Abstract
Vesicoureteral reflux (VUR) is the retrograde flow of urine from the bladder to the upper urinary tract and is one of the most prevalent urologic diagnoses in children. Management options include observation with or without continuous antibiotic prophylaxis and surgical correction via endoscopic, open, or laparoscopic/robotic approaches. Surgical intervention may be necessary in children with persistent reflux, renal scarring, and recurrent febrile urinary tract infections or in cases of parental choice. Endoscopic treatment of VUR is an outpatient procedure and is associated with decreased morbidity compared to ureteral reimplantation. The classic subureteral Teflon injection (STING) technique is the most commonly described method and is now frequently referred to as subureteral transurethral injection. It involves injecting a bulking material below the ureteral orifice, providing tissue augmentation under the refluxing orifice thereby increasing the submucosal length of the ureter and creating a fixation point to enhance the valve mechanism. The concept of ureteral hydrodistention and intraluminal submucosal injection (hydrodistention implantation technique or HIT) has led to improved success rates in eliminating reflux. Modifications of the double HIT technique now include proximal and distal intraluminal injections that result in coaptation of both the ureteral tunnel and orifice.
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References
Sargent MA. What is the normal prevalence of vesicoureteral reflux? Pediatr Radiol. 2000;30:587–93.
Skoog SJ, Peters CA, Arant Jr BS, Copp HL, Elder JS, et al. Pediatric vesicoureteral reflux guideline panel summary report: clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis. J Urol. 2010;184:1145–51.
Koyle M, Kirsch A, Barone C, Elder J, Shifrin D, Skoog S, et al. Challenges in childhood urinary tract infection/vesicoureteral reflux investigation and management: calming the storm. Urology. 2012;80:503–8.
Lackgren G, Kirsch AJ. Endoscopic treatment of vesicoureteral reflux. BJU Int. 2010;105:1332–47.
Matouschek E. Die behandlung des vesikorenalen refluxes durch transurethrale einspritzung von Teflon paste. Urologe A. 1981;20:263–4.
O’Donnell B, Puri P. Treatment of vesicoureteral reflux by endoscopic injection of Teflon. Br Med J. 1984;289:7–9.
Kirsch AJ, Perez-Brayfield M, Scherz HC. The modified STING procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter. J Urol. 2004;171:2413–16.
Cerwinka W, Scherz HC, Kirsch AJ. Dynamic hydrodistention classification of the ureter and the double HIT method to correct vesicoureteral reflux. Arch Esp Urol. 2008;61:882–7.
Knudson MJ, Austin JC, McMillan ZM, Hawtrey CE, Cooper CS. Predictive factors of early spontaneous resolution in children with primary vesicoureteral reflux. J Urol. 2007;178:1684–8.
Sung J, Skoog S. Surgical management of vesicoureteral reflux in children. Pediatr Nephrol. 2012;27:551–61.
Peters CA, Skoog SJ, Arant Jr BS, Copp HL, Elder JS, Hudson RG, et al. Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol. 2010;184:1134–44.
Kirsch AJ, Kaye JD, Cerwinka WH, Watson JM, Elmore JM, Lyles RH, et al. Dynamic hydrodistention of the ureteral orifice: a novel grading system with high reproducibility and clinical correlation in children with vesicoureteral reflux. J Urol. 2009;182:1688–92.
Kaye JD, Srinivasan AK, Delaney C, Cerwinka WH, Elmore JM, Scherz HC, et al. Clinical and radiographic results of endoscopic injection for vesicoureteral reflux: defining measures of success. J Pediatr Urol. 2012;8:297–303.
Kalisvaart JF, Scherz HC, Cuda S, Kaye JD, Kirsch AJ. Intermediate to long-term follow-up indicates low risk of recurrence after double HIT endoscopic treatment for primary vesicoureteral reflux. J Pediatr Urol. 2012;8:359–65.
Kirsch AJ. Injection therapy for reflux: why it works and why it fails. J Urol. 2012;188:16–7.
Cerwinka WH, Kaye JD, Leong TL, Elmore JM, Scherz HC, Kirsch AJ. Selective endoscopic treatment of the non-refluxing contralateral ureter prevents new contralateral vesicoureteral reflux. J Pediatr Urol. 2013;9(1):51–5.
Cerwinka WH, Qian J, Easley KA, Scherz HC, Kirsch AJ. Appearance of dextranomer/hyaluronic acid copolymer implants on computerized tomography after endoscopic treatment of vesicoureteral reflux in children. J Urol. 2009;181(3):1324–8.
DeCaro JP, Kirsch AJ. Dextranomer-hyaluronic acid implants misdiagnosed as bladder tumor on transvaginal ultrasonography. Obstet Gynecol. 2012;119(2):476–8.
McMann LP, Scherz HC, Kirsch AJ. Long-term preservation of dextranomer/hyaluronic acid copolymer implants after endoscopic treatment of vesicoureteral reflux in children: a sonographic volumetric analysis. J Urol. 2007;177:316–20.
Elmore JM, Kirsch AJ, Heiss EA, Gilchrist A, Scherz HC. Incidence of UTI in children following successful ureteral reimplantation versus endoscopic deflux implantation. J Urol. 2008;179(6):2364–7.
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Arlen, A.M., Scherz, H.C., Kirsch, A.J. (2014). Endoscopic Injection Techniques for Vesicoureteral Reflux. In: Godbole, P., Koyle, M., Wilcox, D. (eds) Pediatric Endourology Techniques. Springer, London. https://doi.org/10.1007/978-1-4471-5394-8_22
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DOI: https://doi.org/10.1007/978-1-4471-5394-8_22
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