[Penile glans amputation during circumcision: causes, treatments and preventive measures].

INTRODUCTION: Penile glans amputation during circumcision is a rare but potentially devastating complication. The mechanism and causes are poorly understood and incomprehensible. It is important to identify the causes of these complications, to suggest a mechanism and to propose prevention measures. MATERIALS: Between 2005 and 2019, six patients with penile glans amputationafter circumcision were analyzed. All were operated without medical evidence, for religious reasons. THE RESULTS: The operations were performed by local anesthesia, at home - in 5 patients, in 1 child - at polyclinic. All children were circumcised by scalpel with guillotine method, without visualization of glans. Partial amputation of penile glans was observed in 2 children (33.3%). Complete cut-off of the glans at the level of the coronal sulcus was revealed in 4 boys (66.6%). Meatoplasty with urethral mobilizations was performed 2 patients (33.3%) with partial amputation. The tops of corpus cavernous was covered of with the remnants of the skin of penile shaft in two boys (33.3%). Glansplasty was performed in 2 other patients (33/3%), using a labial mucosa graft to reconstruct the shape of glans and glanular groove. The follow up have showed meatostenosis in two boys (33.3%) in the first 2 months after surgery. One child required repeated meatoplasty (16.6%), another had a recovery of normal urine flow rates after urethral dilatation and stenting (4 weeks). CONCLUSION: Visual control of the glans position during circumcision will prevent the amputation. "Guillotine" techniques including, Mogen clamp-type devices, are considered potentially dangerous. Circumcision in newborns, without general anesthesia, in the presence of swelling of the foreskin have an increased risk of glans damage. Preliminary examination of the glans and adequate release of preputial adhesions help to prevent complication of circumcision and to identify combined malformations (hypospadia, epispadia, concealed penis.).

[Physiological and pathological conditions of the prepuce in childhood: treatment methods].

The authors analyse treatment of 3235 patients with prepuce pathology aged from 8 days to 16 years, the results of the treatment of preputial sac pathology; describe clinical manifestations of phimosis (physiological, hypertrophic, cicatricial) in children; formulate treatment policy, indications and contraindications for conservative and surgical treatment; provide practical recommendations on hygiene and care for infant and young age boys.

[Diagnosis and treatment of renal injuries in children].

A total of 154 children with renal injury have been treated in 1994-2004. In addition to standard examination all the children have undergone ultrasound examination with doppler investigation of renal flow. By severity of renal damage, the patients were divided into three groups. Group 1 consisted of 117 (75.9%) children with lesions of degree I and 11; group 2 (n = 31, 20.1%) - of degree III and IV; group 3 (n = 5, 3.2%) - of degree V. Group 1 children had contusion of the kidney and local subcapsular ruptures of the kidney. They were treated conservatively. Conservative-expectant policy was employed for patients of group 2 who had deep ruptures of the kidney without urinous infiltration or trauma with minimal accumulation of urine. Thirty children were operated. Urgent surgery was indicated in signs of active hemorrhage, hemorrhagic shock.