Subureteric Teflon Injection Research Articles

Newly diagnosed contralateral reflux after successful unilateral endoscopic correction: is it due to the pop-off mechanism?

Our aim was to analyze the incidence of newly diagnosed contralateral vesicoureteral reflux after successful endoscopic correction of unilateral reflux by subureteral Teflon (polytetrafluoroethylene) injection and to explain the possible mechanisms responsible for new contralateral reflux. A total of 1,195 children underwent successful endoscopic correction of high grade primary and duplex grades III to V vesicoureteral reflux by subureteral polytetrafluoroethylene injection. Unilateral and bilateral reflux was noted in 495 and 700 children, respectively. The 495 cases of unilateral reflux were retrospectively analyzed for new contralateral reflux. Voiding cystourethrography was performed in all cases 3 months and 1 year after injection. New contralateral reflux was diagnosed in 37 children (7%), including reflux in a single system in 33 and into a lower pole of a completely duplicated system in 4. There was no correlation of grade of ipsilateral reflux with the subsequent development of new contralateral reflux. No abnormality of the contralateral ureteral orifice was identified at initial cystoscopy, except for laterally placed ureteral orifices in 2 patients. The low incidence of new contralateral vesicoureteral reflux diagnosed after subureteral polytetrafluoroethylene injection versus open ureteral reimplantation may be due to noninterference with the contralateral trigone in endoscopic correction. The risk of new contralateral reflux did not increase with reflux severity (grades IV and V), suggesting that the pop-off mechanism is unlikely to be the cause of contralateral reflux.

Surgical Versus Endoscopic Correction of Vesicoureteral Reflux in Children with Neurogenic Bladder Dysfunction

Purpose We attempted to compare the efficacy of subureteral polytetrafluoroethylene injection and ureteral reimplantation for treating vesicoureteral reflux in children with neurogenic bladder dysfunction. Materials and Methods We retrospectively studied the records of all children with neurogenic bladder dysfunction and reflux into single collecting systems treated with cross-trigonal ureteroneocystostomy or subureteral polytetrafluoroethylene injection. Followup cystography was performed 2 months postoperatively and ultrasound was done twice yearly thereafter. Urodynamic data were evaluated when available. Success was defined as complete eradication of reflux. Data were stratified by procedure, patient sex, grade and laterality of reflux, and the presence of unilateral or bilateral reflux, and then compared using chi-square analysis. Results Of 85 patients (118 ureters) identified followup data were available in 95%. Subureteral polytetrafluoroethylene injection and ureteroneocystostomy were done on 60 and 47 ureters, respectively. Both groups were similar in mean patient age, followup and preoperative degree of reflux. Success rates after ureteroneocystostomy and a single injection were 84.3 versus 56.7%. The cumulative success rate of subureteral polytetrafluoroethylene injection was 61% after a second injection. The success rate of ureteroneocystostomy was significantly greater than that of injection (p = 0.02). Reflux resolved in all patients in whom injection failed and who underwent secondary reimplantation. Successful ureteroneocystostomy was unrelated to patient sex, reflux grade or laterality, or bilateral versus unilateral reflux. Subureteral polytetrafluoroethylene injection was more likely to fail in higher grades of reflux (p = 0.03) but success was otherwise unrelated to other parameters. Failure to correct reflux was unrelated to urodynamic findings. Conclusions Primary open ureteral reimplantation is more effective than subureteral polytetrafluoroethylene injection for correcting reflux in children with neurogenic bladder dysfunction. Despite controversy related to the appropriate injectable substance, the relative technical simplicity, outpatient nature, rapid recovery and potential for successful secondary reimplantation support a role for subureteral polytetrafluoroethylene injection in managing reflux in these difficult cases.

Endoscopic Correction of Vesicoureteral Reflux Secondary to Posterior Urethral Valves

Purpose We review our experience with children with high grade vesicoureteral reflux secondary to posterior urethral valves treated endoscopically with subureteral polytetrafluoroethylene (Teflon) injection. Materials and Methods Between 1985 and 1994, 54 infants and children were diagnosed with posterior urethral valves of whom 38 (70 percent) had vesicoureteral reflux. In 9 patients reflux resolved after valve ablation. Seven patients underwent nephroureterectomy for nonfunctioning kidneys and in 2 reflux was treated with continuous chemoprophylaxis. The remaining 20 patients underwent an antireflux procedure, including reimplantation of the ureters in 5 and subureteral polytetrafluoroethylene injection in 15. Of the 15 patients who underwent injection 6 had unilateral and 9 had bilateral vesicoureteral reflux. According to the international classification reflux was grade IV in 6 ureters and grade V in 18. Patient age at injection ranged from 8 months to 6 years (mean 2.2 years). Results Reflux was eliminated in 17 ureters after a single subureteral polytetrafluoroethylene injection. Five ureters required 2 injections and 2 ureters required 3 to correct reflux. Followup of the 15 patients ranges from 1 to 10 years. Followup voiding cystography in the 15 patients (24 ureters) showed no evidence of recurrence of reflux. No clinically untoward effects were noted in these children from the use of polytetrafluoroethylene as an injectable material. Conclusions Subureteral polytetrafluoroethylene injection is a simple and effective endoscopic alternative to open surgery for the management of high grade vesicoureteral reflux secondary to posterior urethral valves.

