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Effectiveness of trigonoplasty to treat primary vesicoureteral reflux
M De Gennaro1, C Appetito, A Lais
1Division of Pediatric Urology, Bambino Gesu Children's Hospital, Rome, Italy.
Insights
Trigonoplasty is a successful surgical option for treating vesicoureteral reflux in children, preserving the vesicoureteral junction. This study shows high success rates, even for higher reflux grades, making it a viable alternative to other procedures.
Area of Science:
- Pediatric Urology
- Surgical Techniques
Background:
- Vesicoureteral reflux (VUR) is a common condition in children.
- Trigonoplasty offers a conservative surgical approach to VUR, preserving the vesicoureteral junction.
- Limited data exists on the long-term efficacy of trigonoplasty, especially in higher grades of reflux.
Purpose of the Study:
- To evaluate the efficacy and safety of trigonoplasty in treating pediatric vesicoureteral reflux.
- To assess the success rates of trigonoplasty across different grades of reflux and age groups.
- To determine the potential for expanding indications for trigonoplasty.
Main Methods:
- A retrospective study of 51 children (4 months to 13 years) undergoing trigonoplasty for VUR between 1986 and 1989.
- 44 patients with sufficient follow-up and 69 refluxing units were analyzed.
- Technical modifications included absorbable sutures and, in some cases, a muscular incision.
Main Results:
- Overall surgical success rate was 97.7% for patients and 92.3% for children under 3 years old.
- High success rates were observed for grades II and III reflux.
- Only one recurrence was noted in a child with pre-existing grade IV bilateral reflux.
Conclusions:
- Trigonoplasty is a highly effective and safe surgical treatment for pediatric vesicoureteral reflux.
- The procedure demonstrates excellent outcomes, even in younger children and those with higher reflux grades.
- Indications for trigonoplasty can be extended to higher reflux grades when ureteral tapering is not necessary and adequate ureteral length is achievable.
Abstract:
Among the surgical procedures to treat vesicoureteral reflux trigonoplasty is a conservative technique that preserves the integrity of the vesicoureteral junction. Since its introduction in 1984 by Gil Vernet it gained only little attention in small series. Between 1986 and 1989 we performed trigonoplasty in 51 children 4 months to 13 years old, of whom 47 had primary vesicoureteral reflux. Our study includes 44 patients who have sufficient followup and 69 refluxing units. Reflux was grade II in 25 units, grade III in 39 and grade IV in 5. Patients were arbitrarily divided into 2 age groups: less than (13) and greater than (31) 3 years old. All children underwent standard preoperative assessment. The operation, with technical modifications (absorbable sutures in all cases and muscular incision added in 12), was performed after failed conservative treatment in all patients except 5 who were operated on at diagnosis. Surgery was successful in 97.7% of the patients and in 92.3% of the children less than 3 years old. The only recurrence was noted on 1 side of a 2-year-old child who had had grade IV bilateral reflux. Considering that reimplantation threatens the integrity of the vesicoureteral junction and endoscopic injections still have unclear side effects, indications for trigonoplasty can be extended to higher grades of reflux if ureteral tapering is not required and a sufficient intramural length of ureter can be obtained.