During the lest 7 years 21 children with vesicoureteral reflux and neurogenic bladder dysfunction and 46 children with primary vesicoureteral reflux were followed. At the time of initial presentation, the mean age of the former group was 5.5 years and the letter group, 2.8 years. The grade of reflux and the nephropathy were more severe in the children with neuropathic bladder than in the children with primary vesicoureteral reflux But in the same reflux grade, there was no statistical difference in the nephropathy between the two groups. The children with vesicoureteral reflux and neuropathic bladder were managed with drug therapy, intermittent catheterization, urinary diversion and ureteral reimplantation. Radiological followup revealed that resolution or improvement of reflux occurred in 36 per cent of renal units managed by intermittent catheterization and 100 per cent in which the ureters were reimplanted. As in the non-neurogenic bladder successful management of reflux and prevention of upper tract deterioration can be achieved by conservative management as well as by ureteroneocystostomy.
Catheterization ; Catheters ; Child ; Drug Therapy ; Follow-Up Studies* ; Humans ; Replantation ; Spinal Cord Injuries* ; Spinal Cord* ; Ultrasonography* ; Ureter ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Catheterization ; Vesico-Ureteral Reflux

PURPOSE: To evaluate the efficacy of subureteral injection types in patients with middle- to high-grade vesicoureteral reflux (VUR). MATERIALS AND METHODS: Between June 1999 and September 2010, subureteral dextranomer was applied at our clinic to 149 patients (214 refluxing ureters) with grades II, III, and IV VUR. Group 1 consisted of 54 patients (80 ureters), and group 2 consisted of 95 patients (134 ureters). The standard subureteric transurethral injection (STING) procedure was applied to group 1, and the modified STING procedure was applied to group 2. A second and if needed a third injection was applied to unsuccessfully treated patients. The mean follow-up period was 2 years. Patients were evaluated by cystography and ultrasonography in the third month of follow-up. RESULTS: VUR was resolved completely after a single injection in 54/80 ureters (67.5%) in group 1 and in 94/134 ureters (70.1%) in group 2. Overall successes after a second or a third injection were 61/80 (76.2%) and 111/134 (82.8%), respectively. There was a statistically significant difference between the groups only for grade IV reflux following multiple injections (p<0.05). CONCLUSIONS: Endoscopic treatment of VUR is a recommended treatment because it is minimally invasive, efficient, and repeatable. Our study confirmed that a modified STING procedure can be an alternative treatment to the standard technique.
Administration, Intravesical ; Adolescent ; Child ; Child, Preschool ; Dextrans/*administration & dosage ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Hyaluronic Acid/*administration & dosage ; Infant ; Male ; Reproducibility of Results ; Treatment Outcome ; Ureter/*surgery ; Urologic Surgical Procedures/*methods ; Vesico-Ureteral Reflux/*drug therapy/ultrasonography

PURPOSE: To evaluate the efficacy of subureteral injection types in patients with middle- to high-grade vesicoureteral reflux (VUR). MATERIALS AND METHODS: Between June 1999 and September 2010, subureteral dextranomer was applied at our clinic to 149 patients (214 refluxing ureters) with grades II, III, and IV VUR. Group 1 consisted of 54 patients (80 ureters), and group 2 consisted of 95 patients (134 ureters). The standard subureteric transurethral injection (STING) procedure was applied to group 1, and the modified STING procedure was applied to group 2. A second and if needed a third injection was applied to unsuccessfully treated patients. The mean follow-up period was 2 years. Patients were evaluated by cystography and ultrasonography in the third month of follow-up. RESULTS: VUR was resolved completely after a single injection in 54/80 ureters (67.5%) in group 1 and in 94/134 ureters (70.1%) in group 2. Overall successes after a second or a third injection were 61/80 (76.2%) and 111/134 (82.8%), respectively. There was a statistically significant difference between the groups only for grade IV reflux following multiple injections (p<0.05). CONCLUSIONS: Endoscopic treatment of VUR is a recommended treatment because it is minimally invasive, efficient, and repeatable. Our study confirmed that a modified STING procedure can be an alternative treatment to the standard technique.
Administration, Intravesical ; Adolescent ; Child ; Child, Preschool ; Dextrans/*administration & dosage ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Hyaluronic Acid/*administration & dosage ; Infant ; Male ; Reproducibility of Results ; Treatment Outcome ; Ureter/*surgery ; Urologic Surgical Procedures/*methods ; Vesico-Ureteral Reflux/*drug therapy/ultrasonography