Common Sheath Reimplantation Yields Excellent Results in the Treatment of Vesicoureteral Reflux in Duplicated Collecting Systems

Purpose We evaluated our 10-year experience with the surgical treatment of vesicoureteral reflux in uncomplicated duplicated collecting systems. Materials and Methods Between 1984 and 1994, 54 refluxing renal units (8 bilateral) in 37 female and 9 male patients required surgery. Patient age ranged from 7 months to 17 years (average 4.9 at surgery). Postoperative followup (average 14.2 months) included voiding cystourethrography and renal sonography or excretory urography. Results Common sheath ureteral reimplantation via an intravesical approach was performed in 48 of the 54 refluxing renal units. Of the remaining 6 renal units detrussorrhaphy was performed in 4, and ureteroureterostomy combined with ureteral reimplantation and partial lower pole nephrectomy were done in 1 each. Two treated renal units had persistent postoperative vesicoureteral reflux, which resolved after subureteral polytetrafluoroethylene (Teflon) injection. No renal unit had postoperative hydronephrosis. Contralateral reflux was identified in 1 patient who underwent unilateral reimplantation. Our overall success rate was 96 percent for the surgical correction of vesicoureteral reflux in uncomplicated duplicated collecting systems. Common sheath reimplantation had a 98 percent success rate. Conclusions Although a duplicated collecting system increases the risk for surgical treatment, the presence of a duplication anomaly does not adversely affect surgical outcome. Modifications of procedures commonly performed in the surgical treatment of single system reflux to accommodate common sheath reimplantation have excellent surgical results with minimal morbidity.

The STING in the refluxing duplex system

To assess the efficacy of the subureteric Teflon injection (STING) procedure in the refluxing duplex ureter. The STING procedure was performed in 23 patients (five boys and 18 girls, mean age 6.5 years, [range 1.5-14]) with six refluxing upper and 31 refluxing lower moieties. Teflon was injected separately into each moiety of the duplex. All patients were assessed by a micturating cystourethrogram and ultrasonography at least 3 months after treatment and the results were analysed retrospectively for the success rate of each refluxing unit and the overall cure rate of patients. No patient suffered ureteric obstruction. After the first STING the unit cure rate was 57% but only nine of 23 patients were completely cured. This improved to a unit cure rate of 68% and 11 patients cured after a second STING. Because the patient cure rate was poor we do not advocate using the STING to treat vesicoureteric reflux in the duplex kidney.

Ten year experience with subureteric Teflon (polytetrafluoroethylene) injection (STING) in the treatment of vesico-ureteric reflux.

Ten year experience with subureteric Teflon (polytetrafluoroethylene) injection (STING) in the treatment of vesico-ureteric reflux.

Correction of primary and secondary vesicoureteral reflux by subureteric Teflon injection.

Polytetrafluoroethylene (Teflon) has been used for various purposes since 1963 and in urologic practice for the treatment of vesicoureteral reflux (VUR) since the 1980s. In this study we report on our experience with Teflon injection for the treatment of 28 children with primary or secondary reflux. An overall success rate of 91.3% was achieved in the treatment of primary and 66.6% in secondary reflux. With these results we conclude that Teflon injection is a good alternative in the treatment of VUR.

