Lessons learned about contralateral reflux after unilateral extravesical ureteral advancement in children

Purpose: The development of contralateral reflux after unilateral antireflux surgery has spawned interest and controversy regarding etiology and management issues. We evaluate our experience to understand better the issues surrounding contralateral reflux. Materials and Methods: We retrospectively reviewed the records of all children seen in a 7-year period who underwent unilateral extravesical ureteral advancement performed by one of us (M. R. Z.) at our institution. Results: A total of 43 children a mean of 50.5 months old underwent unilateral reimplantation. The male-to-female ratio was 12:31. In 12 children contralateral reflux had resolved preoperatively. Overall contralateral reflux developed in 5 patients (11.6%) after unilateral extravesical ureteral advancement. In 1 child in whom new onset contralateral reflux developed on 1 side reflux resolved by 10 months with observation. In 8 of the 12 children (66%) with a history of resolved contralateral reflux there was no recurrence. In 4 of the 12 children recurrent contralateral reflux completely resolved by 14 months postoperatively with only observation. In these 4 patients initial reflux had been grades II and IV in 2 each. To date all fully evaluable reflux in children with previous contralateral reflux recurred has resolved. Conclusions: The recurrence of contralateral reflux after unilateral reimplantation that is expected in a small number of children resolves in the majority, if not in all, with conservative management. We believe that children should not be offered bilateral reimplantation for unilateral reflux and a history of resolved contralateral reflux. If contralateral reflux recurs, it will most likely resolve with time.