Primary vesicoureteric reflux treated by antireflux ureterocystostomy at the vertex of the bladder. A 12-year follow-up and analysis of operative failure.

A total of 618 children with primary vesicoureteric reflux (VUR) were examined preoperatively and 6, 9 and 24 months after an antireflux ureterocystostomy of the vertex of the bladder (AUVB); 206 children were operated on bilaterally, so that 824 AUVBs were performed. Most patients had grade 3 or 4 reflux and only 5% had grade 2 reflux. Successful results were noted in 792 ureteric units; in 10 cases of post-operative stenosis and 17 cases of recurrent VUR a second AUVB was performed. The following causes of operative failure were found: obstruction of the submucosal ureter after tailoring (5 cases), stricture of the new ureteric orifice (3), necrosis of the terminal part of the ureter (2), submucosal ureter too short or too wide (12) and fibrosis of the detrusor muscle over the submucosal ureter (5); a success rate of 84% was noted after the second procedure.