EN
TÜRKÇE
Objective:
This study aimed to evaluate factors associated with clinical success after endoscopic injection therapy in selected children with primary vesicoureteral reflux (VUR) and to assess characteristics associated with radiographic recurrence in the subgroup of patients who underwent postoperative voiding cystourethrography (VCUG).
Materials and Methods:
This retrospective observational study included 80 children aged 2–15 years who underwent endoscopic subureteric injection for primary VUR at a single center and who had follow-up data available. Patients with neurogenic bladder, evident bladder dysfunction, or postvoid residual urine volume >20 mL were excluded. Age, sex, reflux grade, laterality, presence of a duplex collecting system, DMSA differential renal function, injection material, injection technique, and cystoscopic ureteral orifice morphology were recorded. The primary outcome was clinical success, defined as the absence of febrile urinary tract infection within the first 12 months after surgery. The secondary outcome was radiological recurrence, evaluated only in patients who underwent postoperative VCUG. The total number of injections was analyzed as an exploratory indicator reflecting the treatment course.
Results:
A total of 107 refluxing ureters in 80 patients (59 girls, 21 boys; mean age 7.25 ± 3.17 years; mean follow-up duration 19.31 ± 8.66 months; 53 unilateral and 27 bilateral cases) were treated endoscopically. Clinical success after the first injection was 65.4% (70/107) and increased to 69.2% (74/107) after additional injections. Cystoscopic ureteral orifice morphology was significantly associated with clinical success; the clinical success rate was 90.9% (30/33) in horseshoe-type orifices and 60.3% (38/63) in golf-hole–type orifices (p = 0.0038). Radiological recurrence was detected in 19 of 33 ureters (57.6%) that underwent postoperative VCUG, and preoperative VUR grade was the only variable significantly associated with radiological recurrence (p = 0.022).
Conclusion:
Endoscopic injection therapy may provide clinically meaningful infection-free follow-up in selected children with primary VUR. Cystoscopic ureteral orifice morphology appears to be strongly associated with clinical outcomes, whereas higher reflux grade may increase the risk of radiological recurrence. The need for multiple injections may reflect a more complex disease phenotype.