Materials and MethodsMaterials and Methods

• Aim of this study is to evaluate our experience with STING procedure.

• Between Feb 2004 and Feb 2005

• 22 patients & 34 ureters were treated.

• Age between 7 months to 10 years old (mean age 2.6 years)

• Renal sonography & voiding cystourethrograms at 6 weeks.

Bolus

ResultsResults

24%

76%

1

2

• 19 girls and 3 boys• 5 units grad 4• 14 units grad 3• Reflux was corrected

in 16 patients 73%( 23 ureters out of 34 [76%])

• No patient had hydronephrosis / ureteral obstruction.

• 2 patients develop reflux in the other unit/ureter after treatment.

• Both treated with STING.

Open repair after failed injectionOpen repair after failed injection

• STING failed to correct reflux in 5 patients (22%) which were managed by ureteral reimplantation

• Varying degrees of periureteral fibrosis

• Surgical repair not prohibitively difficult

Intraoperative-VCUGIntraoperative-VCUG

• 4 patients had intra-operative VCUG Then they had another VCUG 6 weeks Latter.

• One of them show the presence of the reflux at the latter VCUG. Intra-Op and Pst-Op VCUG

3, 75%

1, 25%

Injection of Duplicated UretersInjection of Duplicated Ureters

• Injection under the distal orifice – uplifting of the “duplex system”

• Injection under and into the refluxing orifice

• 3 children with ureteral duplication were treated 2 of them resolve 67%.

0

0.5

1

1.5

2

2.5

1

Reflux resolve

Reflux did not resolve

What to do after a failed What to do after a failed injection?injection?

Reinjection(s):

Minimally invasive, possibly prolonged

treatment

Open repair:

More invasive,Definitive repair

• Reflux resolved after a second injection in 2 out of 3 patients (67%)

• Answer unclear at present

• Make decision based on:– ? Grade of persisting reflux– ? Parental preference– ? Physician philosophy

Reflux after 2nd STING

33%

67%

ConclusionsConclusions• STING is an excellent Day surgery procdure for

correcting VUR• Deflux material easy to handle compare to

Macroplastique• Endoscopic therapy offers

– Acceptable treatment alternative– Obviously decreased morbidity with acceptable

failure rate and reasonable follow-up• Hydrodistention & orifice grading may indicate

injection for the normal ureter• intra-operative VCUG is not always accurate • More long-term study on outcomes:

Renal scarring Stability of implant/ absence of reflux

Question?Question?

Thank You