Subureteric Teflon Injection (STING)

Subureteric Teflon injection (STING) has been successfully used by several investigators for treating vesicoureteric reflux (VUR) in children. This multicentre European survey reviews the results of STING in 6,216 ureters. Twenty-two paediatric surgeons/urologists from 18 centres in Europe answered an enquiry regarding their experience with STING in the treatment of VUR. 6,216 refluxing ureters were injected with Polytef paste in 4,166 children during 1984-1990. There were 975 boys and 3,191 girls. Their ages ranged from 2 months to 14 years (mean 5.1 years). The reflux was grade I in 4.4% of ureters, grade II in 36.1%, grade III in 40.2%, and grades IV and V in 19.3% of ureters. All patients were followed up for periods ranging from 3 months to 81/2 years and 90% were followed up for more than 2 years. 76.3% of all ureters stopped refluxing after a single injection of Teflon paste, cure rate increased to 84.9% after a second injection. A further 10.2% of refluxing ureters showed significant improvement in the grade of reflux after a single injection and needed no further treatment. 1.3% of ureters were cured after a third or fourth injection. Failure to correct or improve VUR was seen in 224 ureters (3.6%), necessitating reimplantation. Twenty ureters (0.32%) developed vesicoureteric junction obstruction following STING and these were reimplanted without difficulty. Results of this multicentre survey confirm that STING is an effective day care procedure for treatment of all grades of VUR. 95% of all ureters were cured or showed significant improvement after two injections of Teflon paste.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopie Correction of Vesico-Ureteric Reflux in Duplex Systems

Between May 1984 and April 1990, 37 children with vesico-ureteric reflux (VUR) in 43 duplex systems were treated by endoscopic subureteric Teflon injection (STING). There were 32 girls and 5 boys; the duplex systems were complete in 27 refluxing units and incomplete in 16 refluxing units. All patients had high-grade reflux. In incomplete duplicated systems, VUR was corrected in 14 (87.5%) after a single injection of polytef paste and 2 patients required 2 injections to correct VUR. Of the 27 refluxing units with complete ureteral duplication, reflux was corrected in 16 (59%) units after a single injection of polytef paste, and 3 (11%) units showed improvement of VUR to grade I or II after 1 injection; no further treatment was given. 7 units with complete ureteral duplication required 2-4 injections for correction of VUR. STING failed to correct VUR in 1 duplex system which required a re-implantation. In 93% of refluxing units where VUR was corrected by a single injection, the quantity of polytef paste used was less than 0.3 ml. 36 (97%) of patients were discharged home on the day of the procedure. All patients were followed up for 2-8 years. Of the corrected ureters, there were no recurrences in the incomplete duplicated ureters. 3 of the completely duplicated ureters showed recurrence of reflux at follow-up micturating cystography.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopic correction of vesicoureteral reflux in the adult by Teflon injection

Appropriate therapy of vesicoureteral reflux is a controversial topic. Many studies have been performed to compare medical versus surgical treatment and various operations have been described to correct vesicoureteral reflux. In recent years, endoscopic subureteral Teflon Injection has been used successfully, mostly in children. We report our positive experience in 31 adults. The procedure proved to be simple and reliable. No complications have occurred.

Endoscopic correction of primary vesicoureteric reflux by subureteric Teflon injection (STING): follow-up study in 123 patients

During a 4-year period 123 children (191 ureters) with primary vesicoureteric reflux (VUR) were treated endoscopically by subureteric Teflon injection (STING). They have now been followed up for periods ranging from 2 to 6 years. Sixty per cent of the ureters had grade III VUR and 36% had either grade IV or grade V. Reflux was corrected in 149 (78%) ureters after a single injection of polytef paste; 11 (6%) ureters showed improvement to grade I or II reflux after one injection and no further treatment was given; 24 (12%) ureters required two injections and 7 (4%) needed three to four subureteric injections for the correction of VUR. Of the 123 patients, 116 were discharged from the hospital on the day of the procedure. Of the 149 ureters corrected with one subureteric injection, 83% required less than 0.3 ml paste per ureter to stop reflux. At follow-up micturating cystography 91% of the ureters continue to show absence of reflux 2 to 6 years after endoscopic correction; 9% had recurrence of reflux, but more than one-half of the recurrences were only of grade I or grade II severity and required no further treatment. Seven ureters had recurrent grade III or IV reflux and were reinjected without any difficulty. There was no evidence of delayed appearance of vesicoureteric obstruction. Treatment of primary VUR by endoscopic subureteric injection of polytef paste was found simple, safe, and effective in correcting all grades of VUR.

Ureteral obstruction caused by subureteral Teflon injection

From January 1989 to July 1990 we performed the “sting” procedure on 253 ureters. The most significant complications were complete obstruction of the ureter in 2 patients with 3rd- and 4th-degree reflux following injection of 1.5 and 2 ml Teflon. Percutaneous nephrostomy was used as the initial treatment and ureterocystoneostomy as the subsequent surgery. Temporary post-Sting problems of urinary stasis were found in 16 of 167 children studied within the first 3 weeks by sonography or excretory urography.

