Transitional Outcomes of Adults Who Underwent Cohen Ureteroneocystostomy for the Treatment of Vesicoureteral Reflux as Children.

OBJECTIVE

To analyze the transitional outcomes of children who underwent Cohen ureteroneocystostomy(UNC) due to vesicoureteral reflux(VUR).

METHODS

Files of patients who underwent UNC between January 2003 and December 2013 and had >10 years of follow-up were retrospectively reviewed. Demographic and clinical data before surgery were noted. Lower urinary tract dysfunction (LUTD) status was assessed via ICIQ M/F-LUTS, voiding diary and uroflowmetry in all patients. Renal functions, hypertension, proteinuria, febrile/afebrile urinary tract infections(UTIs), and complications associated with pregnancy were noted.

RESULTS

Two hundred and forty-one patients (140 girls, 58.1%) underwent UNC at a median age of 6.5 years (3-14), and 57.7% underwent bilateral surgery. After a median follow-up of 15 years (10-20), median patient age at the last clinic visit was 21 years (18-31). LUTD was detected in 69 (28.6%) patients. Bilateral disease, female gender, history of childhood bladder bowel dysfunction(BBD), presence of renal scar, and older age (≥7 years) at the time of surgery were significantly associated with LUTD in adulthood. Febrile UTI was detected in 7.9% (19/241) following UNC, whereas 6 needed subureteral injection due to persistent low-grade VUR. No patient developed stage 3 or greater chronic kidney disease, but 11(4.6%) patients developed hypertension and 7(2.9%) had proteinuria. Of 67 sexually active female patients,10(14.9%) had febrile UTIs. Of 49 women in whom pregnancy was observed,4(8.1%) had febrile UTIs, 7(14.2%) had afebrile UTIs and 2(4.1%) had pre-eclampsia during pregnancy, but none had a miscarriage or early labor.

CONCLUSION

Despite VUR control, the incidence of febrile UTI and pre-eclampsia during pregnancy should not be underestimated. In addition, a quarter of patients face LUTD when they reach adulthood. Female patients with bilateral disease, renal scar, and previous childhood BBD have higher risks for these transitional clinical problems.