title: STING versus HIT technique of endoscopic treatment for vesicoureteral reflux: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Our study aimed to compare the efficacy of two endoscopic techniques used for the correction of vesicoureteral reflux (VUR): subureteral transurethral injection (STING) and hydrodistension implantation technique (HIT).
  
  
  METHODS
  A systematic review was conducted using MEDLINE, Google scholar, and Cochrane databases from 1984 to 2015. Meta-analysis of the selected studies was performed to compare the extent of reflux resolution following both techniques.
  
  
  RESULTS
  Six observational studies met the inclusion criteria for content. These comprised 632 ureters treated by STING and 895 ureters treated by HIT procedure. All included studies utilized dextranomer/hyaluronic acid (Deflux) as the bulking agent. The overall resolution of VUR was significantly higher in HIT (82.5%) compared to STING (71.4%) [pooled odds ratio (OR)=0.54; 95% confidence interval (CI) 0.42-0.69; P<0.0001; I2=8%]. A subgroup analysis showed that HIT had better outcomes than STING for both lower grade (I-III) [OR=0.43; 95% CI 0.23-0.82; P=0.01; I2=0%] and high-grade VUR (IV-V) [OR=0.43; 95% CI 0.20-0.91; P=0.03; I2=0%]. However, there was no statistical difference in the requirement of additional injections between STING and HIT groups.
  
  
  CONCLUSIONS
  HIT is superior to STING technique for resolution of VUR after Deflux injection. However, more randomized trials with longer follow-up are necessary to demonstrate the benefit of HIT compared to STING procedure.
  
  
  METHODS
  Retrospective comparative studies - level III.
authors: Department of Paediatric Surgery, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore. Electronic address: yap.te.lu@singhealth.com.sg.
authors: Te-Lu
authors: TL
authors: Yap
authors: Department of Paediatric Surgery, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore.
authors: Yong
authors: Y
authors: Chen
authors: Department of Paediatric Surgery, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore.
authors: Shireen A
authors: SA
authors: Nah
authors: Department of Paediatric Surgery, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore.
authors: Caroline Choo Phaik
authors: CC
authors: Ong
authors: Department of Paediatric Surgery, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore.
authors: Anette
authors: A
authors: Jacobsen
authors: Department of Paediatric Surgery, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore.
authors: Yee
authors: Y
authors: Low
mesh_terms: D001672:Biocompatible Materials / Q000008:administration & dosage*; D003911:Dextrans / Q000008:administration & dosage; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007267:Injections; D011138:Polytetrafluoroethylene / Q000008:administration & dosage; D012189:Retrospective Studies; D014513:Ureter; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
chemical_list: D001672:Biocompatible Materials; D003911:Dextrans; C013471:dextranomer; D011138:Polytetrafluoroethylene; D006820:Hyaluronic Acid
keywords: Dextranomer/hyaluronic acid; Endoscopic treatment; HIT; STING; Vesicoureteral reflux