CONTRALATERAL URETERAL MEATAL ADVANCEMENT IN UNILATERAL ANTIREFLUX SURGERY

Purpose: Contralateral vesicoureteral reflux is a well-known developme nt after successful unilateral ureteral reimplantation that is not app arently influenced by the reimplantation technique, We sought to deter mine whether bilateral reimplantation should be performed routinely in unilateral cases, Materials and Methods: From 1984 to 1995 we perform ed contralateral ureteral meatal advancement in 53 children 1 to 9.5 y ears old (mean age 2.5) undergoing surgery for unilateral grades II to V vesicoureteral reflux, including 12 with reflux in duplex systems. Ureteral meatal advancement involves a transverse Y shaped mucosal inc ision from the nonrefluxing orifice to the opposite hemitrigone, The i nferior half of the ureteral orifice is then advanced toward the midli ne using 3 or 4 long-term resorbable sutures. The control group includ ed 98 children who underwent, unilateral surgery for grades II to V re flux from 1990 to 1995, Results: No evidence of vesicoureteral reflux was observed in the 53 children who underwent contralateral meatal adv ancement, There was no obstruction or other complications. At followup contralateral reflux was found in 11 controls after unilateral reimpl antation, Conclusions: Contralateral reflux has been reported in up to 27% of previously reported cases and in 11% of our control group afte r successful unilateral antireflux surgery, Contralateral ureteral mea tal advancement has proved effective for preventing reflux in 100% of cases, It requires minimal invasion of the nonrefluxing ureter, and li ttle additional operative time and cost.