Mini-ureteroneocystostomy: a safe and effective outpatient treatment for unilateral vesicoureteral reflux.

PURPOSE: Medically refractory vesicoureteral reflux is a common condition that can be cured by open surgery. Extravesical ureteroneocystostomy is a safe and effective surgical procedure. We determined whether this could be accomplished with limited dissection via an approximately 2 cm inguinal incision (mini-ureteroneocystostomy).

MATERIALS AND METHODS: All patients with unilateral vesicoureteral reflux who underwent mini-ureteroneocystostomy from 2003 to 2007 were evaluated. We present preoperative characteristics, surgical technique and outcomes in this analysis.

RESULTS: From 2003 to 2007, 57 children underwent mini-ureteroneocystostomy for unilateral vesicoureteral reflux. The group was predominantly female (48 of 57 patients or 84%) with median age of 4.8 years. Median vesicoureteral reflux grade was 3 (range 2 to 5). Duplication anomalies were present in 8 patients, while 5 had a Hutch diverticulum and 5 had a solitary kidney. A total of 47 patients (82%) underwent postoperative voiding cystourethrogram and surgical cure was achieved in all. De novo vesicoureteral reflux was identified in the contralateral ureter in 3 of 47 patients (6%). The procedure was performed on an outpatient basis in 47 of 57 patients (82%). Postoperative complications requiring surgical intervention developed in 2 children.

CONCLUSIONS: Mini-ureteroneocystostomy is an effective modified extravesical technique for vesicoureteral reflux. This procedure is safe and it can be performed on an outpatient basis with excellent results. It has become our standard of care in patients with unilateral vesicoureteral reflux.