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Percutaneous endoscopic trigonoplasty in children: long-term outcomes and modifications in technique
J M Gatti1, P C Cartwright, B D Hamilton
1Division of Urology, University of Utah Health Sciences Center, Primary Children's Medical Center, Salt Lake City 84132, USA.
Insights
Percutaneous endoscopic trigonoplasty (PET) for vesicoureteral reflux showed decreased long-term success rates, especially with bilateral reflux. Modifications like the Cohen technique improved initial success but increased operative time, leading to current non-recommendation.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urologic Oncology
Background:
- Vesicoureteral reflux (VUR) is a common condition in children, increasing the risk of urinary tract infections and renal damage.
- Traditional open surgical repair has high success rates but involves significant morbidity.
- Minimally invasive techniques aim to reduce recovery time and surgical trauma.
Purpose of the Study:
- To present long-term outcomes of percutaneous endoscopic trigonoplasty (PET) for VUR.
- To discuss modifications to the original PET technique, including the Gil-Vernet and Cohen reimplantation methods.
- To evaluate the efficacy and safety of PET compared to traditional open repairs.
Main Methods:
- A cohort of 29 children (46 refluxing ureters) aged 14 months to 18 years underwent PET.
- Follow-up ranged from 19 to 37 months.
- The study compared the Gil-Vernet method (23 patients) with the Cohen reimplantation technique (6 patients).
Main Results:
- Long-term resolution rates for the Gil-Vernet PET technique decreased from 63% to 47% over 30-37 months.
- Success rates were higher for unilateral (83%) versus bilateral reflux (27%) with the Gil-Vernet method.
- The Cohen technique achieved 83% resolution but nearly doubled the operating time; failure was unrelated to reflux grade or patient age.
Conclusions:
- While the Cohen PET technique showed improved initial reflux resolution over the Gil-Vernet method, its overall success rate is lower than traditional open surgery.
- PET procedures require longer operating times and two surgeons, outweighing benefits of faster recovery.
- Current PET techniques are not recommended; future modifications may enhance its viability.
Purpose:
Long-term outcomes of a minimally invasive method of correcting vesicoureteral reflux are presented with a discussion of the modification in our original technique.
Patients And Methods:
A total of 29 children (46 refluxing ureters), 14 months to 18 years old, underwent percutaneous endoscopic trigonoplasty (PET) between December 1994 and June 1996. Follow-up ranged from 19 to 37 months. Reflux was grade 1 in 2, grade 2 in 16, grade 3 in 19, grade 4 in 8, and grade 5 in 1. The technique was a Gil-Vernet method in the first 23 patients and Cohen reimplantation in the last 6 patients.
Results:
Resolution of reflux was observed to decrease from 63% to 47% with long-term (30-37 months') follow-up using the Gil-Vernet technique. Resolution was greater with unilateral reflux than bilateral reflux (83% v. 27%, respectively). The Cohen technique resulted in resolution of reflux in 83%; however, the operating time nearly doubled when compared with the Gil-Vernet group. In both groups, failure was unrelated to grade of reflux, age, operative sequence, or bladder instability.
Conclusions:
Although showing an improvement in resolution of reflux over the Gil-Vernet PET procedure, the Cohen PET reimplant has a lower success rate than traditional open operative reimplants. The PET also requires more operating time and two operating surgeons. Despite some advantages in the promptness of recovery, we do not recommend PET by either technique at this time. Future modifications may make this approach more tenable.