[Videolaparoscopic nephrectomy and nephrouretherectomy in children]. / Videolaparoskopicheskaia nefréktomiia i nefroureteréktomiia u detei.

The experience with 72 laparoscopic nephrectomies and nephrouretherectomies in children aged from 13 days to 14 years is reviewed. 51 children were under 3 years of age, 2 patients - under 1 month of life. Pathological changes of the kidneys with complete loss of function were indications for endoscopic surgery. Complex of examinations in the preoperative period included repeated USE, cystography, urography, scintigraphy, angiography. Time of surgery was 30-150 min (45 min, on the average). Blood loss during surgery was less than 50-60 ml and didn't require hemotransfusion. There were no complications during surgery. Fast recovery of physical activity after surgery, a decrease of hospital stay were seen. There were no postoperative complications and lethality. Laparoscopic nephrectomy and nephrouretherectomy are low-traumatic, safe and effective surgeries in children of any age in different diseases of the kidneys.

Laparoscopic ligation of testicular veins for varicocele in children. A report of 180 cases.

BACKGROUND: The technique of the laparoscopic treatment of varicocele in children is described, and its outcome is discussed. METHODS: A total of 180 patients from 6 to 14 years of age were studied. All of them had left-sided varicocele; 10 of them were recurrences after treatment by other methods. Varicocele was diagnosed on physical examination and confirmed by Doppler ultrasonography. The laparoscopic procedure included obligatory dissection and preservation of the spermatic artery and tinted lymphatic vessels, followed by double ligation of the spermatic veins. RESULTS: There were no intraoperative or postoperative complications and only one case of recurrence (0.6%). CONCLUSION: The suggested technique for laparoscopic varix ligation is a highly effective and reliable method for the treatment of pediatric varicocele. It provides the minimal invasiveness of the approach, effective microsurgical quality of visualization, and dissection with guaranteed preservation of the spermatic artery and lymphatic vessels, along with very low rates of complication and recurrence.

[Improvement of methods of surgical correction of congenital hydronephrosis in children]. / Usovershenstvovanie sposoba khirurgicheskoi korrektsii vrozhdennogo gidronefroza u detei.

The analysis of the authors' own results of surgical treatment for hydrohephrosis in 81 children after the Anderson-Haines-Kucher has revealed that the most common complication is stenosis of the anastomosis made. The authors' modified operation has indicated that the use of a less traumatic access to the pelvioureteral portion, of optic magnification, a microsurgical instrument, 7/0 synthetic suture material, drainage of the renal collecting system with a pyelostomic tube of original design allows the optimal conditions to be created for formation of the pelvioureteral anastomosis and the good results of hydronephrosis treatment to be obtained in children.

[Kidney autotransplantation in children]. / Autotransplantatsiia pochek u detei.

A total of 4 renal autotransplantations were performed in children in the hospital. The indications for the surgery were ureteric injury (n = 2) and megaloureter associated with distal ureteric stenosis (n = 2). In all cases, autotransplantation was conducted into the ipsilateral iliac fossa after perfusion cooling of the kidney for an average of 28 min. No postoperative complications were observed. There was a complete recovery of renal function in all cases.

[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.

[Kidney autotransplantation in ureter injuries and diseases children]. / Autotransplantatsiia pochek pri povrezhdeniiakh i zabolevaniiakh mochetochnika v detskom vozraste.

Six operations for kidney autotransplantation into the ipsilateral iliac fossa were conducted on children aged from 2 to 14 years. In 2 children the operation was performed for a posttraumatic defect in the ureter of a considerable length. Severe neuromuscular dysplasia of the ureter in maintained function of the kidney was the indication for operating on 4 children. No complications occurred in 5 operations. One transplanted kidney had to be removed because of renal artery thrombosis resulting from damage inflicted to the endothelium during washing of the kidney. Operation for autotransplantation of the kidney is a permissible alternative of the traditional methods of replacement or plastics in long posttraumatic strictures and congenital developmental anomalies of the ureter.

[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.

[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.