Trigonoplasty to Treat Secondary Vesicoureteral Reflux in Neurogenic Bladders

Abstract

Objectives: The effectiveness of Gil-Vernet’s trigonoplasty, with technical modifications, was studied in treating vesicoureteral reflux (VUR) in neurogenic bladders. Methods: Modified Gil-Vernet’s trigonoplasty, making the transmural ureters advance over the midline and cross each other in the trigone, was applied in patients with neurogenic bladder dysfunction and VUR, diagnosed by voiding cystourethrogram. Most of the patients were sufficiently followed up by cystourethrogram. Results: 26 patients with neurogenic bladder dysfunction were diagnosed as having 43 refluxing units and underwent modified Gil-Vernet’s trigonoplasty. Reflux was grade I in 5 units, grade II in 7, grade III in 5, grade IV in 18, and grade V in 8, with unilateral reflux in 9 patients and bilateral reflux in 17. Surgery was successful in 95.3% of 43 refluxing units. 22 patients were followed 3–6 months after the operation, and the cure rate was 90.9% (no reflux under voiding cystourethrogram). 18 patients were followed up for more than 2 years without recurrence of VUR. Conclusions: Modified Gil-Vernet’s trigonoplasty might be a useful technique in the management of patients with VUR secondary to neurogenic bladder dysfunction.