Bilateral ureteral reimplant (BUR) at the time of complete primary repair of bladder exstrophy  (CPRE) reduced the rate of recurrent pyelonephritis, and postoperative vesicoureteral reflux (VUR), and the necessity for ureteral surgery in the future. From 2013 to 2019, researchers looked at 64 patients with classic bladder exstrophy (BE) who received CPRE at 3 different institutions. Patients received cephalotrigonal BUR-CPRE in 15 cases and CPRE alone in 49 cases. The primary outcome was the presence of at least 1 episode of pyelonephritis in the medical record. Consistent vesicoureteral reflux (VUR), with a sub-analysis of the number of refluxing renal units and the existence of dilating VUR, and the requirement for later ureteral surgery were secondary outcomes. Where appropriate, descriptive statistics and standard, 2-tailed univariate statistics were utilized to compare the groups. BUR-CPRE was linked to a lower risk of postoperative VUR, the number of refluxing rental units, and the requirement for ureteral surgery (P=0.002, P=0.001, and P=0.048, respectively). Patients who underwent BUR-CPRE had lower incidences of recurrent pyelonephritis and dilating reflux, albeit the difference was not significant. Regardless of BUR-CPRE status, the female gender was related to recurrent pyelonephritis (P=0.005). Following BUR-CPRE, there were no reports of distal ureteral blockage or other problems. The BUR-CPRE group had a mean postoperative follow-up of 46.33 (10.26) months compared to 53.76 (26.05) months for the CPRE group (P=0.11). Recurrent pyelonephritis after bladder closure in patients with BE was a well-documented surgical complication, with rates of postoperative pyelonephritis ranging from 22% to 50% at centers conducting CPRE. The study compared the efficacy of BUR-CPRE to other recent studies. It gave more information regarding the necessity for subsequent ureteral surgeries and more significant long-term follow-up of these complex patients. The study’s limitations include the cohort’s male predominance and the lack of BUR-CPRE randomization. BUR-CPRE reduced postoperative VUR and the requirement for further ureteral surgery; it should be considered when technically possible. While the results show a decrease in recurrent pyelonephritis and dilating reflux, the group would require more longitudinal follow-up.

Source:www.sciencedirect.com/science/article/abs/pii/S1477513121004769