Pediatric Urology Gil-Vernet Antireflux Surgery in Treatment of Lower Pole Reflux

Purpose: Prevalence of ureter and kidney duplication is roughly 1 per 125 people, and is associated with vesicoureteral reflux to lower pole in about 45% of cases. From antireflux surgical principles viewpoint, standard antireflux surgeries can be performed in these kidneys without releasing ureters from each other. We studied the results of Gil-Vernet antireflux surgery in 12 patients with duplicated collecting system and lower pole reflux. Materials and Methods: Between 1996 and 2000, 12 patients with unilateral duplicated system underwent Gil-Vernet antireflux surgery. There were 8 (67%) females and 4 (33%) males with a median age of 5.6 years. Of the patients, 50% had unilateral lower pole reflux in duplex system and 50% had bilateral reflux. Results: Twelve patients with lower pole reflux in duplicated system, and overall, 18 refluxing renal units were treated, using Gil-Vernet antireflux surgery. In 11 (92%) patients, upper pole orifices were non-refluxing and without ureterocele. One (8%) patient had upper pole ureterocele that was treated by a small medial incision in the same session. Median hospital stay was 4 days, and median follow-up was 10 months, in 10 patients who were followed. Of patients, 80% and of refluxing units, 94% improved. Overall, success rate was 88%. Conclusion: Gil-Vernet antireflux surgery is a simple technique, associating with minimum ureteral manipulation for releasing them. Accordingly, we recommend GilVernet antireflux surgery as the first line surgical modality for duplicated ureters with lower pole reflux, without upper pole ureterocele.