Proper technique for the standard subureteric transurethral injection (STING) therapy involves the following steps:
(1) emptying the bladder to ¾ capacity so as not to displace the ureter laterally;
(2) placement of the needle bevel up into the posterior portion of the ureter;
(3) visualization of the creation of the mound with initial injection of 0.1 – 0.2 ml of material. Multiple injection sites implies there was difficulty in obtaining a proper mound in the correct plane, as well as increasing the possibility of leakage of injectable material. Kirsch et al reported improved results by modifying the standard technique by performing hydrodistention of the ureteral orifice and injection into the submucosa of the ureteral tunnel. 1
1. Kirsch AJ , Perez-Brayfield M , Smith EA , Scherz HC . The modified STING procedure to correct vesicoureteral reflux: improved results with submucosal implantation with the intramural ureter. J Urol 2004 ; 171 : 2413 – 16 .