Surgical Management of Bilateral Vesicoureteral Reflux With Unilateral High-Grade Involvement: Comparative Outcomes of Endoscopic, Open Intravesical, and Hybrid Approaches

Abstract

Objective: To determine the optimal surgical approach for patients with high-grade vesicoureteral reflux (VUR) on one side and low-grade VUR on the contralateral side by comparing three strategies: bilateral endoscopic correction, bilateral intravesical cross-trigonal ureteral reimplantation (Cohen technique), and a combined approach involving extravesical reimplantation for the high-grade side and endoscopic correction for the low-grade side.

Methods: Between 2010 and 2023, pediatric patients under the age of eighteen who underwent surgery at our clinic for VUR characterized by high-grade reflux on one side and low-grade reflux on the contralateral side were retrospectively reviewed. Based on the surgical technique, patients were categorized into three groups: Group 1 underwent bilateral endoscopic correction, Group 2 underwent bilateral intravesical reimplantation, and Group 3 underwent the combined approach.

Results: A total of 140 patients were included: 40 in Group 1, 53 in Group 2, and 47 in Group 3. The clinical success rates were 40%, 95%, and 94% for Groups 1, 2, and 3, respectively (P <.001). The median length of hospital stay was 0, 4, and 1 days, respectively (P <.001).

Conclusion: Bilateral endoscopic correction was found to be an inferior treatment option compared to both bilateral intravesical ureteroneocystostomy (UNC) and the combined approach. Unilateral extravesical UNC combined with endoscopic subureteric injection for the contralateral low-grade VUR appears to offer comparable clinical success to bilateral intravesical UNC, while requiring less postoperative hospitalization, pain, and overall cost.