Soylet Y et al. (2004) Quo vadis? Ureteric reimplantation or ignoring reflux during augmentation cystoplasty. BJU Int 94: 379–380

Children with neurogenic bladder, exstrophy-epispadias complex or infravesical obstruction commonly undergo bladder augmentation. In addition, vesico-ureteric reflux (VUR) is sometimes treated by antireflux surgery in these patients. It is unclear, however, whether antireflux surgery is necessary, since VUR may resolve as a result of the augmentation process. Soylet et al. have carried out a retrospective study to address this question.

The authors studied the records of 38 children with neurogenic bladder, exstrophy-epispadias complex or infravesical obstruction who had undergone bladder augmentation. VUR had been detected in all patients before surgery. Group 1 patients (n = 15) had no antireflux surgery, whereas children in Group 2 (n = 23) underwent ureteric reimplantation, either at the same time as the cystoplasty or afterwards.

VUR resolved after cystoplasty in 97% and 93% of refluxing renal units in Groups 1 and 2, respectively. The expected bladder capacities increased following surgery, from 35% to 86% in Group 1 and from 38% to 90% in Group 2. Renal function was maintained in both groups during the mean follow-up of 43 months (range 12–84 months).

Concluding that antireflux surgery had no significant effect on the resolution of VUR or on renal function in this study, the authors recommend using augmentation cystoplasty alone in children with neurogenic bladder, exstrophy-epispadias complex or infravesical obstruction and high- or low-grade VUR.