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Endoscopic correction of primary vesicoureteric reflux by subureteric Teflon injection (STING): follow-up study in 123 patients

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Abstract

During a 4-year period 123 children (191 ureters) with primary vesicoureteric reflux (VUR) were treated endoscopically by subureteric Teflon injection (STING). They have now been followed up for periods ranging from 2 to 6 years. Sixty per cent of the ureters had grade III VUR and 36% had either grade IV or grade V. Reflux was corrected in 149 (78%) ureters after a single injection of polytef paste; 11 (6%) ureters showed improvement to grade I or II reflux after one injection and no further treatment was given; 24 (12%) ureters required two injections and 7 (4%) needed three to four subureteric injections for the correction of VUR. Of the 123 patients, 116 were discharged from the hospital on the day of the procedure. Of the 149 ureters corrected with one subureteric injection, 83% required less than 0.3 ml paste per ureter to stop reflux. At follow-up micturating cystography 91% of the ureters continue to show absence of reflux 2 to 6 years after endoscopic correction; 9% had recurrence of reflux, but more than one-half of the recurrences were only of grade I or grade II severity and required no further treatment. Seven ureters had recurrent grade III or IV reflux and were reinjected without any difficulty. There was no evidence of delayed appearance of vesicoureteric obstruction. Treatment of primary VUR by endoscopic subureteric injection of polytef paste was found simple, safe, and effective in correcting all grades of VUR.

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References

  1. Arnold GE (1962) Vocal rehabilitation of paralytic dysphonia: technique of intracordial injection. Arch Otolaryngol 76: 358–368

    Google Scholar 

  2. Aubert D, Destuynder O, Zoupanos G (1989) Le traitement du reflux vesicorenal de l'enfant par injection endoscopique de polytetrafluoroethylene (Teflon). Ann Urol 23: 367–372

    Google Scholar 

  3. Aubert D, Zoupanos G, Destuynder O, Hurez F (1990) ‚STING’ procedure in the treatment of secondary reflux in children. Eur Urol 17: 307–309

    Google Scholar 

  4. Birmingham Reflux Study Group (1987) Prospective trial of operative versus nonoperative treatment of severe vesicoureteric reflux in children: five years observations. Br Med J 295: 237–241

    Google Scholar 

  5. Blake NS, O'Connell EO (1989) Endoscopic correction of vesicoureteric reflux by subureteric Teflon injection: follow-up ultrasound and voiding cystography. Br J Radiol 62: 443–446

    Google Scholar 

  6. Brown S (1989) Open versus endoscopic surgery in the treatment of vesicoureteric reflux. J Urol 142: 499–501

    Google Scholar 

  7. Bullock KN, Deane AM, Ashken MH (1985) Endoscopic Teflon injection for a refluxing ureteric stump after simple nephrectomy. Br Med J 290: 1109

    Google Scholar 

  8. Canning DA, Gearhart JP (1989) Limitations and alternatives to endoscopic correction of vesicoureteral reflux with polytef paste. Pediatr Surg Int 4: 149–153

    Google Scholar 

  9. Carini M, Serni S, Lapini A, Selli C, Menchi I (1989) Endoscopic treatment of refluxing ureteric stump following nephrectomy with Tissucol and Teflon injection. Eur Urol 16: 312–314

    Google Scholar 

  10. Claes H, Stroobants D, Van Meerbeek J, Verbeken E, Knockaert D, Baert L (1989) Pulmonary migration following periurethral polytetrafluoroethylene injection for urinary incontinence. J Urol 142: 821–822

    Google Scholar 

  11. Cocche G, Schmit M, Aubert D, Destuynder O, Lemouil A (1988) Reflux vesico-ureteral. J Radiol 69: 577–579

    Google Scholar 

  12. Dedo HH, Urria RD, Lawson L (1973) Intrachordial injection of Teflon in the treatment of 135 patients with dysphonia. Ann Otol Rhinol Laryngol 82: 661–667

    Google Scholar 

  13. Dewan PA, Guiney EJ (1990) Endoscopic correction of vesicoureteric reflux in children with spina bifida. Br J Urol 65: 646–649

