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Objective: To determine preoperative predictive factors of postoperative complications of ureteric re-implantation in children by using the modified Clavien classification system (MCCS), which has been widely used for complication rating of surgical procedures., Patients and Methods: In all, 383 children who underwent ureteric re-implantation for vesico-ureteric reflux (VUR) and obstructing megaureters between 2002 and 2011 were included in the study. Intravesical and extravesical ureteric re-implantations were performed in 338 and 45 children, respectively. Complications were evaluated according to the MCCS. Univariate and multivariate analyses were used to determine predictive factors affecting complication rates., Results: In all, 247 girls and 136 boys were studied. The mean (sd) age was 46 (25) months and the mean (sd) follow-up was 49.4 (27.8) months. The mean (sd) hospitalisation time was 4.7 (1.6) days. Complications occurred in 76 (19.8%) children; 34 (8.9%) were MCCS grade I, 22 (5.7%) were grade II and 20 (5.2%) were grade III. Society of Fetal Urology (SFU) grade 3-4 hydronephrosis, obstructing megaureters, a tailoring-tapering and folding procedure, refractory voiding dysfunction and a duplex system were statistically significant predictors of complications on univariate analysis. Prior injection history, paraureteric diverticula, stenting, gender, age, operation technique (intra vs extravesical) were not significant predictors of complications. In the multivariate analysis refractory voiding dysfunction, a tailoring-tapering and folding procedure, obstructing megaureters (diameter of >9 mm) and a duplex system were statistically significant predictors of complications., Conclusion: Ureteric re-implantation remains a valid option for the treatment of certain patients with VUR. Refractory voiding dysfunction, a tailoring-tapering and folding procedure, obstructing megaureters (diameter of >9 mm) and associated duplex systems were the main predictive factors for postoperative complications. Use of a standardised complication grading system, such as the MCCS, should be encouraged to allow the valid comparison of complication rates between series., (© 2014 The Authors. BJU International © 2014 BJU International.)

Objective: To evaluate video-urodynamic (VUD) results before and after surgery in children with high-pressure, low-compliance bladders and vesico-ureteric reflux (VUR), who had augmentation cystoplasty with no antireflux surgery, hypothesising that in these patients, poor preoperative bladder dynamics is not always the cause of the associated VUR, as VUR persists in some patients., Patients and Methods: We assessed objective VUD criteria where antireflux surgery might potentially be necessary to avoid reflux after augmentation, and retrospectively evaluated the clinical consequences of persistent VUR and compared it to those whom VUR resolved. In all, 19 patients with VUR and hypocompliant bladders (mean age 11.4 years, range 5-21) had augmentation ileocystoplasty. Lower urinary tract function was assessed before surgery and at 3 and 6 months afterward with VUD. Symptomatic febrile urinary tract infections (UTIs) and progressive renal scarring on scintigraphy were retrospectively evaluated in all patients., Results: VUR persisted in nine patients despite a low-pressure bladder. In all patients with persistent VUR, VUD at 6 months after surgery showed that VUR started at low bladder volumes (mean 29.6 mL, range 19-52) and low pressures (mean 14.6 cmH(2)O, range 9.6-25) when compared to the group with no persistent VUR. Before surgery VUD showed that reflux started at the beginning of the filling phase (mean 14.8 mL, range 8-33) with very low intravesical pressures (mean 7.8 cmH(2)O, range 4-17) in these nine patients. During the follow-up febrile UTIs were significantly more frequent in the group with persistent VUR. One patient had progressive renal scarring on scintigraphy after cystoplasty., Conclusion: Preoperative VUD findings might be a very important predictor of the spontaneous resolution of VUR. In these patients concomitant VUR should be corrected simultaneously during bladder augmentation if it starts at low pressures on preoperative VUD, as persistence of VUR can induce scarring from febrile UTIs.