A New Approach to Vesicoureteral Reflux Persisting after Posterior Urethral Valve Ablation Using Gil-vernet Antireflux Technique

Classic anti reflux procedures on children with a history of posterior urethral valve does not usually yield good results and often ends up with ureteral obstruction and even permanent urinary diversion. From 1981 through 1988,21 boys with history of posterior urethral valve (PUV) underwent evaluation for vesicoureteral (VU) reflux; 17 boys had VU reflux. Following valve ablation, reflux disappeared in nine cases. Eight boys continued to have reflux (average follow up after valve ablation was 17 months). The grade of refluxes was IV or higher in all of the cases. Gil-Vernet anti reflux procedure was performed in these boys. VU reflux disappeared in 11 of 12 refluxing ureters in these eight boys postoperatively. An excellent success rate (91.7% ) was seen without upper tract deterioration in any of the cases. Average follow up was six months with the longest being 13 months. This is the first report of the application of Gil-Vernet antireflux technique in persistent reflux following valve ablation and seems a breakthrough in managment of PUV refluxes, eliminating the need for preliminary diversion as performed in the past. We recommend this simple, highly effective approach as the procedure of choice in managment of VU refluxes following valve ablation in children withPUV. MJIRI, Vol. 2, No.4, 249-254, INTRODUCTION Managment of reflux persisting after posterior urethral valve ablation is still a difficult problem.3 The result of classic ureteroneocystostomy operations in this condition has been associated with serious complications. Since we observed excellent results using the Gil-Vernet antireflux procedure even in high grade primary vesicoureteral (VU) refluxes, 2 we decided to apply this simple technique in those VU refluxes persisting after valve ablation in children with posterior urethral valve (PUV). • Presented at the XXI Congress of the International Society of Urology, Buenos Aires,ArgentinaJOct. 9-14,1988. 249 ]