The "incidental anesthetic" - an opportunity for the endoscopic correction of vesicoureteral reflux in children

Introduction: The endoscopic management of vesicoureteral reflux (VUR) with subureteric injection (STING) has become more popular. The low morbidity associated with the STING procedure has led to some authors advocating its use as a first-line therapy. Many parents are uncomfortable with this procedure being performed in children because of the potential morbidity associated with general anesthesia. We present an alternative without added anesthetic morbidity: offering the parents a STING when their is undergoing an anesthetic for another surgical indication. Methods: We reviewed the records of 10 children who underwent incidental dextranomer/hyaluronic acid copolymer (DHA) injection over a 2-year period. Results: We considered the treatment outcome after a single STING procedure to be successful in 8 (80%) patients and a failure in 2 (20%). Distribution of VUR grade, according to the highest grade per patient, was high in 5 (50%) patients, moderate in 3 (30%) and low in 2 (20%). We observed no complications. Conclusion: The idea of performing STING in children under incidental anesthetic introduces yet another possibility in the paradigm of VUR care. Though the long-term efficacy of DHA remains to be determined, this option reduces the potential morbidity of DHA as first-line therapy while favourably altering the cost benefit.