Long-term follow-up after ureteral reimplantation in children: a 12-year analysis.

Abstract

Purpose: To evaluate the incidence of late surgical complications and long-term kidney outcomes following ureteral reimplantation (UR) for high-grade vesicoureteral reflux (VUR) and primary obstructed megaureter (POM), assessing the necessity of routine long-term follow-up.

Methods: A retrospective review was conducted of 135 children who underwent UR between 2006 and 2013, with at least 10 years of follow-up. Primary outcomes included postoperative ureterovesical junction obstruction (pUVJO) and febrile urinary tract infections (UTIs). Secondary outcomes assessed kidney function and morphology (renal ultrasound changes, elevated BUN/creatinine, and arterial hypertension).

Results: Fifty-three renal units in 34 children met the inclusion criteria. pUVJO occurred in 7.5% of units, exclusively after Politano-Leadbetter (P-L) reimplantation, and within eight months postoperatively. Nine children experienced febrile UTIs, primarily within the first postoperative year. One child with reflux nephropathy (RN) developed chronic kidney disease 12 years later, and another developed RN without impaired function. No hypertension was observed in the cohort.

Conclusion: Children with uneventful recoveries and no pUVJO in the first year have a low risk of late complications, suggesting limited benefit from routine long-term follow-up. Higher risk groups, including those undergoing P-L reimplantation, girls, and those with preoperative RN, may warrant extended follow-up.