Bladder functional outcome after delayed vesicostomy closure and antireflux surgery in young infants with 'primary' vesico-ureteric reflux

Objective To evaluate bladder function by conventional urodynamic investiga tions in young infants with primary vesico-ureteric reflux (VUR) who had un dergone an initial temporary cutaneous vesicostomy followed by later antire flux surgery and vesicostomy closure. Patients and methods From 1983 to 1990, nine boys (10-360 days old) with pr imary VUR were treated with an initial vesicostomy, followed by delayed clo sure of the vesicostomy and the simultaneous surgical correction of reflux. Severe VUR was detected bilaterally in seven and unilaterally in two infan ts at the time of the initial diagnosis. The mean (SD, range) age at vesico stomy was 12.4 (8, 3-23) months and the duration of bladder defunctionaliza tion 38.7 (25.5, 18-90) months. All patients were assessed urodynamically a fter closing the vesicostomy, using rapid-fill cystometry with normal salin e solution at room temperature. The mean (range) age at the time of urodyna mic testing was 7.3 (5-15)years; the mean (SD, range) follow-up was 10.1 (4 .1. 5-17) years. Results Six boys with bilateral VUR underwent successful ureteroneocystosto my; nephroureterectomy was required in one patient. In two patients the VUR resolved with time. After re-functionalization, the mean (SD, range) maxim um cystometric capacity, expressed as a percentage of the mean bladder capa city for age, was 1.4 (0.5, 0.6-2.2)%, In three patients the bladder capaci ty was higher (greater than or equal to 40%) than expected for age, while o ne had diminished (<70%) bladder capacity. The mean (range) end-filling det rusor pressure was 14.5 (5-42) cmH(2)O and the mean (SD, range) compliance 24 (13.9, 4-14) mL/cmH(2)O. Two patients had a compliance of < 10 mL/cmH(2) O, one of whom had associated unstable detrusor contractions of 90 cmH(2)O. The mean (SD, range) detrusor voiding pressure at peak flow was 47.3 (16.8 , 5-76) cmH(2)O. One patient had a residual urine volume of 8% of bladder c apacity. At the follow-up, only one patient (aged 5 years) with detrusor in stability had urinary incontinence, Conclusion This study shows that the bladder of young infants with primary VUR treated with temporary vesicostomy regained normal function after re-fu nctionalization of the lower urinary tract.