Peculiarities of endoscopic treatment of vesicoureteral reflux in children

Background. Vesicoureteral reflux is a disease of the bladder-ureter joint, caused by a violation of the closing mechanism of the lower part of the urinary tract, as a result of which a certain amount of urine transported through the ureter into the bladder, under the influence of intravesical pressure, constantly or periodically returns (regurgitation) to the upper urinary tract in the direction of the kidney. According to the literature, vesicoureteral reflux affects approximately 1% of all children, according to various sources. Purpose – is to highlight the importance of the pathology of vesicoureteral reflux using data from the literature and own observations. Materials and Methods. 31 patients who were diagnosed with VUR were included in the study. Previously, these children were examined in the conditions of somatic departments of Vinnitsia Regional Pediatric Clinical Hospital. Patients underwent endoscopic correction of VUR using gels (Nubiplant, Vantrix, Deflux, Dexell) according to the STING method. Results. An analysis of the medical records of 31 inpatients who were treated in the surgical department of the Vinnytsia Regional Pediatric Clinical Hospital from 2019 to 2023 was conducted. During the stay in the hospital, the patient underwent a diagnostic examination (taking an anamnesis, general blood and urine tests, determining the level of urea and creatinine; ultrasound of the kidneys, micturition cystoureterography, if necessary – excretory urography, echocardiography). Endoscopic treatment was performed – endovesical injection of a volume-forming gel into the submucosal part of the refluxing ureter (above the ureter, into the bladder wall) – the STING (Subureteric Teflon Injection) variant. Conclusions. VUR is a fairly common pathology among children, which has a multifactorial nature. The variety of manifestations, the high prevalence of this pathology and the severity of complications require early diagnosis and determination of treatment tactics. Regarding the gender distribution of the pathology, it should be noted that girls are sick more often than boys. Unilateral and bilateral VUR occurs with the same frequency, while reflux of the II–III stages occurs most often. The maximum morbidity was observed at the age of 6 to 9 years, and from 0 to 3 years. In 35–60% of cases, reflux causes sclerotic changes in the kidney, secondary shrinkage of the kidney. According to the literature, nephrosclerosis due to chronic pyelonephritis in VUR is formed in 30–60% of cases, which leads to the development of the terminal stage of chronic renal failure in 25–60% of patients, due to a decrease in the functional renal reserve, as an indicator of the compensatory capabilities of the kidneys. Most research suggests that endoscopic and surgical intervention are the best treatment methods for VUR with frequent manifestations of infection.