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Updated: Oct 18, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
A comparative study of endoscopic trigonoplasty for vesicoureteral reflux in children and in adults
1Department of Urology, Nagoya University School of Medicine, Japan. kikuo@dd.iij4u.or.jp
Insights
Endoscopic trigonoplasty is less invasive for children and adults, but less effective in resolving vesicoureteral reflux in pediatric patients. New surgical approaches are needed to improve outcomes for children.
Area of Science:
- Urology
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Endoscopic trigonoplasty is an experimental treatment for vesicoureteral reflux (VUR).
- This study compares surgical outcomes between pediatric and adult patients undergoing this procedure.
Purpose of the Study:
- To investigate and compare the efficacy and safety of endoscopic trigonoplasty in children versus adults with VUR.
- To identify factors influencing treatment success rates in different age groups.
Main Methods:
- 51 patients underwent endoscopic trigonoplasty, with 15 pediatric and 21 adult patients included in the analysis.
- Pediatric patients had a higher proportion of bilateral VUR and higher reflux grades compared to adults.
- Key outcomes measured included operative time, complications, pain management, catheter duration, and VUR resolution rates at 3 and 12 months.
Main Results:
- No significant differences were observed in operative time, complications, analgesic use, catheterization duration, or hospital stay between children and adults.
- At 3 months, VUR resolution was 70% in children and 96% in adults. At 12 months, resolution rates were 59% in children and 74% in adults.
- Recurrence rates due to trigonal splitting were similar (13% in children, 14% in adults).
Conclusions:
- Endoscopic trigonoplasty is a minimally invasive option for both pediatric and adult VUR patients.
- Vesicoureteral reflux resolution rates are significantly lower in children compared to adults.
- Anatomical differences, such as ureteral orifice distance and detrusor muscle thickness, may favor adult patients, necessitating novel surgical concepts for pediatric VUR treatment.
Background:
Endoscopic trigonoplasty is an experimental therapy for vesicoureteral reflux. We investigated differences in surgical results between children and adults.
Methods:
Endoscopic trigonoplasty was performed on 51 patients and 15 pediatric and 21 adult patients were included in this study. The children accounted for 27 cases of refluxing ureter (grade II, 8; III, 14; IV, 4; V, 1) and the adults for 28 cases (I, 4; II, 18; III, 4; IV, 2). There was a greater proportion of bilateral disease and a higher average degree of reflux in the children's group.
Results:
We found no significant differences in operative time, complications, analgesics usage, the duration of the indwelling catheter and hospital stay. Our follow up at 3 months showed that the reflux had ceased in 19 of 27 cases (70%) in the children's group and in 27 of 28 cases (96%) in the adults' group. The next follow up at 12 months showed that there was no reflux in 16 of 27 cases (59%) in 15 children and in 17 of 23 adult cases (74%). Trigonal splitting caused recurrence of reflux greater than grade II, in two children (13%) affecting four ureters and in three adults (14%) affecting four ureters.
Conclusions:
Endoscopic trigonoplasty has proved to be equally less invasive in children and in adults, but vesicoureteral reflux was less often resolved in children. This suggests that the greater original distance between the ureteral orifices and the greater thickness of the detrusor muscle favor the adult patient. For children, a new surgical concept is needed to increase cessation rate of vesicoureteral reflux.
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