[Surgical learning curve for top-down two-knot laparoscopic pyeloplasty in congenital hydronephrosis in children].

The aim was to evaluate the surgical learning curve and advantages of top-dow two-knot laparoscopic pyeloplasty in children with uretero-pelvic junction obstruction (UPJO). MATERIALS AND METHODS: A retrospective analysis of medical records regarding 98 patients from Speranskij Childrens Municipal Hospital No9, Moscow and Regional Clinical Hospital No7, Volgograd, aged from 3 to 24 months with unilateral hydronephrosis of varying degrees, according to the SFU classification (Society of Fetal Urology) in the Onen modification was carried out. LP in all children was performed in accordance with the Heins-Andersen technique, with minimal resection of the pelvis. In order to compare different techniques for the formation of pyeloureteral anastomosis, patients are divided into two groups: on the first group (n=59) TDTKT was performed, and on the second (n=39) - the standart knotting technique (SKT) was performed. The patients were operated by two surgeons from different clinics. Average time of operation, learning curves, frequency of post-operative complications and post-operative assessments were included as criteria for the comparison of the two groups. RESULTS: Using TDTKT allowed a reduction in mean time of surgery of 30%. Positive results were obtained in both groups of patients by reducing the degree of hydronephrotic transformation of the kidney during their follow-up year. CONCLUSION: Using TDTKT not only permits an experienced surgeon to reduce his duration of operation to 67.86 minutes, it also positively affects the surgical learning curve for less experienced surgeons. In this regard, this technique can be recommended to surgeons who do not have much experience in conducting laparoscopic pyeloplasty.

[Uretero-ureteral anastomosis (ureteropyeloanasto-mosis) for the duplicated upper urinary tract in children].

INTRODUCTION: The duplex kidney is one of the most common congenital abnormalities of the urinary tract, and various surgical procedures exist for the management of this condition. Depending on the surgeon preferences, patients with duplex kidney may undergo heminephrectomy with ureterectomy using open or laparoscopic approach, uretero-cysto-anastomosis of the ectopic ureter or two ureters in a single block. Recently, there have been reports of inter-ureter anastomoses. Here we report our multicenter experience in open and laparoscopic uretero-ureteral anastomosis (UUA). The study aimed to improve the treatment results in children with urodynamic dysfunction due to the duplicated upper urinary tract. MATERIALS AND METHODS: We retrospectively analyzed medical records of 64 children treated from 2007 to 2017. There were 22 (32.8%) boys and 43 (67.2%) girls with mean age 40.2 months at the time of surgery. All of them had duplex kidneys, including 27 (42.2%) right-sided and 37 (57.8%) left-sided. Of them, 15 (23.4%) children underwent distal UUA (DUAA), and 49 (76.6%) had proximal UUA (PUUA). RESULTS: After surgery, acute pyelonephritis occurred in three patients. In the early postoperative period, a prolonged urinary leakage from surgical site drainage was observed in three (6.1%) patients after laparoscopic PUUA. One (4.2%) child developed a stumpitis. Thus, complications occurred in 7 (10.9%) children; one of them (1.6%) needed additional treatment. CONCLUSION: Distal and proximal UUA is a safe and effective surgical treatment for urinary outflow disorders in patients with the duplicated upper urinary tract, minimizing the risk of the duplex kidney dysfunction.

[Venous drainage of the testis and the causes of the development of varicocele in children]. / Venoznyi ottok ot iaichka i prichiny razvitiia varikotsele u detei.

The article discusses the results of angiological examination of 42 children with primary and 13 with recurrent varicocele by the method of ++trans-scrotal antegrade venotesticulography. Three groups of patients were distinguished: I--with drainage of blood into the left testicular vein, II--with drainage into the left cremasteric vein, III--with simultaneous drainage into the two above-indicated veins. Incompetence of the valvular apparatus of the left testicular vein and impaired blood drainage from the left external iliac vein with the development of retrograde flow of blood along the left cremasteric vein are the most frequent causes of varicocele in children.

[Characteristics of the hydrodynamic situation in the urinary tract in vesico-ureteral reflux based on an analysis of a general type of equation of the linear transport model]. / Kharakteristika gidrodinamicheskoi situatsii v mochevykh putiakh pri puzyrno-mochetochnikovom refliukse na osnovanii analiza uravneniia obshchego vida lineinoi transportnoi modeli.

Upper urinary tract urodynamics are described through a linear deterministic chamber model. An analysis of possible urodynamic variants in vesico-ureteral reflux (VUR), using a mathematical model, has suggested that hydrodynamic situation in the refluxing ureter will be dependent on vesical and ureteral activity where ureterovesical incompetence and VUR are of similar grades. Where ureteral anatomy and function remain fairly intact, urinary regurgitation under high pressure shall be accompanied by the development of a considerable intraureteral hypertension. Besides, VUR-associated urodynamic disorder must have an obstructive component whose markedness will depend on the extent of arterial motor impairment, intravesical hypertension or a combination of the two. Urodynamic and radioisotopic studies have completely confirmed the theoretical postulations. In second- or third-degree VUR, for example, the highest intraureteral pressure developed in children with uninhibited bladder, while in fourth-degree VUR the bladder showed no response to gradual intravesical pressure rise. Urodynamic disturbance was already shown to have a functional/obstructive component in those cases of second-degree VUR where the bladder was uninhibited and be free of it in cases of normal bladder reflex and third-degree VUR.