Effectiveness of trigonoplasty to treat primary vesicoureteral reflux.
Among the surgical procedures to treat vesicoureteral reflux trigonoplasty is a conservative technique that preserves the integrity of the vesicoureteral junction. Since its introduction in 1984 by Gil Vernet it gained only little attention in small series. Between 1986 and 1989 we performed trigonoplasty in 51 children 4 months to 13 years old, of whom 47 had primary vesicoureteral reflux. Our study includes 44 patients who have sufficient followup and 69 refluxing units. Reflux was grade II in 25 units, grade III in 39 and grade IV in 5. Patients were arbitrarily divided into 2 age groups: less than (13) and greater than (31) 3 years old. All children underwent standard preoperative assessment. The operation, with technical modifications (absorbable sutures in all cases and muscular incision added in 12), was performed after failed conservative treatment in all patients except 5 who were operated on at diagnosis. Surgery was successful in 97.7% of the patients and in 92.3% of the children less than 3 years old. The only recurrence was noted on 1 side of a 2-year-old child who had had grade IV bilateral reflux. Considering that reimplantation threatens the integrity of the vesicoureteral junction and endoscopic injections still have unclear side effects, indications for trigonoplasty can be extended to higher grades of reflux if ureteral tapering is not required and a sufficient intramural length of ureter can be obtained.
De Gennaro
M
M
Division of Pediatric Urology, Bambino Gesu Children's Hospital, Rome, Italy.
Appetito
C
C
Lais
A
A
Talamo
M
M
Capozza
N
N
Caione
P
P
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009132:Muscles / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000379:methods; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*