Outcome of ureteral reimplantation in children with the urge syndrome

Purpose: While bladder dysfunction, particularly detrusor-sphincter incoord ination, appears to be associated with a higher ureteral reimplantation fai lure rate, the potential effect of the urge syndrome or detrusor instabilit y alone on surgical outcome remains unclear. We assessed the effect of the underlying urge syndrome on the outcome of ureteral implantation in cases o f primary vesicoureteral reflux. Materials and Methods: We retrospectively reviewed the charts of all patien ts who underwent ureteral reimplantation for primary vesicoureteral reflux at our institution in an 11-year period. The urge syndrome was considered f requency, urgency or urge incontinence with absent urinary tract infection. Patients with and without the urge syndrome were compared with respect to the rate of urinary tract infection and renal scarring as well as postopera tive outcome. Results: We identified 25 patients (40 ureters) with and 67 (113 ureters) w ithout the urge syndrome. Reimplantation was successful in all except I ure ter in a patient without the urge syndrome. Postoperatively 2 patients with out the syndrome had transient contralateral reflux and IL in each group ha d transient ipsilateral reflux. No case required reoperation. Postoperative ly patients with the syndrome had a significantly higher incidence of febri le (16% versus 1.5%, p <0.05) and afebrile (52% versus 12%, p <0.05) urinar y tract infection. Conclusions: The results of ureteral reimplantation are excellent with 99.3 % success irrespective of the presence or absence of the urge syndrome. Thu s, when clinically indicated, reimplantation may be performed safely in suc h cases. The higher incidence of postoperative urinary tract infection in p atients with the urge syndrome may require continuing antibiotic prophylaxi s in addition to anticholinergics until voiding symptoms resolve.