Bradic’s anti-reflux uretero-cysto-anastomosis in children with recurrent obstructive megaureter

Introduction. Congenital ureterovesical junction (UVJ) obstructions quite rarely serve as an indication for ureteral reimplantation, and recurrent obstructions resulting from surgical treatment are even less frequent. Cases of acquired UVJ obstruction following endoscopy and ureteral reimplantation done for vesicoureteral reflux correction are fairly rare. The lack of known publications analyzing treatment of recurrent obstructive megaureter predetermines topicality of our research. Purpose. Evaluate the efficiency and safety of extravesical anti-reflux uretero-cysto-anastomosis performed using Bradic’s technique for children with recurrent obstructive megaureter (OM). Materials and methods. The work is based on the experience of surgical OM correction in 5 children aged 1 to 4 years, 4 boys and a girl with a recurrent UVJ obstruction following prior ureteral reimplantation for correction of UVJ obstruction (4 children) or vesicoureteral reflux (1 patient). Antenatal UVJ obstruction had been diagnosed in 2 patients. In all cases the examination included urine analysis, its culture study, ultrasonography of the kidneys and urinary tracts, dynamic renal scintigraphy, micturating cystography, and, where indicated, intravenous urography and SCT of the kidneys. All patients underwent Bradic’s extravesical reimplantation. Results. During postoperative care period, a considerable reduction of the dilatation of renal collecting system was accomplished in all five patients along with the differential renal function preserved on the presurgery level and a steady remission of urinary tract infection based on clinical manifestations and laboratory findings. Conclusions. The simplicity of Bradic’s extravesical ureteral reimplantation represents its advantage over intravesical methods. Extravesical approach allows easy ureteral length and width correction. Limited experience of Bradic’s surgery in pediatric cases of recurrent OM requires confirmation with further randomized clinical trials.

ureterovesical junction obstruction, recurrence, megaureter, children