Extensive surgery on the trigone for complete ureteral duplication does not cause incontinence or voiding problems

Objectives. To evaluate whether extensive trigonal surgery for duplicated k idneys is harmful for later bladder and urethral function. Methods. Of 201 surgically treated children with kidney and ureteral duplic ation, 145 were followed up for at least 1 year. The mean follow-up was 5 y ears (range 1 to 15), and all patients were at least 7 years old at the dat e of their last follow-up visit. Trigone surgery was performed in 105 child ren; bilateral trigonal surgery in 26, unroofing in 25, and total excision in 5. On all later consultations, the presence of infection, voiding habits , continence pattern, and ultrasound findings for residual urine volume and kidney function were noted. Children with recurrent urinary tract infectio n or dysfunctional voiding for more than 2 years underwent a urodynamic exa mination. Results. Nine children, of whom five were boys, had nocturnal enuresis only . Eight patients had day and nighttime wetting. Seven of the 8 patients had recurrent urinary infections; urodynamic evaluation revealed a high compli ance (with residual urine) in three of these children and four had detrusor instability. One girl had an irregular bladder neck, with stress incontine nce. All reflux, whether surgically or conservatively treated and also thre e of four occurring de novo, disappeared within 1 year after surgery. In th e group without voiding dysfunctions, seven cystitis and five pyelonephriti s attacks occurred. Conclusions. Neither extensive trigonal surgery nor pre-existing trigonal d eformation by ureteroceles provokes later bladder dysfunction. (C) 2000, El sevier Science Inc.