysed in two groups. G roup 1 comprised those undergoing asynchronous bilateral procedures (t wo patients, four units) and unilateral procedures (15 patients, 15 un its), and group 2, those undergoing synchronous bilateral procedures ( 12 patients, 24 units), The mean (range) follow-up was 17 months (6-39 ) and 15 months (7-24), respectively, Results Three patients had anten atal hydronephrosis related to WR post-natally and 26 had urinary trac t infections (13 recurrent, one with haematuria, seven 'breakthrough', one with calculi and four with enuresis). The mean age at operation w as 54 months (range 14-167), The mean (range) duration of anaesthesia was 69 min (40-120) in group 1 and 80 min (65-120) in group 2. All pat ients were catheterized urethrally for a mean (range) duration of 3 da ys (2-4) in group 1 and 5 days (2-15) in group 2 and the mean hospital stay was 3 days (2-6) and 6 days (4-16), respectively, Post-operative complications occurred in 14 patients including one bladder spasm, fi ve urinary tract infections, two with urinary retention, three with ha ematuria and one each of pneumonia, epididymo-orchitis, anuria, failur e to stent and conversion to Cohen reimplantation. Operative success a nd clinical success were similar within groups but differed between gr oups, although not significantly (15 of 17 in group 1 and eight of 12 in group 2). Conclusion Unilateral but not synchronous bilateral detru sorrhaphy seems an appropriate surgical treatment for VUR.