Evolution of the treatment of vesicoureteral reflux in Spain.

Abstract

We determined the changes in the treatment of vesicoureteral reflux (VUR) at children's hospitals in Spain as well as the long-term results of endoscopic treatment (ET) with polytetrafluoroethylene, namely with STING (subureteral polytetrafluoroethylene injection). A survey was performed of all pediatric urology units in Spain to determine changes in the diagnosis and treatment of VUR in the last 10 years. Also, a conjoint study was made of STING case records at 5 Spanish hospitals where there is expertise in the technique. The response rate was 34 of 44 cases (78%). The most significant changes were the introduction of urodynamics and the progressive establishment of ET as a substitute for open surgery and prolonged medical treatment. At more than 90% of the units ET is now done with different materials with a cure rate of 75% after 1 injection and a low index of complications. The results of the STING study in 2,035 refluxing ureters showed a cure rate of about 90% for 2 or 3 injections for grades I to IV reflux and just under 70% for grade V. Also, the cure rate for complex reflux was 60% and the index of complications was less than 1.2% with some intravesical migration. There have been many changes in the approach to VUR with an increasing use of urodynamics and ET. Since the long-term results of STING are reliable and no long-term complications have been observed, polytetrafluoroethylene appears to be the product with the best quality/price ratio for use in ET. However, it is being replaced.