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.