title: Trigonal splitting is a major complication of endoscopic trigonoplasty at 1-year followup.
abstract: OBJECTIVE
  The long-term results of endoscopic trigonoplasty in patients with vesicoureteral reflux were investigated.
  
  
  METHODS
  We performed endoscopic trigonoplasty in 28 patients with vesicoureteral reflux, including 6 girls 6 to 8 years old. Reflux was grade I in 14 reno-ureteral units, grade II in 15, grade III in 8, grade IV in 1 and grade V in 1. Median followup was 23 months.
  
  
  RESULTS
  At a median of 3 months postoperatively vesicoureteral reflux was not apparent in 37 units (95%) and it was downgraded in 1 (3%). At a median of 12 months postoperatively 27 (79%) and 4 (12%) of the 34 ureters had cessation and downgrading, respectively. Of the 13 select patients who underwent cystoscopy 3 had retreating ureteral orifices and 5 had trigonal splitting 6 to 12 months postoperatively. Vesicoureteral reflux was demonstrated in 3 of the 5 patients (4 ureters) with trigonal splitting and in 1 (1 ureter) with retreating ureteral orifices. At a median of 24 months after surgery voiding cystography showed reflux in only 1 of 15 units. No postoperative upper urinary tract dilatation was noted at followup.
  
  
  CONCLUSIONS
  Cessation rates of vesicoureteral reflux 12 months after endoscopic trigonoplasty were low with a high incidence of trigonal splitting. These unsatisfactory results mandate technical refinements to avoid trigonal splitting.
authors.affiliation: Department of Urology, Nagoya University School of Medicine, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Okamura
authors.forename: N
authors.initials: N
authors.lastname: Kato
authors.forename: S
authors.initials: S
authors.lastname: Takamura
authors.forename: J
authors.initials: J
authors.lastname: Tanaka
authors.forename: T
authors.initials: T
authors.lastname: Nagai
authors.forename: H
authors.initials: H
authors.lastname: Watanabe
authors.forename: Y
authors.initials: Y
authors.lastname: Tsuji
authors.forename: Y
authors.initials: Y
authors.lastname: Ono
authors.forename: S
authors.initials: S
authors.lastname: Ohshima
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D001743:Urinary Bladder / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*