Ureteral Reimplantation in Infants

Abstract

Between 1984 and 1990, 30 infants (46 ureters) 8 weeks to 6 months old (mean age 4 months) underwent ureteral reimplantation. Weight at operation ranged from 4.9 to 9.5 kg. (mean 6.9). Underlying abnormalities were primary vesicoureteral reflux (28 ureters), primary ureterovesical junction obstruction (11), ectopic ureterocele (4) and ectopic ureter (3). Patients with reflux underwent surgery because of high grade reflux (grade IV or V) or breakthrough infection. Infants with primary ureterovesical junction obstruction underwent obstructive diethylenetriaminepentaacetic acid diuretic renograms. Reimplantations performed included 44 Glenn-Anderson advancements, 1 Cohen cross-trigonal advancement and 1 Politano-Leadbetter procedure. Of the ureters 30 (65%) were tapered intravesically. Ureteral stents were used in all instances. Transient ureteral obstruction developed in 2 children following stent removal and 1 required temporary percutaneous nephrostomy drainage. No permanent ureterovesical obstruction was noted in any patient. Followup at 18 months revealed no postoperative reflux in 43 of 46 ureters (93%). One infant required repeat reimplantation to correct a vesicoureteral fistula and the remaining 2 patients (2 ureters) with low grade reflux (grade I and II) are being observed. Surgery was successful in 27 of 30 tapered ureters (90%) and in all 16 of the nontapered ureters (100%). While the majority of infants with ureterovesical junction abnormalities may be observed, some may require surgery. Reimplantation, when necessary in this age group, can be performed with a high degree of success and diverting procedures such as vesicostomy or ureterostomy can be avoided.