title: Endoscopic treatment of primary grades IV and V vesicoureteral reflux in children with subureteral injection of polytetrafluoroethylene.
abstract: OBJECTIVE
  We evaluated our experience with endoscopic STING (subureteral polytetrafluoroethylene injection) for grades IV and V vesicoureteral reflux.
  
  
  METHODS
  We reviewed the records of 221 boys and 305 girls who underwent STING for primary grades IV (430) and V (96) vesicoureteral reflux between 1984 and 2000. Median patient age at STING was 3 years (range 3 months to 14 years). Reflux was unilateral and bilateral in 335 and 191 children, respectively (717 refluxing units). Median followup was 11.6 years (range 1 to 17).
  
  
  RESULTS
  Reflux was corrected in 420 of the 717 refluxing units (58%) after a single injection. Reflux resolved after a second and third injection in 185 ureters (26%). High grade reflux was converted to grades I and II in 112 ureters (15%) and did not require any further treatment. STING failed to correct reflux in 7 units (0.9%), which were managed by ureteral reimplantation (5) and nephrectomy (2) due to poor renal function. Voiding cystourethrography showed recurrent vesicoureteral reflux in 9 units (1.2%), including 2 with low grade reflux for which no treatment was given. Seven ureters required repeat injection due to grades III and IV reflux. No untoward effects were noted in any patients in whom polytetrafluoroethylene was used as the injected material.
  
  
  CONCLUSIONS
  STING is a simple, safe and effective outpatient procedure for grades IV and V vesicoureteral reflux.
authors.affiliation: Children's Research Centre, Our Lady's Hospital for Sick Children, University College Dublin, Dublin, Ireland.
authors.forename: Boris
authors.initials: B
authors.lastname: Chertin
authors.forename: Diane
authors.initials: D
authors.lastname: De Caluwé
authors.forename: Prem
authors.initials: P
authors.lastname: Puri
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007267:Injections; D008297:Male; D011138:Polytetrafluoroethylene; D012189:Retrospective Studies; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000145:classification / Q000628:therapy*
chemical_list: D011138:Polytetrafluoroethylene