[Surgical correction of multiple ureter obstructions in children]. / Khirurgicheskaia korrektsiia mnozhestvennykh obstruktsii mochetochnikau detei.

Obstruction in the pyeloureteral region is often combined with an obstacle of an anatomical or functional character in the distally located parts of the ureter. The authors treated by operation 80 patients with congenital hydronephrosis in the period from 1986 to 1991. An additional distally located stricture of the ureter was found during intraoperative catheterization in 10 cases. In 9 of 10 cases the obstacle was at a distance of 1.7-2.0 cm from the pelvioureteral junction. Due to the small distance between the strictures the affected segment could be resected and an Andersen-Haynes anastomosis formed. The authors believe that the presence of double obstructions indicates marked dysplastic changes of the ureteral wall. In view of this, the use of optic magnification, microsurgical instruments, and ultrathin suturing material in the formation of the anastomosis is recommended. In 3 children operated on by the above discussed method the postoperative course was uneventful. A clinical case is given in illustration. It is suggested in the discussion that the indications for retrograde pyelography may be widened so as to identify additional strictures of the ureter at the diagnostic stage.

[The treatment procedure in vesicoureteral reflux in young children]. / O taktike lecheniia puzyrno-mochetochnikovogo refliuksa u detei mladshego vozrasta.

A group of 54 children with vesicoureteral reflux recognized in the first 3 years of life was analysed. All of them received adequate nonoperative treatment including prolonged antibacterial therapy and management of cystitis and urodynamic disorders of the lower urinary tract. According to the degree of vesicoureteral reflux (VUR), the children were divided into two groups. Group 1 consisted of 29 children with Degrees I-II VUR in 37 ureters. Nonoperative treatment was effective in 75% of cases. Retrospective appraisal of urograms revealed no signs of cicatricial-sclerotic changes in the parenchyma of the kidneys. In five children with Degree II VUR of long duration the kidneys were smaller than the normal size of their age. Group 2 was made up of 24 patients with Degrees III-V VUR into 34 ureters. No changes were found in the renal parenchyma on urograms made during the first examination. During follow-up, however, signs of reflux-nephropathy (RN) were detected, which according to the recommendations of the International group for reflux study were evaluated as Degree I RN--10 cases, Degree II RN--12 cases, Degree III RN--8 cases, and Degree IV RN--4 cases. The authors believe nonoperative treatment of children with Degrees I-II VUR to be justified, patients with Degrees III-V VUR call for active surgical intervention from the moment that the reflux is recognized.

[The surgical treatment of congenital hydronephrosis in children]. / Operativnoe lechenie vrozhdennogo gidronefroza u detei.

Available are the results of surgical treatment (Andersen-Hynes operation and its modifications) of 85 children with hydronephrosis bor the period 1981-1987. The patients' age ranged from 6 months to 14 years. Anastomotic stenosis occurred in 12% of the procedures as a result of: urethral or pelvic trauma when suturing, wound channels due to the needle perforating puncture, catgut unwanted properties, tissue strain at the anastomosis site, inadequate renal drain. This necessitates modification of the operative technique: surgical manipulations restricted to the operated on pelvic part and pelvic-urethral segment, optical amplification, microsurgical instruments, synthetic suture. An original pyelostoma made of silicon rubber was used in draining. Out of 34 surgical cases, good results were achieved in 31, satisfactory in 3. No complications were recorded.

[Formation of a urinary reservoir from a small intestinal graft in children with exstrophy of the urinary bladder]. / Sozdanie mochevogo rezervuara iz tonkokishechnogo transplantata u detei c ékstrofiei mochevogo puzyria.

The authors suggest a new approach to the treatment of patients with exstrophy of the urinary bladder-the formation of an urinary reservoir from a detubulerized intestinal graft after II Kocks' method. This method, as well as its analogues, is mainly used in adults after radical cystectomy. Improved surgical techniques have been suggested on the basis of experimental works which allow the age features and the peculiarities of the functional condition of the formed reservoir to be taken into account. Analysis of the results of clinical use of the suggested method showed it to be effective in solving the problem of rehabilitation of patients with exstrophy of the urinary bladder, which allows it to be recommended as the operation of choice in the management of this developmental anomaly.

[Angiographic diagnosis of agenesia, aplasia and hypoplasia in children]. / Angiograficheskaia diagnostika agenezii, aplazii i gipoplazii pochek u detei.

