[Surgical treatment of vesicoureteral reflux by tunnelling of the detrusor muscles].

Detrusor tunnelling is an extravesical surgical procedure of ureteral reimplantation. It is surely the least traumatic method of surgical correction of vesico-ureteral reflux because antireflux mechanism is achieved with minimal detrusor muscle dissection. This procedure simplifies implantation of dilated ureters, double ureters as well as the ureters shortened by previous antireflux surgical procedures. Ureteral tapering is unnecessary. One hundred and forty detrusor tunnelling uretero-cysto-neostomies in 102 patients have been performed in the University Children's Hospital between January 1990 and September 1994. The youngest patient was 1 month old and the eldest was 15 years (mean age 6.8 years). Indications for surgical treatment were primary (45.0%) and secondary (26.4%) megaureter as well as grade IV & V (international classification) vesico-ureteral reflux (28.6%). Follow up was 1-40 months (mean 26 months). Excellent postoperative results were achieved in 130 detrusor tunnelling uretero-cysto-neostomies, i.e. more than 90% of patients. Complication rate was 7.1% (6 patients-10 ureteral units) and about one third were classified as major-postoperative relapses or stenosis or minor-intraoperative mucosal perforation, hematuria, parahiatal diverticulum, spontaneous proximal migration of ureteral double J stent-about two thirds.