PRIMARY VESICOURETERIC REFLUX - A 24 YEAR FOLLOW UP AND ANALYSIS OF OPERATIVE FAILURE

Aim: The aim of this study is to compare Lich-Gregoir procedure and antireflux ureterocystoneostomy at the vertex of the bladder (AUVB). In the course of 24 years of treatment of the primary VUR we performed two antireflux plastics: the antireflux ureterocystoneostomy at the vertex of the bladder (AUVB) and the Lich-Gregoir procedure. Methods: We have performed 1854 antireflux plastic procedures on 1480 children between 1978 and 2001. Operative results were assessed as satisfactory or unsatisfactory according to standard clinical evaluation procedures performed two years after the operation. Results: During those 24 years (1978-2001) 1480 children were operated on, 374 bilaterally, so that a total of 1854 antireflux ureterocystoneostomies were performed. Between 1978 and 1992 we performed only the AUVB, and from 1992, both AUVB and the Lich-Gregoir procedure. Of the total of 1854 antireflux ureterocystoneostomies, the AUVB was performed in 1082 ureteric units and Lich-Gregoir operation in 772 ureteric units. The final late result was evaluated 2 years after the operation. Satisfactory results were achieved in 93.5% with the AUVB and 96% with Lich-Gregoir procedure. The postoperative failure rate was found in 6.5% of the AUVB and 4% of the Lich-Gregoir operations. The recurrence rate was more frequent with the AUVB (5%), then with the Lich-Gregoir procedure (1.5%), but postoperative stenosis was more frequent with the use of Lich-Gregoir procedure (2.5%). Conclusion: Today, as the first operative method we prefer the Lich-Gregoir procedure. If the result of the Lich-Gregoir procedure is unsatisfactory, we recommend the AUVB as the first and second recurrence operation. In case of the repeated VUR recurrence or the postoperative stenosis, as the last operation we used to perform the antireflux ureteroileocystoplasty with intussuscepted segment of ileum