Problems of the diagnosis of congenital renal developmental defects (CRDD) still continue to present a certain interest. Basing on their own experience in the diagnosis of CRDD in 188 of 527 children with renal pathology, the authors arrived at a conclusion that intravital diagnosis of renal aplasia was not only possible with the help of angiography, but also extremely necessary because agenesia and aplasia were two separate entities in their genesis, limiting the potentialities of reconstructive operations in aplasia. Hypoplasia in children was very frequent and was characterized by 5 types of the angiographic picture. Analyzing the state of the contralateral kidneys in CRDD, the authors considered some features of compensatory hypertrophy.

[Angiographic diagnosis of agenesia, aplasia and hypoplasia of kidneys in children]. / Angiograficheskaia diagnostika agenezii, aplazii i gipoplazii pochek u detei.

Problems of the diagnosis of congenital renal developmental defects (CRDD) still continue to present a certain interest. Basing on their own experience in the diagnosis of CRDD in 188 of 527 children with renal pathology, the authors arrived at a conclusion that intravital diagnosis of renal aplasia was not only possible with the help of angiography, but also extremely necessary because agenesia and aplasia were two separate entities in their genesis, limiting the potentialities of reconstructive operations in aplasia. Hypoplasia in children was very frequent and was characterized by 5 types of the angiographic picture. Analyzing the state of the contralateral kidneys in CRDD, the authors considered some features of compensatory hypertrophy.

[Treatment of short urethral strictures in children using magnets]. / Lechenie korotkikh striktur uretry u detei s pomoshch'iu magnitov.

In 20-35 per cent of short (up to 05 cm) urethral stenosis or cicatricial obliterations of urethra it was found advisable to start the treatment with nonoperative technique. Before 1982 bouginage or tunneling of urethra were commonly used. In 5 out of 6 children the strictures relapsed. Since 1983 when permanent magnets were employed, in 4 out of 5 patients normal urination recovered. 1 child was exposed to preventive 5-months bouginage to ensure constant patency of urethra. Long-term results in all the children satisfied the investigators. But out of 3 magnet-treated children with longer strictures (more than 1 cm) the disease relapsed in 2. It was concluded that in patients with longer stenosis the method was a failure, but in those with short ones the technique was more effective than routine methods. Besides, technical availability, safety and shorter terms of the treatment could also be regarded as the benefits of the aforementioned therapy.

[Surgical treatment of urethral strictures in children]. / Khirurgicheskoelechenie striktur uretry u detei.

Under analysis were results of treatment of posttraumatic strictures of the urethra in 34 children. A method of treatment of the urethra structures has been developed in experiments in dogs with the use of permanent magnet. Comparison of results of treatment of 2 groups of patients treated by traditional methods (19 patients) and by the proposed method (15 patients) has shown that using the new method is followed by two times less amount of recurrences and complications.

[Use of suspended catheters (stents) during surgery of hydronephrosis in children]. / Primenenie podvesnykh kateterov (stentov) pri operatsiiakh po povodu gidronefroza u detei.

The application of hanging catheters (stents) in operations for hydronephrosis in children has considerable advantages over classical (open) methods of drainage. Bacteriological investigations of analyses of urea performed in open and closed closed systems of drainage have shown less incidence of infection of the upper urinary tracts with intrahospital gram-negative flora after operation on patients operated upon with using stents, which gave less amount of postoperative complications.

The pathogenesis of left-side varicocele in children.

Phlebographic and manometric tests were performed in a group of 144 boys, aged 10-15 years having a left-side varicocele. From the measurements of relative blood-flow which were made between the left renal vein and the vena cava, the left external iliac vein and the vena cava, the left renal vein and the left external iliac vein, it is evident that the varicocele is only the result of the application of Bernouillé's Law to the particular characteristics of the ilio-cava and renal venous circulation.

[Functional evaluation of reduction of venous outflow from the testis in left-side varicocele in children]. / Funktsional'naia otsenka reduktsii venoznogo ottoka ot iaichka pri levostoronnem varikotsele u detei.

A functional state of venous return from the testicles was estimated on the grounds of a direct measurement of pressure gradients among main points of venous return on 61 unoperated adolescents, aged from 13 to 15, and with marked varicocele; and in 10 children of the same age without varicocele (a control group). The results of the estimation have proved that the hydrostatic pressure in the veins of the pampiniform plexus is directly responsible for their hyperdistension in the vertical position. An exceptional role of renal venous hypertension in the genesis of varicocele in children is doubtful.