Introduction/Purpose: Vesicoureteral reflux (VUR) is a medical condition characterized by the retrograde flow of urine up the ureters, which can lead to urinary tract infections and kidney disease. Identifying predictive factors and outcomes in patients undergoing ureteroneocystostomy (UNC) for VUR is crucial for the effective management of this condition. Previous studies have shown that age, race, and operative time may influence the risk of previous reflux procedures. However, further investigation is needed to better understand these risk factors. This retrospective study aimed to identify predictive factors and outcomes in patients receiving UNC following failed previous VUR reoperations, compared to patients undergoing primary UNC. The objective was to elucidate any differences and provide valuable insights for clinical decision-making.
Methods or Case Description: This study utilized pediatric data from the 2020 American College of Surgeons National Surgical Quality Improvement Program (NSQIP). A total of 1,495 pediatric patients undergoing UNC for VUR were included in the analysis. The patients were divided into four groups based on their previous reflux procedures. Chi-square analysis and analysis of variance (ANOVA) were employed to compare categorical and continuous variables, respectively. Patient demographics, preoperative characteristics, and postoperative outcomes were analyzed through univariate and multivariate analyses.
Outcomes: Among the patients receiving UNC, 89.4% had no previous reflux procedures, 5.6% had previous UNC, 4.3% had previous sub-ureteric injection (SI), and 0.8% had previous UNC and SI. Factors such as age, non-Caucasian race, VUR severity, and certain comorbidities were found to be associated with previous reflux procedures. Patients undergoing secondary UNC had increased operative time, length of stay, and readmission rates compared to those undergoing primary UNC. No significant differences were observed in the risk of unplanned urinary catheterization. Patients with previous UNC and SI had a higher likelihood of bacterial growth and urinary tract infection.
Conclusion: This study identified predictive factors and outcomes in patients undergoing UNC for VUR. Age, race, and operative time were associated with a higher incidence of previous reflux procedures. Patients receiving secondary UNC experienced increased operative time, length of stay, and readmission rates compared to those undergoing primary UNC. The study contributes to the understanding and management of VUR, providing valuable insights for clinical practice and future research.
