Treatment and prevention of complications after extravesical antireflux technique.

An extravesical antireflux technique was performed in 300 consecutive patients who presented primary vesicoureteral reflux (VUR). The following results are reported: Elimination of VUR in 99% of the cases without complications. Early complications reported include: urinary retention, suppurative pyelonephritis and fistulae. Urinary retention occurred in 2 patients presenting other congenital abnormalities. Vesicocutaneous fistulae occurred in 2 patients due to obstruction of the catheter for vesical drainage; they closed spontaneously under adequate drainage of the bladder. Suppurative pyelonephritis and/or anuria occurred in 6 patients due to transitory obstruction due to edema of the new vesicoureteral junction and were treated with bilateral nephrostomy and progressed with good results after withdrawal of the nephrostomies. Late complications included: persistence of VUR in 8 patients due to two types of technical failure, too short a tunnel and dehiscence of the muscular suture; obstruction of the new vesicoureteral junction in five ureters due to three causes, excessive dissection of the ureters, mucosal stenosis and stenosis of the new hiatus; contralateral reflux in 6 patients due to nonsystematical performance of endoscopic examination of the ureteral meatus preoperatively in the first series of 100 consecutive cases. On the basis of the results achieved, the authors give specific suggestions that allow the technical prevention of the small number of complications that may occur using the extravesical antireflux technique in the treatment of VUR.

Nonrefluxing colonic conduit: efficiency and complications of ureterocolic anastomosis.

The efficiency of and complications in 65 cases of colonic conduit have been studied (64 cases of bladder exstrophy and 1 case of cloacal exstrophy). For the ureterocolic reimplantation, we employed the Leadbetter technique and a modified kelalis technique. The results after 1-12 years in 128 renoureteral units showed 28 complications (21 obstruction and 7 refluxing units). Other types of complications have been observed and reported in this work. The high incidence of obstruction was probably due to the long submucous tunnel in the ureterocolic reimplantation. We believe that the sigmoidal conduit is an adequate method for temporary or permanent diversion.