title: Evolution of the treatment of vesicoureteral reflux in Spain.
abstract: OBJECTIVE
  We determined the changes in the treatment of vesicoureteral reflux (VUR) at children's hospitals in Spain as well as the long-term results of endoscopic treatment (ET) with polytetrafluoroethylene, namely with STING (subureteral polytetrafluoroethylene injection).
  
  
  METHODS
  A survey was performed of all pediatric urology units in Spain to determine changes in the diagnosis and treatment of VUR in the last 10 years. Also, a conjoint study was made of STING case records at 5 Spanish hospitals where there is expertise in the technique.
  
  
  RESULTS
  The response rate was 34 of 44 cases (78%). The most significant changes were the introduction of urodynamics and the progressive establishment of ET as a substitute for open surgery and prolonged medical treatment. At more than 90% of the units ET is now done with different materials with a cure rate of 75% after 1 injection and a low index of complications. The results of the STING study in 2,035 refluxing ureters showed a cure rate of about 90% for 2 or 3 injections for grades I to IV reflux and just under 70% for grade V. Also, the cure rate for complex reflux was 60% and the index of complications was less than 1.2% with some intravesical migration.
  
  
  CONCLUSIONS
  There have been many changes in the approach to VUR with an increasing use of urodynamics and ET. Since the long-term results of STING are reliable and no long-term complications have been observed, polytetrafluoroethylene appears to be the product with the best quality/price ratio for use in ET. However, it is being replaced.
authors.affiliation: Children's Hospital of Infanta Cristina, Badajoz, Spain. jmmoran@unex.es
authors.forename: Jose M
authors.initials: JM
authors.lastname: Moran Penco
authors.forename: Andre
authors.initials: A
authors.lastname: Gomez Fraile
authors.forename: Jorge
authors.initials: J
authors.lastname: Rodríguez Alarcon
authors.forename: Francisco
authors.initials: F
authors.lastname: Garcia Merino
authors.forename: Diego
authors.initials: D
authors.lastname: Vela
authors.forename: Santiago
authors.initials: S
authors.lastname: Sanjuán Rodriguez
authors.forename: Aldolfo
authors.initials: A
authors.lastname: Aransay Brantot
mesh_terms: D002648:Child; D006801:Humans; D007267:Injections; D011138:Polytetrafluoroethylene / Q000008:administration & dosage*; D013030:Spain; D011795:Surveys and Questionnaires; D018666:Ureteroscopy / Q000706:statistics & numerical data / Q000639:trends*; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
chemical_list: D011138:Polytetrafluoroethylene