STING for Vesicoureteral Reflux

  • Selcuk Yucel
  • Linda A. Baker


Vesicouretal reflux (VUR) is the retrograde flow of urine from the bladder into the upper urinary system. It affects 1% of boys and girls. The ureterovesical junction is compromised by short submucosal ureteral length, insufficient detrusor backing to the ureter, and/or periureteral diverticuli. Vesicoureteral reflux is present in 29% to 70% of children with urinary infections1,2 and is typically diagnosed by contrast voiding cystourethrogram or nuclear cystogram. The association among VUR, urinary tract infections (UTIs), and renal scarring has been noted for years. The overall goal of managing the child with UTIs is to prevent renal scarring, hypertension, or chronic renal failure. In fact, 3% to 25% of children with end-stage renal disease lost their renal function because of reflux nephropathy.2,3 Renal scarring is detected best by DMSA scanning. However, some of the radiologically detected changes are congenital in nature and not acquired from postnatal UTIs (males > females).4,5


Renal Scarring Acid Copolymer Febrile Urinary Tract Infection Xenon Light Source DMSA Scanning 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kass EJ, Kernen KM, Carey JM. Paediatric urinary tract infection and the necessity of complete urological imaging. Br J Urol Int 2000;86(1):94–96.Google Scholar
  2. 2.
    Duckett JW. Vesicoureteral reflux: a “conservative” analysis. Am J Kidney Dis 1983; 3(2):139–144.PubMedGoogle Scholar
  3. 3.
    Avner ED et al. Renal transplantation and chronic dialysis in children and adolescents: the 1993 annual report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 1995;9(1):61-73.Google Scholar
  4. 4.
    Marra G et al. Severe vesicoureteral reflux and chronic renal failure: a condition peculiar to male gender? Data from the ItalKid Project. J Pediatr 2004;144(5):677–681.PubMedCrossRefGoogle Scholar
  5. 5.
    Nguyen HT et al. 99m Technetium dimercapto-succinic acid renal scintigraphy abnormalities in infants with sterile high grade vesicoureteral reflux. J Urol 2000;164(5): p. 1674–1678; discussion 1678–1679.PubMedCrossRefGoogle Scholar
  6. 6.
    Hoberman A et al. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 2003;348(3):195–202.PubMedCrossRefGoogle Scholar
  7. 7.
    Elder JS et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol 1997;157(5):1846–1851.PubMedCrossRefGoogle Scholar
  8. 8.
    International Reflux Study Committee. Medical versus surgical treatment of primary vesicoureteral reflux: report of the International Reflux Study Committee. Pediatrics 1981;67(3):392–400.Google Scholar
  9. 9.
    Polito C et al. Cyclic voiding cystourethrography in the diagnosis of occult vesicoureteric reflux. Pediatr Nephrol 2000;14(1):39–41.PubMedCrossRefGoogle Scholar
  10. 10.
    Lyon RP, Marshall S, Tanagho EA. The ureteral orifice: its configuration and competency. J Urol 1969;102(4):504–509.PubMedGoogle Scholar
  11. 11.
    O’Donnell B, Puri P. Treatment of vesicoureteric reflux by endoscopic injection of Teflon. Br Med J (Clin Res Ed) 1984;289(6436):7–9.CrossRefGoogle Scholar
  12. 12.
    Chertin B, De Caluwe D, Puri P. Endoscopic treatment of primary grades IV and V vesicoureteral reflux in children with subureteral injection of polytetrafluoroethylene. J Urol 2003;169(5):1847–1849; discussion 1849.PubMedCrossRefGoogle Scholar
  13. 13.
    Kirsch AJ et al. The modified sting procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter. J Urol 2004;171 (6 Pt 1):2413–2416.PubMedCrossRefGoogle Scholar
  14. 14.
    Perez-Brayfield M et al. Endoscopic treatment with dextranomer/hyaluronic acid for complex cases of vesicoureteral reflux. J Urol 2004;172(4 Pt 2): 1614–1616.PubMedCrossRefGoogle Scholar
  15. 15.
    Lackgren G et al. Endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid copolymer is effective in either double ureters or a small kidney. J Urol 2003;170(4 Pt 2):1551–1555; discussion 1555.PubMedCrossRefGoogle Scholar
  16. 16.
    Herz D et al. Efficacy of endoscopic subureteral polydimethylsiloxane injection for treatment of vesicoureteral reflux in children: a North American clinical report. J Urol 2001;166(5):1880–1886.PubMedCrossRefGoogle Scholar
  17. 17.
    Kirsch AJ, Perez-Brayfield MR, Scherz HC. Minimally invasive treatment of vesicoureteral reflux with endoscopic injection of dextranomer/hyaluronic acid copolymer: the Children’s Hospitals of Atlanta experience. J Urol 2003;170(1):211–215.PubMedCrossRefGoogle Scholar
  18. 18.
    Rubenstein JN et al. The PIC cystogram: a novel approach to identify “occult” vesicoureteral reflux in children with febrile urinary tract infections. J Urol 2003;169(6): 2339–2343.PubMedCrossRefGoogle Scholar
  19. 19.
    Lackgren G et al. Long-term followup of children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J Urol 2001;166(5): 1887–1892.PubMedCrossRefGoogle Scholar
  20. 20.
    Chertin B et al. Endoscopic treatment of vesicoureteral reflux: 11 to 17 years of followup. J Urol 2002; 167(3):1443–1445; discussion 1445–1446.PubMedCrossRefGoogle Scholar
  21. 21.
    Elder JS et al. Endoscopic Therapy for Vesicoureteral Reflux: A Meta-Analysis. I. Reflux Resolution and Urinary Tract Infection. J Urol 2006;175(2): 716–722.PubMedCrossRefGoogle Scholar
  22. 22.
    Diamond DAet al. Mechanisms of failure of endoscopic treatment of vesicoureteral reflux based on endoscopic anatomy. J Urol 2003;170(4 Pt 2):1556–1558; discussion 1559.PubMedCrossRefGoogle Scholar
  23. 23.
    Elmore JM, Scherz HC, Kirsch AJ. Dextranomer/ Hyaluronic Acid for Vesicoureteral Reflux: Success Rates After Initial Treatment Failure. J Urol 2006;175(2):712–715.PubMedCrossRefGoogle Scholar
  24. 24.
    Snodgrass WT. Obstruction of a dysmorphic ureter following dextranomer/hyaluronic acid copolymer. J Urol 2004;171(1):395–396.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2007

Authors and Affiliations

  • Selcuk Yucel
    • 1
  • Linda A. Baker
    • 2
  1. 1.Children’s Medical Center at DallasUniversity of Texas Southwestern Medical Center at DallasDallasUSA
  2. 2.Department of UrologyUniversity of Texas Southwestern Medical Center at DallasDallasUSA

Personalised recommendations