STING for VesicoUreteric STING for VesicoUreteric Reflux in Children.Reflux in Children.

Chris FearneMalta Institute for Medical Education

Vesico Ureteric RefluxVesico Ureteric Reflux

Vesico Ureteric RefluxVesico Ureteric Reflux

Prophylactic AntibioticsProphylactic Antibiotics

DMSADMSA

Vesico Ureteric Reflux: Vesico Ureteric Reflux: ReimplantationReimplantation

ReimplantationReimplantation

EndoscopicEndoscopic

STINGSTING

STINGSTING

nn PediatricPediatric EndosurgeryEndosurgery & Innovative Techniques& Innovative Techniquesnn LongLong--Term FollowTerm Follow--Up of Endoscopic Treatment of Up of Endoscopic Treatment of VesicoureteralVesicoureteral

Reflux: ThreeReflux: Three--CenterCenter ExperienceExperiencenn Mar 2003, Vol. 7, No. 1: 39Mar 2003, Vol. 7, No. 1: 39--4545nn

BorisBoris ChertinChertin, MD, , MD, AlonAlon FridmansFridmans, MD, Claudio, MD, Claudio GranataGranata, MD, , MD, VincenzoVincenzo JasonniJasonni, MD, A, MD, A FarkasFarkas, MD, FAAP, , MD, FAAP, PremPrem PuriPuri, MD, MS, FRCS, FAC, MD, MS, FRCS, FACBackground:Background: We reviewed our experience with We reviewed our experience with subureteralsubureteral polytetrafluoroethylenepolytetrafluoroethylene(Teflon) injection (STING) in the treatment of (Teflon) injection (STING) in the treatment of vesicoureteralvesicoureteral reflux (VUR), with special reflux (VUR), with special emphasis on longemphasis on long--term effectiveness and morbidity.term effectiveness and morbidity.

nn Patients and Methods:Patients and Methods: From 1984 to 2001, 1916 patients, 488 male and 1428 female From 1984 to 2001, 1916 patients, 488 male and 1428 female (3037 refluxing (3037 refluxing uretersureters) with a mean age of 3.7 years (range, 3 months) with a mean age of 3.7 years (range, 3 months--15 years), 15 years), were treated were treated endoscopicallyendoscopically with STING. Reflux was grade I in 154 (5.1%), II in 509 with STING. Reflux was grade I in 154 (5.1%), II in 509 (16.8%), III in 1450 (47.7%), IV in 743 (24.5%), and V in 181 (6(16.8%), III in 1450 (47.7%), IV in 743 (24.5%), and V in 181 (6%) %) uretersureters. Primary . Primary VUR, reflux in duplex systems, and reflux secondary to VUR, reflux in duplex systems, and reflux secondary to neuropathicneuropathic bladder were bladder were present in 2778 (91.4%), 205 (6.8%), and 54 (1.8%) present in 2778 (91.4%), 205 (6.8%), and 54 (1.8%) uretersureters, respectively. All patients , respectively. All patients were followed up for periods ranging from 1 to 18 years, with a were followed up for periods ranging from 1 to 18 years, with a median followmedian follow--up of up of 11 years.11 years.

nn Results:Results: Reflux resolved in 2032 (Reflux resolved in 2032 (66.9%66.9%) ) uretersureters after one after one injection, in 776 (injection, in 776 (25.5%25.5%) after two, and in 111 (3.7%) after three ) after two, and in 111 (3.7%) after three injections. VUR improved to grade I after one or two injections injections. VUR improved to grade I after one or two injections in in 81 (2.7%) 81 (2.7%) uretersureters, which required no further treatment. , which required no further treatment. SubureteralSubureteral injection failed to correct reflux in 37 (1.2%), which injection failed to correct reflux in 37 (1.2%), which then were treated with then were treated with ureteralureteral reimplantation. At followreimplantation. At follow--up, reflux up, reflux had recurred in 41 (1.4%) had recurred in 41 (1.4%) uretersureters, and 23 of these had only grade , and 23 of these had only grade I or II VUR.I or II VUR.

nn Conclusion:Conclusion: The results of this study confirm that The results of this study confirm that endoscopicendoscopic STING is a simple and STING is a simple and effective outpatient procedure in the treatment of VUR. No longeffective outpatient procedure in the treatment of VUR. No long--term morbidity was term morbidity was observed in our patients with the use of observed in our patients with the use of polytetrafluoroethylenepolytetrafluoroethylene during 17 years of during 17 years of followfollow--upup

nnShould STING Should STING replace prophylaxis?replace prophylaxis?

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