Treatment of vesico-ureteric reflux in children with neuropathic bladder: a comparison of surgical and endoscopic correction.
OBJECTIVE
Vesico-ureteric reflux (VUR) is a common problem in children with neuropathic bladder. Lesser-degree VUR may be manageable by intermittent catheterization or by anticholinergics, but higher grades usually require surgical treatment. If left untreated, two thirds of such patients may experience deterioration of the upper renal tracts. The aim of this study was to compare the results of the STING (Subureteric Teflon Injection) technique with surgical ureteric reimplantation as treatment for VUR in neuropathic bladder.


METHODS
From January 1981 to December 1996, 58 children with NB (81 ureters) were treated for VUR. STING and Cohen ureteroneocystotomy were performed in 40 and 41 ureters, respectively. Mean age was 4.5 years (STING) and 5.1 years (Cohen).


RESULTS
Twenty-nine of 40 refluxing ureters (72.5%) were cured by STING, whereas Cohen eradicated reflux in 39 of 41 ureters (95.5%). No complications were observed in either group. All the ureters in which STING failed were treated successfully by Cohen ureteroneocystostomy. The 2 ureters still refluxing after surgical reimplantation were cured successfully by a single STING. The mean follow-up was 6.8 years in the Cohen group and 4.8 years in the STING group. During follow-up, no recurrence was observed in patients cured by open reimplantation. In the STING group, 2 previously cured ureters showed recurrence of VUR: both were treated successfully by a further STING.


CONCLUSIONS
Open ureteral reimplantation is more effective than STING in correcting VUR in children with neuropathic bladder dysfunction. Nevertheless, the good success rate, the relative technical simplicity, outpatient nature, and rapid recovery point to STING as a safe and effective procedure for the initial treatment of VUR. Failure of STING does not preclude a successful open operation.
Granata
C
C
Department of Paediatric Surgery, Giannina Gaslini Hospital for Sick Children, Genova, Italy.
Buffa
P
P
Di Rovasenda
E
E
Mattioli
G
G
Scarsi
P L
PL
Podesta
E
E
Dodero
P
P
Jasonni
V
V
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D006801:Humans; D007223:Infant; D008297:Male; D011138:Polytetrafluoroethylene / Q000008:administration & dosage / Q000627:therapeutic use*; D012092:Replantation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000150:complications*; D014718:Vesico-Ureteral Reflux / Q000209:etiology / Q000601:surgery / Q000628:therapy*
D011138:Polytetrafluoroethylene