Success of Trigonoplasty Anti-Reflux Surgery and Its Predictive Factors

Abstract

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.