    Google Scholar 

  14. Diamond T, Boston E (1987) Reflux following endoscopic treatment of ureteroceles. A new approach using endoscopic subureteric Teflon injection. Br J Urol 60: 279–280

    Google Scholar 

  15. Dodat H (1990) Evolution du diagnostic et du traitement des duplicites pyeloureterales chez l'enfant. Pediatrie 45: 115–122

    Google Scholar 

  16. Dodat H, Paulhac JB (1987) Traitement endoscopique du reflux vesicoureteral par injection de Teflon chez l'enfant. Resultats preliminaires. Pediatrie 4: 211–214

    Google Scholar 

  17. Dodat H, Takvorian PH (1990) Treatment of vesicoureteral reflux in children by endoscopic injection in Teflon. Eur Urol 17: 304–306

    Google Scholar 

  18. Farkas A, Moriel EZ, Lupa S (1990) Endoscopic correction of vesicoureteral reflux: our experience with 115 ureters. J Urol 144: 534–536

    Google Scholar 

  19. Fioretti G (1988) Sulla correzione endoscopia del reflusso vescicoureterale primitivo. Rass It Chir Ped XXX: 15–19

    Google Scholar 

  20. Geannotti P, Pistolesi D, Murzi P, Morelli G, Marconi A (1986) Treatment of vesicorenal reflux in adults by endoscopic injection of Teflon. Acta Urol Belg 54: 168

    Google Scholar 

  21. Geiss S, Alessandrini P, Allouch G, Aubert D, Bayard M (1990) Multicenter survey of endoscopic treatment of vesicoureteral reflux in children. Eur Urol 17: 328–329

    Google Scholar 

  22. Gelet A, Salas M, Martin X, Faure JL, Dubernard JM (1988) Reflux vesico-uretero-renal de l'adulte. Presse Med 17: 373–375

    Google Scholar 

  23. Gelet A, Salas M, Martin X, Faure JM, Dubernard JM (1987) Traitement endoscopique du reflux vesico-ureteral. J d'Urol 93: 263–268

    Google Scholar 

  24. Gore MD, Fernbach SK, Donaldson JS, Shkolnick A, Zaontz MR, Kaplan WE (1989) Radiographic evaluation of subureteric injection of Teflon to correct vesicoureteral reflux. Am J Radiol 152: 115–119

    Google Scholar 

  25. Hughes PD (1989) Teflon injection for ureteric reflux. Med J Aust 150: 608

    Google Scholar 

  26. International Reflux Study Committee (1981) Medical versus surgical treatment of primary vesicoureteral reflux. Pediatrics 67: 392–400

    Google Scholar 

  27. Jackson CL, Kay R, Bretan P, Novick AC, Steinmuller D (1989) Endoscopic correction of vesicoureteral reflux in the renal transplant candidate. J Urol 142: 710–711

    Google Scholar 

  28. Kaplan WE (1988) Endoscopic injection of polytetrafluoroethylene for treatment of vesicoureteral reflux. Urol Clin North Am 15: 777–783

    Google Scholar 

  29. Kaplan WE, Dalton DP, Firlit CF (1987) The endoscopic correction of reflux by polytetrafluoroethylene injection. J Urol 138: 953–955

    Google Scholar 

  30. King PA (1988) The endoscopic correction of vesicoureteric reflux. Aust N Z J Surg 58: 569–571

    Google Scholar 

  31. Lacombe A (1990) Ureterovesical reimplantation after failure of endoscopic treatment of reflux by submucosal injection of polytef paste. Eur Urol 17: 318–320

    Google Scholar 

  32. Lacombe A, Besancenez A (1989) Reimplantation uretero-vesicale apres echec de traitement endoscopique du reflux par injection de Teflon. Ann Urol 23: 83–84

    Google Scholar 

  33. Lewy RB (1976) Experience with vocal cord injection. Ann Otol Rhinol Laryngol 85: 440–450

    Google Scholar 

  34. McLorie GA, McKenna PH, Jumper BM, Churchill BM, Gilmour RF, Khoury AE (1990) High grade vesicoureteric reflux: analysis of observational therapy. J Urol 144: 537–540

