Treatment of vesico-ureteric reflux in children with neuropathic bladder: A comparison of surgical and endoscopic correction

Background/Purpose: Vesico-ureteric reflux (VUR) is a common problem in chi ldren with neuropathic bladder. Lesser-degree VUR may be manageable by inte rmittent catheterization or by anticholinergics, but higher grades usually require surgical treatment. If left untreated, two thirds of such patients may experience deterioration of the upper renal tracts. The aim of this stu dy was to compare the results of the STING (Subureteric Teflon Injection) t echnique with surgical ureteric reimplantation as treatment for VUR in neur opathic bladder. Methods: From January 1981 to December 1996, 58 children with NE (81 ureter s) were treated for VUR. STING and Cohen ureteroneocystotomy were performed in 40 and 41 ureters, respectively. Mean age was 4.5 years (STING) and 5.1 years (Cohen). Results: Twenty-nine of 40 refluxing ureters (72.5%) were cured by STING, w hereas Cohen eradicated reflux in 39 of 41 ureters (95.5%). No complication s were observed in either group. AII the ureters in which STING failed were treated successfully by Cohen ureteroneocystostomy. The 2 ureters still re fluxing after surgical reimplantation were cured successfully by a single S TING. The mean follow-up was 6.8 years in the Cohen group and 4.8 years in the STING group. During follow-up, no recurrence was observed in patients c ured by open reimplantation. In the STING group, 2 previously cured ureters showed recurrence of VUR: both were treated successfully by a further STIN G. Conclusions: Open ureteral reimplantation is more effective than STING in c orrecting VUR in children with neuropathic bladder dysfunction. Nevertheles s, the good success rate, the relative technical simplicity, outpatient nat ure, and rapid recovery point to STING as a safe and effective procedure fo r the initial treatment of VUR. Failure of STING does not preclude a succes sful open operation. J Pediatr Surg 34:1836-1838. Copyright (C) 1999 by W.B . Saunders Company.