Abstract
Background:
We reviewed our experience with subureteral polytetrafluoroethylene (Teflon) injection (STING) in the treatment of vesicoureteral reflux (VUR), with special emphasis on long-term effectiveness and morbidity.
Patients and Methods:
From 1984 to 2001, 1916 patients, 488 male and 1428 female (3037 refluxing ureters) with a mean age of 3.7 years (range, 3 months-15 years), were treated endoscopically 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%) ureters. Primary VUR, reflux in duplex systems, and reflux secondary to neuropathic bladder were present in 2778 (91.4%), 205 (6.8%), and 54 (1.8%) ureters, respectively. All patients were followed up for periods ranging from 1 to 18 years, with a median follow-up of 11 years.
Results:
Reflux resolved in 2032 (66.9%) ureters after one injection, in 776 (25.5%) after two, and in 111 (3.7%) after three injections. VUR improved to grade I after one or two injections in 81 (2.7%) ureters, which required no further treatment. Subureteral injection failed to correct reflux in 37 (1.2%), which then were treated with ureteral reimplantation. At follow-up, reflux had recurred in 41 (1.4%) ureters, and 23 of these had only grade I or II VUR.
Conclusion:
The results of this study confirm that endoscopic STING is a simple and effective outpatient procedure in the treatment of VUR. No long-term morbidity was observed in our patients with the use of polytetrafluoroethylene during 17 years of follow-up.
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