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Percutaneous endoscopic trigonoplasty: a minimally invasive approach to correct vesicoureteral reflux
P C Cartwright1, B W Snow, J C Mansfield
1Department of Pediatric Urology, Primary Children's Medical Center, Salt Lake City, Utah, USA.
Purpose:
A procedure was designed to correct vesicoureteral reflux with minimally invasive technology.
Materials And Methods:
A total of 22 children 14 months to 18 years old underwent percutaneous endoscopic trigonoplasty between January and June 1995. Followup ranges from 4 to 11 months. In 32 ureters reflux was grade 2 in 13, grade 3 in 13, grade 4 in 5 and grade 5 in 1.
Results:
All patients had normal sonography of the kidneys after surgery. On followup voiding cystourethrography at 2 or 6 months there was resolution of reflux in 20 of the 32 ureters (62.5%). The probability of resolution was unrelated to patient age, laterality of reflux, initial grade, operative sequence or preoperative bladder instability. The 3 major complications were vesicovaginal fistula, hyponatremia and perivesical fluid collection.
Conclusions:
Percutaneous endoscopic trigonoplasty is technically feasible but it involves a distinct learning curve. It offers significant advantages related to more rapid recovery with less discomfort. The success rate is modest at present. If it were to be improved with technical modifications, percutaneous endoscopic trigonoplasty may change the basic approach to treating children with vesicoureteral reflux.