Histological changes following submucosal teflon injection in the bladder

Histological examination following subureteric Teflon injection was carried out on 32 ureters and four granulomatous polyps. When the Teflon was correctly placed in the submucosa it remained circumscribed and reflux was more likely to be corrected. If the Teflon was placed more deeply it became diffuse, caused a giant cell reaction, and was less likely to correct the reflux. The granulomatous polyps may represent a reaction to leakage of Teflon from the injection site.

Open Versus Endoscopic Surgery in the Treatment of Vesicoureteral Reflux

Surgical reimplantation of the ureters was compared to subureteral injection of polytetrafluoroethylene (Polytef) in the treatment of primary vesicoureteral reflux. Reflux was eliminated successfully in 98 per cent of the 76 ureters treated by reimplantation and in 70 per cent of the 40 ureters treated endoscopically. Although the surgical morbidity of endoscopic surgery appears to be less than that of open surgery, the patients undergoing endoscopic surgery required more hospital admissions, more anesthetics and more micturating cystourethrograms than did those in the reimplantation group. It is concluded that subureteral polytetrafluoroethylene injection does not represent a satisfactory substitute for reimplantation.

Endoscopic correction of vesico-ureteric reflux by subureteric Teflon injection: follow-up ultrasound and voiding cystography.

The technique of subureteric Teflon injection for the correction of vesico-ureteric reflux was first described by Puri and O'Donnell in 1984. The Teflon granuloma that occurs after the injection anchors the submucosal ureter, thereby preventing reflux. This paper reviews the ultrasound and cystographic findings in 88 patients with 115 refluxing ureters followed-up for periods ranging from 3 months to 3 years. Reflux disappeared in 91 ureters (79.1%) and the degree of reflux improved in 22 ureters (19.1%). In this follow-up study, the size of the granuloma on ultrasound was assessed in relation to the number of injections, the total volume of Polytef paste used and the outcome of the procedure. A well circumscribed granuloma was seen at the orifices of 92 ureters. There was no ureteric granuloma evident in 23 ureters and Teflon plaques were found at the trigone in six patients. Complications were rare. One large granuloma caused severe obstruction requiring re-implantation. The size of the granuloma appears to depend on individual tissue reaction rather than on the other factors. The presence or the size of the granuloma bears no direct relationship to the success of the procedure.

Endoscopic management of vesico-ureteric reflux in children with neuropathic bladder secondary to myelomeningocoele.

Vesicoureteric reflux (VUR) is a major cause of morbidity and mortality in children with neuropathic bladders secondary to myelomeningocoele. The majority deteriorate with age and early treatment is necessary to avoid this. Endoscopic subureteric Teflon injection ("STING") allows correction of reflux in small children who would otherwise be difficult to manage. The results of treatment of VUR in 41 ureters in 24 children with neuropathic bladders using "STING" are reported. All ureters had grade III-V VUR. Thirty ureters (73%) showed disappearance of reflux after one injection. Of the remaining 11, VUR disappeared in 7 after a second injection. Apart from failure, the only other major complication was septicaemia in one patient. The mean hospital stay was 1.4 days (1-8 days). At a mean follow-up time of 22 months there was radiological improvement in the upper renal tracts in 27 of the 37 (73%) in which VUR disappeared, none has deteriorated and there has been only one relapse. These results suggest that "STING" should be considered as the method of choice in the management VUR in children with neuropathic bladder in view of the problems associated with open operation in these children.

Technical Refinements in Endoscopic Correction of Vesicoureteral Reflux

Subureteral polytetrafluoroethylene (Teflon) injection (the Sting) was used for endoscopic correction of vesicoureteral reflux in more than 400 patients since March 1984. The basic principle involves injection of 0.2 to 0.8ml. of polytetrafluoroethylene paste under the intravesical portion of the affected ureter. The refinements of the technique and the various types of equipment used are described. A protocol for followup is outlined. (J. Urol, part 2, 140:1101-1102, 1988)

73 - Endoscopic Subureteric Teflon(R) Injection for the Treatment of Vesicoureteral Reflux

No AccessJournal of Urology1 Jun 1987Endoscopic Subureteric Teflon(R) Injection for the Treatment of Vesicoureteral Reflux William E. Kaplan, and Daniel P. Dalton William E. KaplanWilliam E. Kaplan More articles by this author , and Daniel P. DaltonDaniel P. Dalton More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)75223-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Endoscopic Subureteric Teflon(R) Injection for the Treatment of Vesicoureteral Reflux." The Journal of Urology, 137(6), p. 122A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 6June 1987Page: 122A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information William E. Kaplan More articles by this author Daniel P. Dalton More articles by this author Expand All Advertisement PDF DownloadLoading ...