Detrusorrhaphy for repair of unilateral vesicoureteral reflux: report of 76 patients using a modified technique.

OBJECTIVE

To present our results for repair of unilateral vesicoureteral reflux in 76 children using a modified technique of detrusorrhaphy.

METHODS

A retrospective chart review was performed for 76 children who underwent repair of unilateral vesicoureteral reflux by a modified technique of detrusorrhaphy. Of the 76 refluxing ureters, 12 were associated with historically refluxing contralateral ureters. In addition, 72/76 were grades II to IV; 4/76 grade V; three had a paraureteral diverticulum; four completely duplicated collecting systems; and two had associated ureteroceles. The surgical technique was modified to preserve both the obliterated umbilical artery and superior vesical pedicle and to minimize trigonal distortion through dissection lateral to the trigone in a direct path to the bladder neck.

RESULTS

Seventy-five of 76 ureters were successfully repaired (99%). The remaining ureter showed initial improvement to grade I reflux and spontaneous resolution by 1 year. Obstruction did not occur. Three episodes of "new onset" contralateral vesicoureteral reflux were noted postoperatively. This represents a substantial decrease in incidence (3.9%) when compared with previously reported series (18%).

CONCLUSION

Detrusorrhaphy is a reasonable treatment of unilateral vesicoureteral reflux with utility in the full range of anatomic associations. This approach is also associated with a lower incidence of new onset, contralateral reflux when compared with intravesical surgery.