Md. Bomalaski et al., WHAT IMAGING STUDIES ARE NECESSARY TO DETERMINE OUTCOME AFTER URETERONEOCYSTOSTOMY, The Journal of urology, 158(3), 1997, pp. 1226-1228
Purpose: After ureteroneocystostomy we have performed renal ultrasonog
raphy within the first 3 months to exclude hydronephrosis, voiding cys
tography after 3 months to exclude vesicoureteral reflux and subsequen
t ultrasonography to monitor the upper tracts. This study attempted to
determine those patients at risk for hydronephrosis or recurrent vesi
coureteral reflux, Materials and Methods: We studied the: records of p
atients who underwent ureteroneocystostomy in the last decade at our i
nstitutions to find the incidence and degree of preoperative and posto
perative hydronephrosis and vesicoureteral reflux. Results of initial
postoperative imaging were compared to radiological imaging throughout
followup (mean 2.3 years). Patients with postoperative reflux were ev
aluated for risk factors that differentiated them from others. Results
: Excluding patients with neuropathic bladder or ureterocele, 167 unde
rwent 278 ureteroneocystostomies at a mean followup of 26.5 months, Pe
rsistent vesicoureteral reflux was noted in 4 kidneys (1.4%) and contr
alateral reflux developed in 3 of the 48 cases (6.3%) of unilateral ur
eteroneocystostomy. There was no statistical difference in success rat
es among cross-trigonal, ureteral advancement or extravesical techniqu
es. New onset mild hydronephrosis in 13 kidneys (4.7%) at the initial
followup study (mean 1.6 months) completely resolved in 12 and remaine
d mild in 1. No patient had progression of existing hydronephrosis and
1 had recurrent vesicoureteral reflux after initial negative cystogra
phy. Risk factors for postoperative reflux or hydronephrosis were preo
perative dysfunctional voiding, preoperative hydronephrosis or scarrin
g on sonography and postoperative urinary tract infection. None of the
88 patients without these risk factors had postoperative hydronephros
is or reflux. All patients with persistent, contralateral or recurrent
reflux were selected using these criteria (p <0.003). Conclusions: Co
mplication rates after nontapered ureteroneocystostomy in children wit
hout neuropathic bladder are quite low, Mild postoperative hydronephro
sis was not clinically significant in our patients, Children with abno
rmal preoperative ultrasound or dysfunctional voiding are identified a
s a high risk group for postoperative hydronephrosis or recurrent refl
ux. All other patients received lit-tie benefit from postoperative ima
ging, suggesting that further evaluation of this group is necessary on
ly in the presence of a postoperative urinary tract infection.