[VESICOURETERAL REFLUX INTO SMALL KIDNEY DIAGNOSTIC AND THERAPEUTIC PARADIGM].

The causes of renal size reductionin children by 20 percent or more from the age norm include abnormalities of urodynamics of upper (UUT) and lower (LUT) urinary tract, combined with vesicoureteral reflux (VUR) and infra-vesical obstruction (IVO). Several issues regarding diagnosis and choice of treatment in children with small kidneys depending on the severity of functional abnormalities and the presence of comorbidities still remain controversial. 101 children with small kidneys accounting for 3.1% of the entire number of urologic patients admitted to the clinic were followed for 25 years. 78 (77.2%) patients were simultaneously diagnosed as having ipsilateral vesicoureteral reflux (VUR) (2.4% of the total number of hospitalized children). Moreover, contralateral VUR was found in 63% of patients. In 5.1% of children, anomalies of the contralateral kidney were identified: lumbar dystopia (3.8%), duplication of the renal pelvis and ureter (1.3%). Combination with IVO was found in 25.5% of cases. 75 (96%) children with vesicoureteral reflux into the small kidney were operated on. Reconstructive plastic surgery was made in 72 (92%) those patients. Indications for conservative management were identified in patients with intermittent VUR of I-II degree into small kidney or both kidneys. In case of detection of IVO, initial surgery was carried out to eliminate the obstruction. Conservative therapy was aimed at getting rid of the inflammatory process, restoring the function of kidney and bladder, and at the treatment of concomitant vulvovaginitis. In the absence of positive results of 6-8 months of conservative treatment or in case of the negative clinical course, the operation was considered justified. Indications for antireflux surgery were the failure of conservative therapy for intermittent VUR into small kidney or both kidneys, the presence of VUR of III-V degree into one or both kidneys. In cases of bilateral VUR antireflux surgery was performed simultaneously. Indications for nephrureterectomy were complete loss of kidney function, a combination of several unfavorable prognostic signs, namely a significant reduction of the renalsize (renal area less than 30% of the age norm); severely impaired kidney function (reduced contribution to the total accumulation of up to 10% or less); the presence of ultrasonic and radiographic evidence of secondary shrinkage; pronounced abnormalities of UUT urodynamics; failure of treatment of frequent and severe pyelonephritis exacerbations. It is shown that VUR is often combined with a decreased renal size, creating difficulties in selecting treatment tactics and determining the prognosis of the disease further. The proper strategy is to prevent disease progression and reduce the need for organ-removal surgery in children.

[Complications of surgical treatment of hypospadia]. / Oslozhneniia operativnogo lecheniia gipospadii.

127 new cases of hypospadia were treated in 1980-2002. A total of 348 operations including urethroplasty by Duplay and Cecil were made. 78 of the operations were followed by complications out of which 26 were corrected in the postoperative period and had no effect on the treatment results. The first stage of surgical correction of hypospadia (89 operations) brought complications in 13.48% cases. Recurrent distortion of the cavernous bodies was most typical complication at this stage. In most cases development of scarry deformation was due to inflammatory changes early after surgery. Derivatives of prednisolone proved effective in the treatment of hypertrophic scars. This complication correlated with skin plastic repair (longitudinal suturing or creation of oncoming triangular flaps) to correct the defect. The second stage of hypospadia surgery was urethroplasty made in 196 cases. It was accompanied with complications in 13.25 patients. Fistulas of newly-created urethra (11.73%) were the most typical and frequent complication. The number of postoperative complications varied greatly depending on the disease form and method of urethral reconstruction. Cecil urethroplasty brought complications in 7.94% cases. Efficacy of neurourethra creation by Duplay varied greatly depending on the length of the created neourethral portion and the number of local skin resources (8-33-83.33% complications).

[Ultrasonic study in the diagnosis of developmental defects and diseases of the urinary system in children]. / Ul'trazvukovoe issledovanie v diagnostike porokov razvitiia i zabolevanii mochevoi sistemy u detei.

Echography has recently become one of the leading methods of examination in different branches of medicine. Despite its high informativeness, however, it is not used widely in pediatrics. The article generalizes the practical experience accumulated in ultrasonic examination of urinary organs in children with developmental anomalies and diseases of the kidneys, ureters, urolithiasis, and Wilms' tumor. Besides, the possibility of echography as a screening test in outpatient examination of children with changed values of urinalysis is shown for the first time in pediatric practice. The authors describe the advantages of the method in combined developmental anomalies and regular medical examination of patients after various methods of treatment. They emphasize its merits (absolute safety, no injurious effect, high informativeness, the possibility of performing it in children who are in a grave condition, its extensive use under outpatient conditions, etc.). It is shown the ultrasonic examination in outpatient clinics makes it possible to divert from the traditional plan of radiourological examination of children, which includes excretory urography performed in children in inpatient clinics as a rule. It is obvious that the use of echography as a diagnostic test will make it possible to exclude the radiation load which is most harmful for the growing and developing organism and will not require mass hospitalization, which will undoubtedly have a high therapeutic and economical effect.

[Kidney injuries in children]. / Povrezhdeniia pochek u detei

Anatomo-topographic features of the kidneys in children mostly condition a great incidence of its damage, compared with adults. One hundred and fifty children with renal injuries were observed, 147 of them with closed injuries and 3 -- with open ones. In 10 cases a trauma of anomalously developed kidneys was noted. 124 children were treated conservatively, 26 children were operated upon, in 16 of them organ-preserving operations were performed, in 10 children -- nephrectomay. Late results were followed up in 51 children in terms from 6 months to 10 years (40 patients were treated conservatively and 11 -- were operated upon). As a result of the conducted control investigation all patients were subdivided into three groups: practically healthy children (25), children with roentgenoradiological changes on the part of the injured kidney but without signs of clinico-laboratory symptomatics (11) children with posttraumatic complications (15). An analysis of late results enabled to revise indications to surgery in an acute period of trauma in behalf of their extension.