Korean J Urol.  2014 Sep;55(9):615-619. 10.4111/kju.2014.55.9.615.

Does the Modified STING Method Increase the Success Rate in the Management of Moderate or High-Grade Reflux?

• Karabacak
• Yalcinkaya F
• Altug U
• Sertcelik
• Demirel F

• KMID: 2069780
• DOI: http://doi.org/10.4111/kju.2014.55.9.615

Abstract

PURPOSE
To evaluate the efficacy of subureteral injection types in patients with middle- to high-grade vesicoureteral reflux (VUR).
MATERIALS AND METHODS
Between June 1999 and September 2010, subureteral dextranomer was applied at our clinic to 149 patients (214 refluxing ureters) with grades II, III, and IV VUR. Group 1 consisted of 54 patients (80 ureters), and group 2 consisted of 95 patients (134 ureters). The standard subureteric transurethral injection (STING) procedure was applied to group 1, and the modified STING procedure was applied to group 2. A second and if needed a third injection was applied to unsuccessfully treated patients. The mean follow-up period was 2 years. Patients were evaluated by cystography and ultrasonography in the third month of follow-up.
RESULTS
VUR was resolved completely after a single injection in 54/80 ureters (67.5%) in group 1 and in 94/134 ureters (70.1%) in group 2. Overall successes after a second or a third injection were 61/80 (76.2%) and 111/134 (82.8%), respectively. There was a statistically significant difference between the groups only for grade IV reflux following multiple injections (p<0.05).
CONCLUSIONS
Endoscopic treatment of VUR is a recommended treatment because it is minimally invasive, efficient, and repeatable. Our study confirmed that a modified STING procedure can be an alternative treatment to the standard technique.

Keyword

Dextranomer; Endoscopy; Injections; Surgical; Vesico-ureteral reflux

MeSH Terms

Administration, Intravesical
Adolescent
Child
Child, Preschool
Dextrans/*administration & dosage
Endoscopy
Female
Follow-Up Studies
Humans
Hyaluronic Acid/*administration & dosage
Infant
Male
Reproducibility of Results
Treatment Outcome
Ureter/*surgery
Urologic Surgical Procedures/*methods
Vesico-Ureteral Reflux/*drug therapy/ultrasonography
Dextrans
Hyaluronic Acid

Reference

1. Matouschek E. Treatment of vesicorenal reflux by transurethral teflon-injection (author's transl). Urologe A. 1981; 20:263–264.

2. O'Donnell B, Puri P. Treatment of vesicoureteric reflux by endoscopic injection of Teflon. Br Med J (Clin Res Ed). 1984; 289:7–9.

3. Puri P, Kutasy B, Colhoun E, Hunziker M. Single center experience with endoscopic subureteral dextranomer/hyaluronic acid injection as first line treatment in 1,551 children with intermediate and high grade vesicoureteral reflux. J Urol. 2012; 188:4 Suppl. 1485–1489.

4. Routh JC, Kramer SA, Inman BA, Ashley RA, Wolpert JJ, Vandersteen DR, et al. Utility of dextranomer/hyaluronic acid injection in setting of bladder and ureteral anomalies. Urology. 2008; 71:435–438.

5. Capozza N, Lais A, Matarazzo E, Nappo S, Patricolo M, Caione P. Influence of voiding dysfunction on the outcome of endoscopic treatment for vesicoureteral reflux. J Urol. 2002; 168(4 Pt 2):1695–1698.

6. Karami H, Razi A, Mazloomfard MM, Javanmard B. Is there any role for urodynamic study in children with high-grade vesicoureteral reflux? Urology. 2012; 79:888–891.

7. Mendez R, Somoza I, Tellado MG, Liras J, Sanchez A, Pais E, et al. Predictive value of clinical factors for successful endoscopic correction of primary vesicoureteral reflux grades III-IV. J Pediatr Urol. 2006; 2:545–550.

8. Lackgren G, Kirsch AJ. Surgery illustrated - surgical atlas endoscopic treatment of vesicoureteral reflux. BJU Int. 2010; 105:1332–1347.

9. Kirsch AJ, Perez-Brayfield M, Smith EA, Scherz HC. The modified sting procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter. J Urol. 2004; 171(6 Pt 1):2413–2416.

10. Cerwinka WH, Scherz HC, Kirsch AJ. Dynamic hydrodistention classification of the ureter and the double hit method to correct vesicoureteral reflux. Arch Esp Urol. 2008; 61:882–887.

11. Sung J, Skoog S. Surgical management of vesicoureteral reflux in children. Pediatr Nephrol. 2012; 27:551–561.

12. Capozza N, Caione P. Modification of the sting procedure for vesicoureteral reflux: ureteral repositioning and injection. Arch Esp Urol. 2008; 61:254–257.

13. Routh JC, Reinberg Y, Ashley RA, Inman BA, Wolpert JJ, Vandersteen DR, et al. Multivariate comparison of the efficacy of intraureteral versus subtrigonal techniques of dextranomer/hyaluronic acid injection. J Urol. 2007; 178(4 Pt 2):1702–1705.

14. Molitierno JA, Scherz HC, Kirsch AJ. Endoscopic treatment of vesicoureteral reflux using dextranomer hyaluronic acid copolymer. J Pediatr Urol. 2008; 4:221–228.

15. Gupta A, Snodgrass W. Intra-orifice versus hydrodistention implantation technique in dextranomer/hyaluronic acid injection for vesicoureteral reflux. J Urol. 2008; 180:4 Suppl. 1589–1592.

16. Routh JC, Reinberg Y. Predicting success in the endoscopic management of pediatric vesicoureteral reflux. Urology. 2010; 76:195–198.

17. Routh JC, Inman BA, Reinberg Y. Dextranomer/hyaluronic acid for pediatric vesicoureteral reflux: systematic review. Pediatrics. 2010; 125:1010–1019.

18. Lavelle MT, Conlin MJ, Skoog SJ. Subureteral injection of Deflux for correction of reflux: analysis of factors predicting success. Urology. 2005; 65:564–567.

19. Holmdahl G, Brandstrom P, Lackgren G, Sillen U, Stokland E, Jodal U, et al. The Swedish reflux trial in children: II. Vesicoureteral reflux outcome. J Urol. 2010; 184:280–285.

20. Nseyo U, Mancini JG, Wiener JS. Symptomatic bilateral delayed partial ureteral obstruction after bilateral endoscopic correction of vesicoureteral reflux with dextranomer/hyaluronic acid polymer. Urology. 2013; 81:184–187.