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Distant implications and complications of antireflux operations in children with vesicoureteral reflux, based on 900 cases
Article published in Urologia Polska 2008/61/Supl. 1.


Marcin Życzkowski, Andrzej Paradysz, Mieczysław Fryczkowski
Katedra i Klinika Urologii w Zabrzu ¦l±skiego Uniwersytetu Medycznego w Katowicach



Results of surgical treatment of VUR are well known from large numbers of papers. Well known are also complications and implications of VUR. But observation time over 42 years is very rare and allows to study patients’ histories, to verify results and estimate anatomical and functional changes related to VUR.


The aim of the study is to estimate distant implications and complications of antireflux operations in children with vesico-ureteral reflux, based on 900 cases.

Materials and methods.

Histories of 900 patients operated due to VUR between 09.1964. and 12.2006. were estimated retrospectively. Age of operated patients was between 2 months and 15 years (mean – 6.7 years old). There were 645 girls (71.67 %) and 255 boys (28.33%). Bilateral antireflux operation was performed in 452 cases (50.2%), left side operation – 254 (28.2%) and right side – 194 (21.6%). Most common ureter reimplantation methods were: Cohen (373), Politano-Leadbetter (310), our own modification (61), Faur (36), Hendren (28), Glen-Anderson (28), Gregoir-Lich (11), Girgis (7). Unilateral or bilateral ureter duplication was observed in 77 (8.5%) patients. Preoperative and postoperative examinations included: basic laboratory exams, urine culture, cystography, IVP and, according to becoming these methods more popular: sonography, scintigraphy and CT scan.


VUR was the cause of death in 18 children (2%). 52 reoperations (5.77%) were performed, included 34 (3.77%) due to recurrence of VUR and 18 (2%) due to vesico-ureteral stricture. Secondary nephrectomies and heminephrectomies were performed in 40 (4.4%) patients. Contralateral VUR was observed in 28 patients, which was 6.25% of all cases after unilateral antireflux operation. This complication was most commonly seen – in 17 cases after Politano-Leadbetter method. Among these 28 patients bilateral ureter duplication was observed in 4 patients and unilateral in 3 patients. Significant bacteriuria before operation was observed in 19 (67.8%) patients. 15 children (53.6%) were treated conservatively and 3 (10.7%) endoscopicaly before.


Late implications and complications requiring secondary surgical treatment were observed in 10.17% patients. There is high risk of appearance of contralateral VUR in children after unilateral antireflux operation. The highest risk is after Politano-Leadbetter method and risk increasing factors are: early conservative or endoscopic treatment of VUR, ureteral duplication and urinary tract infection.