Abstract:

Purpose: Endoscopic treatment seems to be the first choice of therapy in most of the patients with vesicoureteral reflux (VUR) since it is easily applicable and repeatable without complication. The existence of relationship between the DMSA results and recurrence of urinary tract infection in cases with VUR has been demonstrated in previous studies. We aimed to search a relationship between the renal functions set by DMSA and the success of STING procedure in patients with primary VUR.Material And Method: 132 patients on whom STING procedure has been applied for primary VUR at our clinic between the years 2002 to 2009 were evaluated retrospectively in this study. Initial findings of DMSA scintigraphy of the patients in relation to scarring degree at the hospital admission and their improvement after STING procedure were evaluated.Findings: 132 cases were included in our study consisting of 36 (27%) male and 96 female (73%) in between the ages of 5 months to 16 years (mean 6,59±3,23). 113 cases (86%) referred for the complaints of recurrent urinary tract infection, 14 cases (10%) had enuresis and 5 cases (4%) diagnosed as prenatal hydronephrosis. VUR was detected in 194 ureters of the 132 patients. VUR was bilateral in 62 (47%) patients, on the right side in 29 (22%) patients and on the left side in 41 (31%) patients. Initially, grade II VUR in 10 (5, 1%) cases, grade III VUR in 79 (40,8%), grade IV VUR in 63 (32,4%) cases and grade V VUR in 42 (21,7%) cases were confirmed. Recovery was determined in 105 (54.68%) ureters after the first injection. Second injection was applied to 82 ureters resulting with recovery in 22 ureters. Additional recovery was achieved in 11 ureters after the application of third injection to 50 patients. Thus the initial success rate of 54.68% reached to a success rate of 71.13% with repeated injections. Open surgery was applied to 32 ureters of 24 patients in whom no positive response was noted after STING procedure. DMSA findings were normal in 19 (14%) patients and abnormal in 113 (86%) patients at the initial hospital admission. A significant negative correlation was detected between the grade of VUR and the recovery after STING procedure (p>0,001). DMSA findings were not predictive in the success of STING procedure in children with primary VUR on the same degree category (p>0,05).Conclusion: Follow-up results are evaluated on an average of 42 months period in our study. VUR was treated in 54% of the ureters following the first injection and the recovery rate reached to 71% after the third injection. The results of this study revealed that the single meaningful parameter in estimating the recovery by STING application is the degree of VUR. There was no correlation between the initial DMSA findings and the success of the STING procedure

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