Subureteric injection in complex vesicoureteral reflux in pediatric patients: a retrospective observational study.

PURPOSE This study evaluated the effectiveness of subureteric injection (SUI) compared to ureteral reimplantation in treating vesicoureteral reflux (VUR) among children, focusing on whether SUI reduces the need for surgical interventions, especially in complex cases.

METHOD We retrospectively analysed 132 children diagnosed with VUR. We divided the patients into two groups: Group 1 - only VUR cases (n=65) and Group 2 - complex cases (n=67). We diagnosed VUR and complex pathologies by voiding cystourethrography (VCUG) and cystoscopic examination. VUR was graded according to the International Reflux Study Committee classification system. SUI and intravesical ureteroneocystostomy (UNC) were used as surgical treatment methods.

RESULTS In Group 2, complex pathologies included duplex renal collecting systems (1.6%), bladder diverticulum (11.4%), bladder trabeculation (27.8%), and posterior urethral valves (18%). SUI was performed in 48.5% of patients, with 22.7% requiring reimplantation after SUI, while 28.8% underwent direct reimplantation. Success rates of SUI (65.6%) and reimplantation (70.6%) were similar (p=0.68), though lower in children aged 0-2 years with high-grade VUR (45% for Grade 5) and renal scarring (48%). Mean recurrence times were 8.4±3.2 months for SUI and 9.1±3.8 months for reimplantation.

CONCLUSIONS The success of SUI and ureteral reimplantation was comparable in both simple and complex cases, suggesting SUI is a viable first-line option, particularly in patients older than 2 years with low-grade reflux. However, further studies are needed to confirm these findings.