1. Materials and Methods Aim of this study is to evaluate our experience with STING procedure. Between Feb 2004 and Feb 2005 22 patients & 34 ureters were treated. Age between 7 months to 10 years old (mean age 2.6 years) Renal sonography & voiding cystourethrograms at 6 weeks. Bolus

2. Results 19 girls and 3 boys 5 units grad 4 14 units grad 3 Reflux was corrected in 16 patients 73%( 23 ureters out of 34 [76%]) No patient had hydronephrosis / ureteral obstruction.

3. 2 patients develop reflux in the other unit/ureter after treatment. Both treated with STING.

4. Open repair after failed injection STING failed to correct reflux in 5 patients (22%) which were managed by ureteral reimplantation Varying degrees of periureteral fibrosis Surgical repair not prohibitively difficult

5. Intraoperative-VCUG 4 patients had intra- operative VCUG Then they had another VCUG 6 weeks Latter. One of them show the presence of the reflux at the latter VCUG.

6. Injection of Duplicated Ureters Injection under the distal orifice – uplifting of the “duplex system” Injection under and into the refluxing orifice 3 children with ureteral duplication were treated 2 of them resolve 67%.

7. What to do after a failed injection? Reinjection(s): Minimally invasive, possibly prolonged treatment Open repair: More invasive, Definitive repair

8. Reflux resolved after a second injection in 2 out of 3 patients (67%) Answer unclear at present Make decision based on: –? Grade of persisting reflux –? Parental preference –? Physician philosophy

9. Conclusions STING is an excellent Day surgery procdure for correcting VUR Deflux material easy to handle compare to Macroplastique Endoscopic therapy offers –Acceptable treatment alternative –Obviously decreased morbidity with acceptable failure rate and reasonable follow-up Hydrodistention & orifice grading may indicate injection for the normal ureter intra-operative VCUG is not always accurate More long-term study on outcomes: Renal scarring Stability of implant/ absence of reflux

10. Question?

11. Thank You