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Success of trigonoplasty anti-reflux surgery and its predictive factors
Abbas Basiri1, Amir Hossein Kashi, Nasser Simforoosh
1Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University, M.C., Tehran 16666 77951, Iran. basiri@unrc.ir
Introduction:
This study was designed to evaluate factors contributing to failure in Gil-Vernet antireflux operation.
Materials And 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.