[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.

[Reflux nephropathy in children: early diagnosis and monitoring].

Vesicoureteral reflux (VUR) is the most common type of obstructive uropathy in children. Reflux nephropathy (RN) is one of the most common complications of VUR that inevitably leads to chronic kidney disease. Patients with end-stage kidney disease require costly treatment, and the only way to cure them is kidney transplantation. A timely institution of renoprotective therapy is a key factor helping to preserve the function of the native kidneys. Hence, it is necessary to devise new highly sensitive and minimally invasive methods for early diagnosis of RN. The purpose of this article is to review the molecular mechanisms of initiation and progression of kidney fibrosis and the opportunities of instrumental and non-instrumental methods for its diagnosis. Special attention is paid to highly specific and highly sensitive non-invasive methods for the detection of minimal changes in the renal parenchyma. The authors discuss the promising biomarkers for the diagnosis and prediction of RN.