    Google Scholar 

  35. Malizia A, Reiman H, Myers RP, Sande JR, Barham SS, Benson RC, Dewanjee MK, Utz WT (1984) Migration and granulomatous reaction after periurethral injection of polytef paste. JAMA 251: 3277–3281

    Google Scholar 

  36. Mann CI, Jequier S, Patriquin H, La Berge I, Homsyt YL (1988) Intramural Teflon injection of the ureter for treatment of vesicoureteral reflux: sonographic appearance. Am J Radiol 151: 543–545

    Google Scholar 

  37. Marcellin L, Geiss S, Laustriat S, Becmeur F, Bientz J, Sauvage P (1990) Ureteral lesions due to endoscopic treatment of vesicoureteral reflux by injection of Teflon: pathological study. Eur Urol 17: 325–327

    Google Scholar 

  38. Martinez-Pineiro L, Armero AH, Mora M, Avellane JA (1988) Tratamiento del reflujo vesicoureteral en adultos mediante inyeccion endoscopica de pasta de Teflon. Arch Esp Urol 41: 53–56

    Google Scholar 

  39. Mittleman R, Maracini J (1983) Pulmonary Teflon granulomas following periuretheral Teflon injection for urinary incontinence. Arch Pathol Lab Med 107: 611–612

    Google Scholar 

  40. Mocellini Iturralde JA, Fernandez A, Rovegno A, Bechara A (1985) Tratamiento del reflujo vesicoureteral por injection endoscopica de Teflon. Arch Esp Urol 38: 579

    Google Scholar 

  41. O'Donnell B (1990) Management of urinary tract infection and vesicoureteric reflux in children: the case for surgery. Br Med J 300: 1393–1394

    Google Scholar 

  42. O'Donnell B (1990) Progress in the management of vesicoureteric reflux. Postgrad Med J 66: S44-S46

    Google Scholar 

  43. O'Donnell B, Puri P (1986) Endoscopic correction of primary vesicoureteric reflux. Br J Urol 58: 601–604

    Google Scholar 

  44. O'Donnell B, Puri P (1986) Endoscopic correction of primary vesicoureteric reflux: results in 94 ureters. Br Med J 293: 1404–1406

    Google Scholar 

  45. O'Donnell B, Puri P (1988) Endoscopic correction of vesicoureteric reflux using subureteric Teflon injection — the STING. In: Jonas U, Dabhoiwala NF, Debruyne FMJ (eds) Endourology, Springer, Berlin Heidelberg New York Tokyo, pp 101–107

    Google Scholar 

  46. O'Donnell B, Puri P (1988) Technical refinements in endoscopic correction of vesicoureteral reflux. J Urol 2: 140: 1101–1102

    Google Scholar 

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

    Google Scholar 

  48. Politano VA (1974) Periurethral polytetrafluoroethylene injection for urinary incontinence. J Urol 111: 180–183

    Google Scholar 

  49. Politano V (1990) Injection technique for urinary incontinence. International Congress of Endoscopic Paediatric Urology, Basle, Switzerland

  50. Puri P (1990) Endoscopic correction of primary vesicoureteric reflux. In: Hoey HMCV, Puri P (eds) Paediatric nephrology: progress in research and practice. Wiley, Chichester, pp 21–26

    Google Scholar 

  51. Puri P (1990) Endoscopic correction of primary vesicoureteric reflux by subureteric injection of polytetrafluoroethylene. Lancet 335: 1320–1322

    Google Scholar 

  52. Puri P, Guiney EJ (1986) Endoscopic correction of vesicoureteric reflux secondary to neuropathic bladder. Br J Urol 58: 504–506

    Google Scholar 

  53. Puri P, O'Donnell B (1984) Correction of experimentally produced vesicoureteric reflux in the piglet by intravesical injection of Teflon. Br Med J 289: 5–9

    Google Scholar 

  54. Puri P, O'Donnell B (1987) Endoscopic correction of grades IV and V primary vesicoureteric reflux: six to 30 month follow-up in 42 ureters. J Ped Surg 22: 1087–1091

    Google Scholar 

  55. Puri P, O'Donnell B (1988) Endoscopic correction of vesicoureteric reflux using subureteric Teflon injection. In: Spitz L, Nixon HH (eds) Operative surgery: Paediatric surgery, 4th edn. Butterworths, pp 522–527

