Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Urol Int 2010;84:84–88 DOI: 10.1159/000273472 Success of Trigonoplasty Anti-Reflux Surgery and Its Predictive Factors Abbas Basiri Amir Hossein Kashi Nasser Simforoosh Farzaneh Sharifiaghdas Parham Halimi-Asl Seyed Hassan Inanlu Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University, M.C., Tehran, Iran low-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. Copyright © 2010 S. Karger AG, Basel Introduction Primary vesico-ureteral reflux (VUR) occurs in ap- proximately 1% of infants and children and is associated with recurrent urinary tract infections (UTIs) [1]. Trigonoplasty has long been introduced to treat VUR in children [2]. Gil-Verent procedure and its modifica- tions had been reported from many centers up to 2005 [3–10] and are probably still in use in some centers [10– 13]. In some centers, trigonoplasty is used in combination with unilateral antireflux reimplantations to prevent contralateral reflux [6, 14]. Furthermore, promising re- sults of trigonoplasty have recently been reported [11–13, 15] and another study has reported high success rates for a modified Gil-Verent method in patients with reflux sec- ondary to neurogenic bladder [10]. In a study on endo- scopic trigonoplasty in children, the success rate of Gil- Verent was reported to decrease with longer follow-up [16] . Key Words Vesico-ureteral reflux  Trigonoplasty  Gil-Vernet  Voiding dysfunction  Breakthrough infection  Ureteral orifices 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 pri- mary vesico-ureteral reflux were included. Trigonoplasty was done according to a modified Gil-Verent procedure. Re- lapse was diagnosed on the postoperative direct radionu- clide cystography (DRNC) 3 or 6 months after operation. De- mographic and intraoperative data were used to assess fac- tors 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 fol- lowed 3–6 months, one relapse occurred (3%) versus 8 re- lapses in those who were followed 24–39 months (12%). Re- lapse in refluxing units was related to the history of voiding symptoms (30 vs. 3%, p ! 0.001), history of breakthrough in- fections (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 fol- Received: February 2, 2009 Accepted after revision: July 21, 2009 Internationalis Urologia Abbas Basiri, MD Urology and Nephrology Research Center No. 101 Boostan 9th St., Pasdaran Ave. Tehran 16666 77951 (Iran) Tel. +98 21 2256 7222, Fax +98 21 2277 0954, E-Mail basiri @ unrc.ir © 2010 S. Karger AG, Basel 0042–1138/10/0841–0084$26.00/0 Accessible online at: www.karger.com/uin