Endoscopic correction of vesico-ureteric reflux in duplex systems

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Urologic Oncology

Background:

• Vesico-ureteric reflux (VUR) is a common condition in children, often associated with urinary tract infections.
• Duplex systems present unique challenges for VUR management.
• Endoscopic treatment offers a minimally invasive alternative to surgical correction.

Purpose of the Study:

• To evaluate the efficacy and safety of endoscopic subureteric Teflon injection (STING) for treating high-grade VUR in children with duplex systems.
• To compare outcomes in complete versus incomplete duplicated ureters.
• To assess recurrence rates and long-term follow-up.

Main Methods:

• A retrospective review of 37 children (43 duplex systems) treated with STING between May 1984 and April 1990.
• Patients had high-grade VUR and were stratified by complete or incomplete duplex systems.
• Follow-up included micturating cystography, with assessment of recurrence and need for repeat procedures.

Main Results:

• VUR was corrected in 87.5% of incomplete duplex systems after one injection.
• In complete duplex systems, 59% were corrected with one injection; 11% improved.
• Recurrence was not observed in corrected incomplete systems, but occurred in 3 completely duplicated ureters.

Conclusions:

• STING is a highly effective treatment for high-grade VUR in children with incomplete duplex systems.
• While effective for complete duplex systems, recurrence rates are higher compared to incomplete systems.
• The procedure is safe, with most patients discharged on the day of treatment and minimal recurrence in incomplete systems.