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    Item type:Publication,
    COMPARISON OF ENDOSCOPIC AND CONSERVATIVE MANAGEMENT IN PEDIATRIC VESICOURETERAL REFLUX: A RETROSPECTIVE STUDY
    (Macedonian Association of Anatomists and Morphologists, 2025-11)
    ;
    Kamiloski, Marijan
    ;
    Ceku, Gani
    ;
    Cvetanovska, Vesna
    ;
    Lumani Bakjii, Njomza
    AbstractBackground:Vesicoureteral reflux (VUR) is a prevalent congenital urinary tract anomaly in children, often associated with recurrent urinary tract infections (UTIs), renal scarring, and long-term complications such as hypertension and chronic kidney disease. The optimal management of primary VUR—particularly in intermediate grades—remains debated, with both conservative and endoscopic treatments widely used.Objective:To compare clinical and functional outcomes of endoscopic injection therapy versus conservative management in pediatric patients with primary VUR, focusing on reflux resolution, UTI recurrence, renal scarring, and renal function.Methods:This retrospective study included 70 pediatric patients with primary VUR treated at a tertiary center between 2015 and 2018. Thirty-five patients underwent endoscopic subureteric injection with dextranomer/hyaluronic acid copolymer, and 35 received conservative management with antibiotic prophylaxis. Comparative analysis assessed changes in VUR grade, recurrence of UTIs, renal scarring (via technetium-99m dimercaptosuccinic acid [DMSA] scintigraphy), renal function by kidney side, and serum creatinine levels.Results:Endoscopic treatment achieved complete reflux resolution in 74.3% of cases. A significant reduction in reflux grade and improvement in right kidney function were observed in the intervention group (p < 0.001). The conservative group showed higher rates of recurrent febrile UTIs and no significant improvement in renal function. Renal scarring was present in both groups but slightly less frequent following endoscopic therapy. Post-treatment left kidney function was significantly higher in the conservative group (p = 0.020), likely reflecting baseline differences.Conclusions:Endoscopic injection therapy is a safe and effective treatment for moderate-to-high-grade VUR in children, associated with superior reflux resolution and better infection control compared to conservative management. Conservative therapy remains appropriate for select low-grade cases but may confer higher risk for recurrent infections and limited renal recovery. Individualized treatment selection is essential to optimize pediatric VUR outcomes
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    Comparative retrospective study for surgically treated primary VUR in pediatric patients
    (2023-03)
    ;
    Radmila Mila Mihajlova Ilie
    ;
    Magdalena Gjorik Petrushevska
    ;
    Gani Çeku
    ;
    Introduction Vesicoureteral reflux have incidence of about 1% in pediatric population. It is a very common pediatric condition. Anomalies of the ureter, the dynamics of the bladder, and the anatomy of the ureterovesical junction can lead to abnormal valve mechanisms and vesicoureteral reflux. Aim The purpose of this study is to evaluate the effectiveness of open and endoscopic urethral reimplantation in relation to the severity of the vesicoureteral reflux and renal function. Materials and Methods We retrospectively analyzed 53 children treated for primary vesicoureteral reflux at the Clinic of Pediatric Surgery in Skopje in the period from 2017 to 2020. Endoscopic treatment was done using subureteric Teflon injection “STING” technique. Operative treatment (open procedure) was used in higher grade vesicoureteral reflux (3 or 4). The evaluation of the results of the treatment was done mainly according to the following criteria: reduced grade of reflux, maintaining renal function, absence of urinary infection and postoperative complications. These outcomes were compared between the two techniques. Results and Discussion The endoscopic procedure was shown to be superior for lower grade vesicoureteral reflux. The open procedure is preferable in cases of higher vesicoureteral reflux or after failure with the endoscopic procedure. Conclusion Treatment of vesicoureteral reflux with the endoscopic procedure is always preferable due to fewer days of hospitalization and as a minimally invasive approach. Both procedures proved to be effective in reflux correction, and successfully reduce the occurrence of febrile urinary tract infections.