Success of trigonoplasty anti-reflux surgery and its predictive factors.
BACKGROUND
This study was designed to evaluate factors contributing to failure in Gil-Vernet antireflux operation.


METHODS
96 patients (150 refluxing units; median (range) age, 60 (12-180) months; M/F, 11/85) with primary vesico-ureteral reflux were included. Trigonoplasty was done according to a modified Gil-Verent procedure. Relapse was diagnosed on the postoperative direct radionuclide cystography (DRNC) 3 or 6 months after operation. Demographic and intraoperative data were used to assess factors contributing to failure.


RESULTS
Resolution of reflux in postoperative DRNC was observed in 87 patients (90.6%) and in 138 refluxing units (92.0%). In patients who were followed 3-6 months, one relapse occurred (3%) versus 8 relapses in those who were followed 24-39 months (12%). Relapse in refluxing units was related to the history of voiding symptoms (30 vs. 3%, p < 0.001), history of breakthrough infections (20 vs. 3%, p = 0.001), golf or stadium like ureteral orifice appearance (15 vs. 4%, p = 0.02), and less distance of ureteral orifices from each other (p < 0.001).


CONCLUSIONS
Trigonoplasty success rate may decrease with long-term follow-up. In multivariable analysis, patients with history of voiding dysfunction, breakthrough infection, golf/stadium like ureteral orifices, and less distant ureteral orifices are at a higher risk of relapse.
Basiri
Abbas
A
Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University, M.C., Tehran 16666 77951, Iran. basiri@unrc.ir
Kashi
Amir Hossein
AH
Simforoosh
Nasser
N
Sharifiaghdas
Farzaneh
F
Halimi-Asl
Parham
P
Inanlu
Seyed Hassan
SH
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009398:Nephrology / Q000379:methods; D012008:Recurrence; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology; D001750:Urinary Bladder, Neurogenic / Q000150:complications*; D013520:Urologic Surgical Procedures / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000601:surgery*