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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.
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