Vesicoureteral Reflux in Children: Endoscopic Treatment

Subureteric Teflon Injection (STING)

“…The number of refluxing ureters treated by each surgeon varied from as low as 30 ureters to well over 1,000 ureters. But the overall cure rate of 76.3% after a single injection of Polytef paste is similar to that achieved in single institutions with sig nificant experience with STING [3,5,9]. The success of endoscopic correction of reflux is lower in duplicated sys tems [8] and in refluxing ureters secondary to neuropathic bladder [10].…”

Clinical Efficacy and Safety in Children with Vesicoureteral Reflux of a Single Injection of Two Different Bulking Agents – Polydimethylsiloxane (Macroplastique) or Dextranomer/Hyaluronic Acid Copolymer (Deflux): A Short-Term Prospective Comparative Study

“…The resolution/improvement rate was 72% after the first injection. Debate over the ideal bulking agent for endoscopic treatment in children with VUR remains controversial [21,22]. Oswald et al [23] compared the efficacy of injection of Macroplastique (58 ureters) or Deflux (56 ureters) and assessed the clinical effects concerning reflux resolution in patients with VUR grade II-IV.…”

Endoscopic Treatment of Reflux: Experimental Study and Review of Teflon® and Collagen

“…The animals used by Malizia [41] were injected periurethrally with large quantitites of the paste. reflux after Teflon injection as Lacombe [36,42,66]. This granulomatous formation is clearly identifiable with ul trasound and CT scan [66], While a Teflon granuloma has been described sur rounding particles that have migrated to the lungs in humans after periurethral injection as a lipiodol-like reac tion, no long-term morbidity and complications have been reported to date with the use of Teflon to correct reflux despite its widespread application [10,25,46].…”

“…reflux after Teflon injection as Lacombe [36,42,66]. This granulomatous formation is clearly identifiable with ul trasound and CT scan [66], While a Teflon granuloma has been described sur rounding particles that have migrated to the lungs in humans after periurethral injection as a lipiodol-like reac tion, no long-term morbidity and complications have been reported to date with the use of Teflon to correct reflux despite its widespread application [10,25,46]. The tissue reaction associated with migration of Teflon parti cles was not similar depending on the organ where parti cles were observed after periurethral injection in animals since lymph nodes and lung tissue showed the characteris tic giant cell reaction, while particles found in the kidney or the brain did not present such a response [41], Because of the concern regarding the migration of Teflon, crosslinked bovine collagen was tried for the endoscopic cor rection of reflux by several authors and by ourselves with a success rate inferior, however, to those reported with Teflon (60-65% after 1 injection) and with no longstand ing effect [7,23,28,40,66].…”

“…Endoscopic treatment of vesicoureteral reflux by subureteric injection of Teflon® was first performed by Matouschek [43] in 1981 in an adult. It has been devel oped for.children by 59] in 1984 and further applied by Schulman [65][66][67], Reflux is a common pathologic finding and accounts for 25-50% of children presenting with urinary infection, and reflux nephropathy accounts for a quarter of all chil dren needing dialysis and transplantation [61]. The ma jority of authors agree that high-grade reflux and children presenting with recurrent urinary infections not con trolled by prophylactic therapy deserve surgical correc tion of reflux.…”