title: Does the modıfıed STING method increase the success rate in the management of moderate or hıgh-grade reflux?
abstract: OBJECTIVE
  To evaluate the efficacy of subureteral injection types in patients with middle- to high-grade vesicoureteral reflux (VUR).
  
  
  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.
authors.affiliation: Department of Urology, Ministry of Health Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.
authors.forename: Osman Raif
authors.initials: OR
authors.lastname: Karabacak
authors.affiliation: Department of Urology, Ministry of Health Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Yalçınkaya
authors.affiliation: Department of Urology, Ministry of Health Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.
authors.forename: Uğur
authors.initials: U
authors.lastname: Altuğ
authors.affiliation: Department of Urology, Ministry of Health Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.
authors.forename: Nurettin
authors.initials: N
authors.lastname: Sertçelik
authors.affiliation: Department of Urology, Ministry of Health Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.
authors.forename: Fuat
authors.initials: F
authors.lastname: Demirel
mesh_terms: D000283:Administration, Intravesical; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007223:Infant; D008297:Male; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014463:Ultrasonography; D014513:Ureter / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid
keywords: Dextranomer; Endoscopy; Injections; Surgical; Vesico-ureteral reflux