Gil-Vernet antireflux surgery in treatment of lower pole reflux.
OBJECTIVE
Prevalence of ureter and kidney duplication is roughly 1 per 125 people, and is associated with vesicoureteral reflux to lower pole in about 45% of cases. From antireflux surgical principles viewpoint, standard antireflux surgeries can be performed in these kidneys without releasing ureters from each other. We studied the results of Gil-Vernet antireflux surgery in 12 patients with duplicated collecting system and lower pole reflux.


METHODS
Between 1996 and 2000, 12 patients with unilateral duplicated system underwent Gil-Vernet antireflux surgery. There were 8 (67%) females and 4 (33%) males with a median age of 5.6 years. Of the patients, 50% had unilateral lower pole reflux in duplex system and 50% had bilateral reflux.


RESULTS
Twelve patients with lower pole reflux in duplicated system, and overall, 18 refluxing renal units were treated, using Gil-Vernet antireflux surgery. In 11 (92%) patients, upper pole orifices were non-refluxing and without ureterocele. One (8%) patient had upper pole ureterocele that was treated by a small medial incision in the same session. Median hospital stay was 4 days, and median follow-up was 10 months, in 10 patients who were followed. Of patients, 80% and of refluxing units, 94% improved. Overall, success rate was 88%.


CONCLUSIONS
Gil-Vernet antireflux surgery is a simple technique, associating with minimum ureteral manipulation for releasing them. Accordingly, we recommend Gil-Vernet antireflux surgery as the first line surgical modality for duplicated ureters with lower pole reflux, without upper pole ureterocele.
Kazemi-Rashed
Fahimeh
F
Urology-Nephrology Research Center, Shaheed Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. fah_kaz@yahoo.com.
Simforoosh
Nasser
N