Politano-Leadbetter ureteroneocystostomy - A 30-year experience

Purpose: We evaluated the results and complications of children with reflux treated with the Politano-Leadbetter ureteroneocystostomy. In particular, we evaluated pre- and postoperative renal parenchymal scarring and the late development of hypertension. Materials and Methods: From 1965 through 1996 , 666 children (814 renal units) were reimplanted by nine urologists. The a verage postoperative evaluation was 10.3 years, and 68.8% of all patients w ere evaluable 10 years after surgery. Results: Postoperative complications occurred in 7.8% and consisted of small bowel serosal injury (0.3%), vesico cutaneous fistula (0.4%) and retrovesical hematoma (0.3%). Persistent reflu x was the most common postoperative complication (5.6%) and was found to oc cur in higher grades of vesicorenal reflux. Ureteral stricture and hydronep hrosis were seen in 1.2% of children, and was corrected with a secondary re implantation. Late stricture occurred in all but 1 patient (0.2%). Renal pa renchymal scarring was found in 21.2% of patients preoperatively, and this increased over time postoperatively to 27.7%. In 8.7% of these patients, hy pertension developed between the 6th and 17th postoperative year. In 6.1%, nephrectomy was carried out, which normalized blood pressures in 87.9% of t hese 30 patients. Conclusions: The Politano-Leadbetter ureteroneocystostomy was successful in 93.6% of all 814 renal units surgically treated. The ope ration is safe, but can be associated with late development of hypertension despite correction of the reflux. Copyright (C) 2000 S. Karger AG, Basel.