  56. Quinn FMJ, Diamond T, Boston VE (1988) Endoscopic management of vesicoureteric reflux in children with neuropathic bladder secondary to myelomeningocele. Z Kinderchir [Suppl] 43: 43–45

    Google Scholar 

  57. Romano C, Locatelli G (1989) II trattamento endoscopico del reflusso vescico-ureterale (the Sting). Rass It Chir Ped XXXI: 128–131

    Google Scholar 

  58. Saslawsky M (1989) Ureterocutaneous fistula: a case report of treatment by subtrigonal injection of polytetrafluoroethylene (Sting procedure). J Urol 142: 1310–1311

    Google Scholar 

  59. Sauvage P, Geiss S, Saussine C, Becmeur F, Bientz J (1990) Analysis and perspectives of endoscopic treatment of vesicoureteral reflux in children with a 20-month follow-up. Eur Urol 17: 310–313

    Google Scholar 

  60. Schulman CC (1987) Endoscopic treatment of reflux. Dial Pediatr Urol 10: 5–6

    Google Scholar 

  61. Schulman CC (1986) Endoscopic treatment of vesicoureteric reflux. Soc Paed Urol (Newsletter) 41: 42

    Google Scholar 

  62. Schulman CC (1986) Traitement endoscopique de reflux vesico-ureteral chez l'enfant. Acta Urol Belg 54: 60

    Google Scholar 

  63. Schulman CC (1986) Traitement endoscopique du reflux vesicoureteral chez l'enfant. Chir Pediatr 27: 181–184

    Google Scholar 

  64. Schulman CC, Pamart D, Hall M, Janssen F, Avni FE (1990) Vesicoureteral reflux in children: endoscopic treatment. Eur Urol 17: 314–317

    Google Scholar 

  65. Schulman CC, Simon J, Pamari D, Avni FE (1987) Endoscopic treatment of vesicoureteral reflux in children. J Urol 138: 950–952

    Google Scholar 

  66. Schulman CC, Simon J, Wespes E, Germeau F (1984) Endoscopic injection of Teflon to treat urinary incontinence in women. Br Med J 288: 192

    Google Scholar 

  67. Sweeney LE, Thomas PS (1987) Evaluation of sub-ureteric Teflon injection as an antireflux procedure. Ann Radiol 30: 478–481

    Google Scholar 

  68. Takvorian PH, Dodat H, Paulhac JB, Gabriele S (1989) Traitement du reflux vesico-ureteral chez l'enfant par injection endoscopique de Teflon. J d'Urol 95: 231–234

    Google Scholar 

  69. Valla JS, Aubert D, Chavrier Y, Limonne B, Galifer RB, Schulman CC (1989). Traitement endoscopique du reflux vesico-ureteral par injection sous muqueuse de pate de Teflon chez l'enfant. Chir Pediatr 30: 37–42

    Google Scholar 

  70. Valla JS, Avril G. Arcamone H, Grinda A (1987) Traitement du reflux vesicoureteral primitif de l'enfant chirurgie ou endoscopie, nouvelle querelle des anciens et des modernes ou methodes complementaires. Cahiers Lenval 8: 167–171

    Google Scholar 

  71. Viville C (1990) Endoscopic treatment of ureterocele and antireflux injection with Teflon paste. Eur Urol 17: 321–324

    Google Scholar 

  72. Vorstman B, Lockhart J, Kaufman M, Politano V (1985) Polytetrafluoroethylene injection for urinary incontinence in children. J Urol 133: 248–250

    Google Scholar 

  73. Yachia D (1989) Submeatal injection of polytetrafluoroethylene paste for the endoscopic treatment of vesicoureteric reflux in adults. Br J Urol 64: 552–555

    Google Scholar 

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  1. National Children's Hospital, Harcourt Street, Dublin, Ireland

    Prem Puri

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Puri, P. Endoscopic correction of primary vesicoureteric reflux by subureteric Teflon injection (STING): follow-up study in 123 patients. Pediatr Surg Int 6, 269–272 (1991). https://doi.org/10.1007/BF00178635

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