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A series of 32 patients with spina bifida, representing 50 renal units with vesicoureteral reflux (VUR), was treated with antireflux operation. All but one patient underwent ureteral reimplantation with Cohen's technique. Another patient was treated with bilateral Politano-Leadbetter's technique. The overall success rates were 92.0% by renal unit and 87.5% by case, with a mean follow-up period of 42.5 months. These results were comparable to those in the recent literature. Failure included recurrence of VUR in 3 patients. Another patient who had undergone unilateral reimplantation developed new occurrence of reflux in the contralateral ureter. Possible masking of contralateral VUR should be taken into consideration in patients with unilateral high grade VUR. We also emphasize the importance of continuing clean intermittent catheterization in a proper manner to be free of VUR postoperatively.

Unusual complications of the Politano-Leadbetter ureteral reimplantation technique are reported in four ureters in three children with primary vesicoureteral reflux (VUR). These ureters were found to pass through an adjacent intraperitoneal viscus including the sigmoid colon, ileum or broad ligament. This complication occurred in 0.48% of the Politano-Leadbetter antireflux operations for primary VUR. Viscus perforation occurred only in children with a relatively high grade VUR. The prognoses of the hydroureter after ureteric reimplantation or ureterolysis, were good in all cases. Although there are several advantages in the transvesical procedure of the original Politano-Leadbetter method, we should not hesitate to go extravesically if there are difficulties in mobilizing the ureter or inducing it into the vesical cavity.