[Plastic repair of the anterior abdominal wall in bladder exstrophy]. / Plastika perednei briushnoi stenki pri ékstrofii mochevogo puzyria.

In 1987-1993 surgical treatment for exstrophy of the bladder was performed in 35 children at the age 8 months--3 years. All the patients underwent one-stage transplantation of the ureters into the semi-isolated segment of the sigmoid colon with antireflux protection of the ostia, bladder extirpation and repair of the anterior abdominal wall. The most difficult stage of the intervention is repair of the abdominal wall defect after removal of the large bladder. Related complications arising in 16% of the surgical patients impose the problem of the technique of safe filling of the abdominal wall defect. In 16 patients with large bladder its demucosation was followed by strengthening of the detrusor muscles with the help of interrupted sutures with fixation to underdeveloped oblique abdominal muscles. The skin defects was filled by raised movable skin flaps on both sides of the divided pubis. The above technique reduced the number of postoperative complications three times. Intestinal eventration was not observed. The wound suppuration and partial defect of the sutures occurred in 1 case. The rest 15 children exhibited healing with minimal scarring and good cosmetic effect.

[The treatment of distal hypospadias in children]. / Lechenie distal'noi gipospadii u detei.

The authors propose a new treatment of distal hypospadia without distortion of the penis. From 1990 to 1994 the operation was performed in 193 boys aged from 4 months to 14 years. The new procedure was tried in 67 patients. It consists in dissection of the skin flap along the ventral surface of the penis with a special cut on the glans penis. The proximal part of the flap is isolated and placed on the glans penis. The urethra is formed on the urethral catheter using interrupted inverting subcuticular sutures (prolen 6/0). The urethra is covered with the preputial skin transformed from the dorsal penis. The edges of the dissected glans penis are sutured with cutaneous preputial flap in the frenulum region to increase the urethral diameter in the distal part. The 6-48-month follow-up results are good: postoperative complications occurred in 7.4% of cases instead of 15.5%: urethral fistulas and postoperative wound opening were registered in 3 and 2 patients, respectively. Reoperations were successful. Cosmetic and urodynamic results were good. The above method of urethral reconstruction is a method of choice in the treatment of distal hypospadia.

[Guided transcutaneous puncture biopsy of the kidneys under ultrasound control in children with nephrourological diseases]. / Pritsel'naia chreskozhnaia punktsionnaia bipsiia pochek pod kontrolem ul'trazvuka u detei s nefrourologicheskimi zabolevaniiami.

The results of 836 transcutaneous puncture renal biopsies in 277 children under 15 years of age demonstrate that the informative value of renal biopsies has risen from 91.6 to 95%, while the number of complications reduced from 26 to 4.9% due to modification of the biopsy techniques and ultrasound control.

[The treatment of hydronephrosis in children]. / Lechenie gidronefroza u detei.

The paper presents the analysis of hydronephrosis treatment performed within 1987-1993 in 76 children. Special attention is paid to surgical techniques, methods of drainage with regard to hydronephrosis degree and pelvic contractility. The drainage system of the renal calicopelvic system using double-opening tube with continuous drop lavage is designed, the scheme of the patients' postoperative management is described. Good outcomes of pelvic electrostimulation are reported.

[Endourethral correction of valvular obstruction in children]. / Endouretral'naia korrektsia klapannoi obstruktsii u detei.

Endourethral dissection of valvular cusps was carried out by means of an urethrotome in 34 boys with Type I and III valves of the posterior urethra. The indications for and the techniques of the dissection on depending on the type of the valve are discussed and measures for preventing complications are suggested. Endoscopic, radiological, and urodynamic methods of examination of the lower urinary tract determined the therapeutic tactics and help in evaluation of the efficacy of the operative treatment. The method allows correction in patients with valves to be performed in one stage in the compensated stage of the disease and after preliminary derivation of urine in the decompensated stage. The authors recommend optic urethrotomy for the treatment of children with valves of the posterior urethra.

[Prolapse of the urethral mucosa in girls]. / Vypadenie slizistoi uretry u devochek.

In the recent 9 years 39 girls aged from 2 to 10 years were treated at the clinic for prolapse of the urethral mucosa. Among them 24 had circular and 15 had segmental prolapse. The disease was encountered most frequently between 6 and 10 years of age, predominantly in the summer. Complex treatment was started with nonoperative measures which were followed by operation if the prolapse persisted or recurred. Spontaneous reduction of the mucosa occurred in 6 of 22 children who were treated by nonoperative measures, in 3 cases the effect was temporary and a recurrence developed. Operative excision of the mucosa was carried out in 36 girls. The results were good. The article discusses the etiopathogenesis of the disease and analyses the morphological changes in the removed urethral mucosa.