Endoscopic treatment of vesico-ureteric reflux in neurogenic bladder--8 years' experience

During an 8-year period, 51 children with neurogenic bladder had endoscopic injection of Teflon (STING) for the management of 69 refluxing ureters. There were 21 boys and 30 girls (age range, 10 month to 16 years). Vesico-ureteral reflux (VUR) had been present for a mean of 4.1 years, and severity distribution was as follows: grade I, 1 ureter; grade II, 5 ureters, grade III, 9 ureters; grade IV, 39 ureters; and grade V, 15 ureters. The follow-up period ranged from 3 months to 8 years (mean, 4 years). Reflux ceased in 57 ureters (82%); in four ureters the VUR recurred (9 months to 6 years later). Bilateral vesico-ureteric junction (VUJ) obstruction occurred in one patient, which required surgical correction 3 years after STING. These data suggest that for difficult cases of VUR in neurogenic bladders, STING is a safe and effective option and should be the initial treatment of choice. However, because of the possibility of late recurrence of VUR or obstruction at the VUJ, long-term follow-up is required.