[Review of surgical treatment results for vesicoureteral reflux in children using the Politano-Leadbetter technique].

The analysis presents 622 children in the age ranged from 4 months to 14 years, operated on vesicoureteral reflux. The treatment was carried on in Department of Pediatric Surgery in Poznan between 1983 and 1992. All these children were operated on with antireflux Politano-Leadbetter technique, modified by Sarrazin, protecting reimplanted ureters with stenting catheters. Duplicated ureters were reimplanted "en bloc" according to Bettex technique, also with Sarrazin modification. Preoperative parameters included: history, radiological evaluations: voiding cystourethrogram, intravenous pyelogram or ultrasound imaging, endoscopic evaluations--cystourethroscopy (with meatal calibration in girls), laboratory blood and urine results. The reflux degree was estimated according to international classification IRSC. There were 12 (2%) children with II degree, 498 (80%) with III degree, 101 (16%) with IV degree and 11 (2%) patients with V degree reflux. In order to compare the results of operative treatment, all analyzed children were subdivided into groups: 303 (48.7%) patients with primary reflux, 77 (12%) with reflux to duplicated pyelo-ureteral systems, 17 (2.7%) with refluxing megaureters, 66 (10%) with reflux to hypoplastic kidney, 99 (15.9%) with cystic cystitis and 114 (18%) children with urethral meatal stricture. Good recovery with uncomplicated postoperative course was obtained in 606 (97.4%) patients. Early postoperative complications occurred in 16 (2.6%). In outpatient control the results of urinalysis and urine cultures, ultrasound imaging and voiding cystourethrograms were tested. Urine cultures were negative in 501 (80.5%) patients 3-4 weeks after discharge increasing to above 92% of patients 6 months after operation. In postoperative imaging control, 600 (96.5%) patients presented with normal status of upper urinary tract, in 14 (2.2%) transient dilatation of reimplanted ureters was observed and in 8 (1.3%) ureters had to be reimplanted because of secondary dilatation. After 6 months postoperative voiding cystourethrograms showed cessation of reflux in 589 (94.6%) patients, in 33 (5.2%) recurrent reflux was observed, which disappeared in 20 of them in control. In 13 patients urodynamic evaluation showed vesicourethral dysfunction, medically curable.