[Transurethral ureteropyeloscopy with lithotripsy and lithoextraction in children].

High efficacy of endoscopic treatment of urolithiasis in adults stimulated its introduction in the strategy of urolithiasis management in children. 133 ureteropyeloscopies with ureterolithotripsy and ureterolithoextraction was performed in 121 children (boys and girls, age 11 months to 16 years). Concrements (0.5-2.0 cm and larger) located in the caliceal-pelvic segment, ureter, 12 patients had bilateral urolithiasis. Ineffective extracorporeal lithotripsy (ELT) was followed by ureteropyeloscopy in 86 (71%) cases. Rigid and fibroureteropyeloscopes were used. Due to ureterolithotripsy and lithoextraction, concrements were removed completely in 98 (80.9%) patients including 5 children with ligature concrements and 11 children with ureteral strictures which required additional endoureterotomy and removal of ligature. In 23 (18%) cases when migration of concrements and their fragments did not allow complete elimination of the concrements, the kidney in ureteropyeloscopy was drained by catheters or stents with further ELT. Postoperative exacerbation of pyelonephritis treated conservatively was registered in 20 (16.5%) children. Long-term complications were not seen. Thus, transurethral uretheropyeloscopy with lithotripsy and lithoextraction is highly effective, low invasive, safe treatment of urolithiasis in children in failure of ELT.

[Diagnosis and treatment of recurrent surface cancer of the urinary bladder (early repeated cystoscopy and biopsy)]. / Diagnostika i lechenie retsidivov poverkhnostnogo raka mochevogo puzyria (ranniaia povtornaia tsistoskopiia i biopsiia).

In spite of some achievements in the field of oncourology, the problem of diagnosis and treatment of surface cancer of the urinary bladder (SCUB) remains urgent because of early recurrence and progression after TUR (50 and 30%, respectively). Repeated cystoscopy and biopsy early after surgery enable the physician to establish a real stage of SCUB (invasion into the bladder wall--criterion T and cell differentiation--criterion G). Early accurate staging of the disease allows design further policy of treatment. Early repeated cystoscopy and biopsy detected recurrence of transient cell SCUB in 51 (24.75%) patients. In 20 (9.7%) patients recurrent tumor located at the site of the previous operation. In other places recurrences were detected in 31 (15.05%) patients. Recurrent tumor was found in 23 (11.16%) cases at stage Ta and 28 (13.6%) patients at stage T1; in 15, 30 and 6 patients with high, moderate and low malignancy grade (22.06, 24.79 and 35.29%, respectively). SCUB progression developed in a total of 15 (7.28%) patients: by T criterion (T1-T2a) in 9 (4.37%) patients and by criterion G (G2-G3) in 6 (2.91%) patients. Thus, early repeated cystoscopy and biopsy detect early residual and recurrent SCUB facilitating design of further treatment policy.

[Endotomy in treating strictures of the upper urinary tract]. / Endotomiia v lechenii striktur verkhnikh mochevyvodiashchikh putei.

The analysis of outcomes of 102 operations of transurethral and percutaneous endotomy in 100 patients is provided. Primary strictures of the upper urinary tract (UUT) were detected in 26 cases. Postoperative strictures existed up to 3 months in 19 cases, 3 to 12 months in 21 cases and at least 12 months in 36 cases. The causes of the strictures lie in previous surgical interventions on the UUT. Of the 102 endoscopic operations, 49 ones were conducted via percutaneous approach, nephrostomic fistula was used in 11 cases. In 42 endotomies the approach to UUT strictures was transurethral, a "cold knife" was applied in 78 operations, electric current in 24 cases. Follow-up for 12 months to 9 years documented good and satisfactory results in 90 (90%) patients. Open operative intervention was necessary for elimination of the intraoperative complication in 1 case, of the postoperative one also in 1 case. The remaining endotomy complications were treated conservatively. Reoperations due to endotomy failure were made in 8 cases of 10. Endotomy of UUT strictures is indicated in primary and early postoperative strictures 0-1 cm in size located at any site of normally developed UUT accessible for rigid endoscopic instruments from percutaneous or transurethral approaches.

[Radiographic-endoscopic diagnosis and treatment of obliterations of the upper urinary tract]. / Rentgenoéndoskopicheskaia diagnostika i lechenie obliteratsii verkhnikh mochevykh putei.

Potentialities of x-ray endoscopic diagnosis and treatment of upper urinary tracts (UUT) obliterations were studied in 26 and 21 patients, respectively. The causes of obliteration were previous urological, surgical, gynecological operations, radiotherapy (one case). Percutaneous or transurethral UUT recanalization was performed in 5 and 16 patients, respectively. The length of the obliteration varied from 0.3 to 1.7 cm. It was located at the level of ureteropelvic segment in 13(62%), in the upper third of the ureter in 4(19%) and in the lower third of the ureter in 4(19%) patients. UUT endoscopic recanalization was successfully performed in 17(81%) patients. The operation took 60-90 minutes. Minor complications were corrected conservatively. Control examination was made after 6 to 15 years follow-up. The result was assessed as positive in the absence of clinical symptoms, recurrent stricture(obliteration), in improvement or no change in renal function. These criteria were met in 14(66.7%) patients. One patient has undergone nephrectomy because of highly deficient renal function and dislocation of the nitinol spiral outside recanalization zone. Two patients live with drained kidney in spite of UUT restored patency. The method proved effective and can be used as first-line therapy in short obliteration (< 1 cm), relatively intact renal function and in the absence of UUT marked hypotonia, more so as the failure does not complicate further surgery. Combined x-ray endoscopic diagnosis is presently most significant in determination of complete stricture(obliteration) of ureteropelvic segment and the ureter, its length and location.

[Transurethral endoureteropyelotomy]. / Transuretral'naia éndoureteropielotomiia.

Transurethral endoureteropyelotomy (TE) finds application in the treatment of the upper urinary tract (UUT). The method implies transurethral dissection of the stricture with "cold" knife, endoscopic scissors, hook-like electrode or laser applicator under roentgenoendoscopic control with subsequent intubation of the stricture by internal stent for 4-6 weeks. Since 1992 TE has been performed in 31 patients (19 males, 12 females) aged from 13 to 70 years for pelviureteral and ureteral strictures (19 and 12 cases, respectively). The length of the narrowing varied from 0.4 to 2.7 cm, 7 patients had congenital and 24 acquired UUT strictures. 26 patients were followed up for 6-48 months. Good therapeutic results (absence of the symptoms and pyeloectasis, improvement of renal function) were observed in 22 (85%) patients. Serious postoperative complications were represented by a trauma of the "crossing" arteries in the pelviureteral zone. To avoid it, a precise preoperative diagnosis of the vascular bed is required.