The document describes two procedures for treating vesicoureteral reflux (VUR): the STING procedure, involving the injection of a gel to prevent urinary reflux, and the HIT technique, which distends the ureter and injects a bulking agent to shape the ureteric orifice. It emphasizes the importance of antibiotic prophylaxis to prevent urinary tract infections and outlines surgical options for children with moderate to severe VUR who do not respond to medical therapy. Observations for mild cases are recommended, but surgical intervention can be effective for more severe situations.

15. STING AND HIT PROCEDURE
STING (subureteral transurethral
injection): STING stands for subureteral
teflon injection. It involves injecting a gel
called Deflux at the point where the ureter/s
and bladder meet. The purpose of this
procedure is to prevent urinary reflux (the
flow of urine back up the ureter/s)
HIT(hydrodistension implantation
technique): In this procedure, the lumen
of the distal ureter is distended by
hydrostatic pressure and the bulking agent
is injected 4 mm into the submucosa of the
mid/distal ureteral tunnel at the 6-o'clock
position. The aim is to convert the ureteric
orifice into a volcano-shaped mound upon
completion of the injection.

22. Antibiotics taken everyday to prevent urinary tract infections
Treatment of reflux nephropathy is based on the unproven assumption that
decreasing reflux and UTIs prevents renal scarring.Children with very mildVUR
require no treatment, but they should be closely observed for symptoms of UTI.
Surgical treatment if vesicoureteral reflux (VUR) is moderate or severe
Surgery is usually only used in children who have not responed to medical
therapy
Surgery to place the ureter back intothe bladder (ureteral reimplantation) can
stop reflux nephropathy in some cases