Nephrectomy combined with lower abdominal extraperitoneal ureteral bladder augmentation in the treatment of children with the vesicoureteral reflux dysplasia syndrome.

Ureterocystoplasty is a novel procedure well suited for treating children with megaureters and small or noncompliant bladders. It combines the benefits of enterocystoplasty without many of its drawbacks. We performed nephrectomy through a posterior approach with extraperitoneal ureteral augmentation in 6 patients with bladder neck obstruction and reflux into a nonfunctioning kidney (the vesicoureteral reflux dysplasia/vesicoureteral reflux nonfunctioning kidney syndrome). In all patients capacity increased significantly. Bladder pressure at capacity decreased in patients who were evaluated by urodynamics postoperatively, and continence was achieved or preserved. There were no complications and hospital stay was short. Nephrectomy via a posterior approach with extraperitoneal ureteral augmentation is an appropriate procedure for children with the vesicoureteral reflux dysplasia syndrome. It should be considered for all such patients before nephroureterectomy is done and irreversible loss of valuable compliant native urothelium occurs.