The Politano-Leadbetter Antireflux Plasty. Investigation of Complications in 245 Children

Abstract

From 1981 to 1988 245 children aged 2 months to 15 years underwent ureteral reimplantation in 326 renal units in our department. The VUR was primary in 180 patients (253 ureters) and 65 patients (73 ureters) showed associated pathologies. The follow-up program, including physical examination, urine sampling and isotope studies (including NMCU), was from 4 to 11 years after surgery. Intraoperative and early surgical complications were found in 29 cases, but no complications affected the late results, especially kidney function. Late complications have been observed in 15 cases, while in 10 cases reoperation because of persistent reflux (n = 4) obstruction (n = 3) and loss of kidney function (nephrectomy n = 3) was required. In 4 cases bladder stones required ESWL, and one patient developed hypertension.

Politano-Leadbetter Ureteroneocystostomy

“…Our findings are also comparable with the results of other operative techniques [1,6,7,9,12,13]. The PolitanoLeadbetter reimplantation is technically somewhat more complex and difficult than, for example, the extravesical Lich-Gregoir procedure [2], wherein the submucosal tunnel is created superior to the ureteral orifice.…”

“…Of the many intra-and extravesical techniques in use, the Lich-Gregoir, Politano-Leadbetter and Cohen have gained the greatest popularity over the past three decades [2][3][4]. Despite these satisfactory surgical results, complications do occurmost frequently ureteral stricture or recurrent reflux [1,5,6]. In this study, 68.8% of a large patient population were able to be followed for at least 10 years.…”

“…It responded to transurethral bladder decompression and these children were not adversely affected. This minor complication is rarely discussed in the literature [6,12].…”

“…Surgical methods to correct vesicorenal reflux have been shown to be safe and relatively free of complications [1][2][3][4][5][6]. All procedures utilize the same principal of lengthening the intramural ureter with a submucosal tunnel [7][8][9].…”

Langzeiterfahrungen mit der Ureterozystoneostomie nach Cohen beim bilateralen vesikoureterorenalen Reflux im Kindesalter

“…Im Vergleich mit der Technik nach Politano-Leadbetter waren die Ergebnisse des "Cohen" insgesamt etwas günstiger [6,7,11,22] [1,4,5,13]. Eine Reihe von Autoren favorisieren aufgrund dessen die Ureteroureterostomie [1,9,17].…”