The thesis contains clinical and statistical analysis of comprehensive diagnostic and treatment of 270 patients with uni- and bilateral vesicoureteral refl ux (VUR) II-IV grades, aged from 9 months to 14 years. Patients with VUR along with conventional clinical-diagnostic complex conducted special surveys: ultrasound of ureterovesical jets using Doppler techniques, biochemical and enzyme immunoassay urine, cystoscopy. Depending on the method of research, patients examination carried out before the intravesical VUR correction - I stage, on the third day after mini-invasive treatment - II stage (early postoperative period), 6 months after the fi rst intravesical intervention - III stage (late), and 1 year after the fi rst or 6 months after second operation - IV stage (remote). At the stage of clinical and laboratory remission patients underwent intravesical urodynamics recovery. Mini-invasive techniques used such as STING (subureteric injection), HIT (hydrodistention implantation technique), Double HIT, as well as the necessary their combination. As implant used national hydrophilic copolymer containing acrylic - pure polymer with fully completed cycle of polymerization. Using analysis of ureterovesical jets clarifi ed and supplemented ultrasound prognostic markers VUR. Proved their effectiveness in monitoring urodynamic in complex investigations together with dynamic patients monitoring after intravesical treatment defects that can signifi cantly reduce the rate of invasive diagnostic methods VUR with radiation exposure - voiding cystourethrography. In patients with VUR for early detection of preclinical insuffi cient function kidney parenchyma and the risk of irreversible remodeling with sclerosing, well as to monitor the clinic progress and evaluate the intravesical treatment identifi ed highly informative biochemical noninvasive markers glomeruli function for excretion microalbumin, creatinine and renal parenchyma sclerosis - for excretion glycosaminoglycans and profi brogenic cytokine TGF-beta1. The negative dynamics of these indicators demonstrates the ineffectiveness of conservative treatment VUR and are indications for intravesical defect correction. Established cystoscopy prognostic factors of efficiency hydrophilic copolymer containing acrylic in the intravesical VUR treatment in children and proves the expediency indications for second mini-invasive correction of defect. Thus, in patients with VUR for ureteral orifi ces in the shape of the stadium with more pronounced signs of deepness that displaced in zone B and lateral to the bladder wall with a hydrodistension grade more than H1 and especially fl abby peristalsis - RR=2,22 [1,58-3,13], Se=0,93, Sp=1,0 characterized by a positive association with the defect in the highest specifi city tests. Determined indications and effectiveness intravesical VUR treatment depending on the location, shape, and hydrodistention grade ureteral contractility of the ureteral orifi ce, and the presence and position of the implant at the second mini-invasive intervention. The effectiveness of the double mini-invasive intervention reaches 90%. Lack of "volcano shape" mound after a single intravesical intervention was pronounced negative prognostic marker of effi ciency for repeated implant injection - RR=0,36 [0,12-1,05], Sp=0,73, and migration of the implant in the lateral direction weaker - RR=0,84 [0,46- 1,51], Sp=0,67. Reducing "volcano shape" mound in volume - RR=1,54 [0,92-2,57], Sp=0,81 and migration bulge to the midline of the bladder - RR=1,39 [0,82-2,34], Sp=0,78 are positive predictive impact of re-injection the implant. In patients with VUR six months after intravesical treatment unilateral defect a new refl ux from the opposite side occurs in 12,5% of patients, in which contralateral ureteral orifi ce have worse characteristics than in almost healthy children. The abnormal confi guration and position of the contralateral ureteral orifi ce with unilateral VUR is a personifi ed indication to a preventive mini-invasive correction of a possible defect. In patients with VUR ureteral orifi ces with combination of factors such as pronounced signs of deepness - in the shape of golf holes, lateralization to the side wall of the bladder in zone D and hydrodistention H3 grade, as well as the absence "volcano shape" mound or the preservation defect IV grade after a single application of hydrophilic copolymer containing acrylic and VUR III grade after repeated ineffective implant injection, prognostically should be considered as unfavorable diagnostic markers for further effective mini-invasive interventions. Such patients ureterocystoneostomy is indicated. Exceptions may constitute only cases of technical errors during primary intravesical intervention or convincing signs of implant extrusion. In other cases it is advisable to repeat mini-invasive correction of defect in the time period of 6 months, which depending of the clinic, such as the frequency of exacerbations pyelonephritis.
