VESICOURETERAL REFLUX

EXTRAVESICAL VERSUS INTRAVESICAL URETERIC REIMPLANTATION IN CHILDREN

Abstract

Objectives: The objective of our study is to compare the extravesical and
intravesical ureteric reimplantation for the treatment of bilateral vesicoureteral reflux in children.
Period: April 2013 and July 2016. Setting: Urology Department of Mayo Hospital, Lahore.
Methodology: 66 children diagnosed with primary vesicoureteral reflux and undergoing
ureteric reimplantation. The Cohen cross-trigonal reimplantation (intravesical) and modified
Lich-Gregoir procedure (extravesical) were performed on two separate groups Group IR
and group ER. The following parameters were compared: postoperative duration of stay in
the hospital, hematuria and bladder spasm. Frequency of hematuria, bladder spasm and
average duration of stay in the hospital were compared in both group. Mean and standard
deviation was calculated for age, gender and duration of surgery in both groups.). Chi square
test was applied to check the association of outcome variables with demographical variables
and duration of surgery. Results: These 100% (n=66) patients were divided into 2 groups
equally, 33 in each, i.e. group ER and group IR. The mean age and duration of surgery of
the patients of group ER were 13.78±2.83 years, 102.45±4.13 minutes respectively. While
the mean age and duration of surgery of the patients of group IR was 30.33±4.58 years and
119.7±10.70 minutes respectively (Table-II).The main outcome variables of this study were
the hospital stay, postoperative bladder spasm and hematuria. The mean hospital stay of the
patients of group ER and group IR was 4.30±1.35 days and 5.84±1.0 respectively (Table-II).
It was observed that bladder spasm in group ER and group IR was 39.4% (n=13) and 54.5%
(n=18) respectively (Figure-1). It was also observed that hematuria in group ER and group IR
was 36.4% (n=12) and 48.5% (n=16) respectively (Figure-2). Conclusion: The observation of
this study concludes that extravesical ureteric reimplantation has an edge over conventional
procedure of intravesical ureteric approach. Intravesical procedure has disadvantages of more
frequency of postoperative complications like, hospital stay, bladder spasms and hematuria.