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Urinary Disorders

Reflux After Reimplantation Ureter

02/06/2009

Question:

I would like to ask about operation reimplantation ureter. My Left ureter had congenital stricture. I just know this stricture ureter last years. This make my kidney become bigger. (Hydrophrenosis). After surgery reimplantation left ureter, I have reflux grade IV - V. Doctor said that he won`t make antireflux because can cause the ureter became stricture again. The Question: 1. Surgery Reimplantation ureter with hydrophrenosis case, shouldn`t make anti reflux? 2. Are this reflux danger to my kidney because I often had urinary tract infection? 3. Should I surgery another operation anti reflux? If yes, are this can affect my ureter? Thanks

Answer:

1) When ureteral stricture is identified in childhood, reimplantation usually requires tapering of the ureter so that reimplant can be done without reflux. As an adult, this may not be possible.

2) Grade IV-V reflux with recurrent urinary tract infections may damage kidney. Renal scan can determine what per cent of your total renal function is contributed by your refluxing kidney, but needs to be done with a bladder catheter in during the test since reflux may skew the results. If the refluxing kidney is less than 10% (or 0-20% depending upon total renal function), that kidney might best be removed to avoid damage to the other side (like high blood pressure).

3) Repeat surgery to reimplant ureter may result in stricture or reflux. The risk-benefit would depend upon your age, the function of the reflux kidney compared to the normal kidney, your total kidney function. Since I have none of the information that would contribute to the decision, I am unable to make recommendation based upon the informaiton provided. You would need to discuss with your urologist who should have all the necessary information regarding your background, medications, general health, and any additional tests that are listed above but have not been done.

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Response by:

James F Donovan, Jr, MD James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati