Document Detail

Should we treat vesicoureteral reflux in patients who simultaneously undergo bladder augmentation for neuropathic bladder?
MedLine Citation:
PMID:  11371958     Owner:  NLM     Status:  MEDLINE    
PURPOSE: If high pressure is responsible for vesicoureteral reflux in neurogenic bladders, eliminating the high pressure should resolve reflux in noncompliant bladders. Nevertheless, the need for simultaneous ureteral reimplantation and bladder augmentation remains controversial in patients with a noncompliant bladder and vesicoureteral reflux. MATERIALS AND METHODS: Bladder augmentation was performed in 8 boys and 8 girls with a noncompliant bladder and vesicoureteral reflux at a mean age of 10 years (range 2 to 17) because they had not responded satisfactorily to clean intermittent catheterization and anticholinergic therapy alone. No effort had been made to correct reflux surgically in these patients. Before bladder augmentation reflux was grade II to III in 4 ureters (3 patients) and IV to V in 18 (13). The bladder was augmented with intestine in 14 patients and with ureter in 2. Mean followup was 5.2 years (range 2.8 to 7.5). RESULTS: After bladder augmentation bladder compliance improved in all patients. Of the 18 ureters with high grade reflux 2 were used for bladder augmentation, and reflux resolved in 13, was downgraded in 1 and persisted in 2. Of the 4 ureters with low grade reflux, reflux disappeared in 2 and was down graded in 2. The rate of high and low grade vesicoureteral reflux resolution or improvement was 87.5% and 100%, respectively. At the end of the study only 3 patients had persistent reflux, which was downgraded in 2. No urinary tract infections developed in any patient and none was receiving chemoprophylaxis 6 months postoperatively. CONCLUSIONS: Our experience indicates that antireflux procedures are not routinely needed in patients with a noncompliant bladder and associated vesicoureteral reflux who undergo bladder augmentation.
P López Pereira; M J Martinez Urrutia; R Lobato Romera; E Jaureguizar
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of urology     Volume:  165     ISSN:  0022-5347     ISO Abbreviation:  J. Urol.     Publication Date:  2001 Jun 
Date Detail:
Created Date:  2001-05-23     Completed Date:  2001-06-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2259-61     Citation Subset:  AIM; IM    
Department of Paediatric Urology, University Hospital "La Paz", Madrid, Spain.
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MeSH Terms
Reconstructive Surgical Procedures*
Urinary Bladder / surgery*
Urinary Bladder, Neurogenic / complications,  surgery*
Urologic Surgical Procedures*
Vesico-Ureteral Reflux / complications,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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