Persistence and appearance of vesicoureteral reflux/obstruction following open reimplantation for vesicoureteral reflux

Abstract

Introduction: Appearance or persistence of vesicoureteral reflux (VUR) and other obstructive complications after open reimplantation of ureters is well known and up to 7.5% of cases require reoperation. In this study, we have assessed children presenting with recurrent urinary tract infection (UTI) following open reimplantation for VUR. Materials and Methods: We retrospectively collected hospital data of 14 children referred to us for management of recurrent UTIs following open ureteric reimplantation for vesicoureteric reflux from January 2006 to December 2015. Results: Fourteen children presented to our center at a mean age of 31.85 ± 10.17 months. The mean serum creatinine was 0.77 ± 0.26 mg% (range 0.5–1.3). Urine culture was positive in all with Escherichia coli being the most common organism grown on culture. Two children had obstruction at the vesicoureteric junction, and the remaining twelve children had 14 ureteral units with VUR. Two children underwent reimplantation into Boari flap, five underwent open reimplantation, and the remaining seven underwent endoscopic Deflux injection. Repeat voiding cystourethrogram done within 1 year of surgery revealed no VUR in any child. Conclusions: Appearance or persistence of VUR and obstructive complications after open reimplantation surgery is a matter of great concern for the parents of these children as well as the treating pediatric urologists. Appropriately selected open/endoscopic treatment can help in resolving these complications.