Case Report: Bilateral syringocele in an adolescent-area of focus.

Rationale: Cystic dilatation of the bulbourethral gland duct (Cowper's syringocele, CS) is a rare urethral pathology. No more than 150 cases of CS have been reported in the literature, of which the vast majority are children with a unilateral location. Bilateral CS has been reported in eight cases; however, detailed anatomy and clinical manifestations have not been reported. In this study, we report a case of bilateral CS with cavity junctions through the medial septum and its successful minimally invasive treatment in an adolescent. Case presentation: A 16-year-old adolescent patient complained of painful urination and post-micturition urinary dribbling. Magnetic resonance imaging (MRI), urethrography, and ureteroscopy data enabled the establishment of the diagnosis and determination of the type of CS. The surgical treatment that was performed was endoscopic marsupialization of both CS chambers. At follow-up examination after 7 months, the complaints had ceased, and there was complete normalization of urination. The maximum flow rate during uroflowmetry was 35 ml per second, on voiding cystourethrography, the residual cavities were not contrasted, and there was no residual urine or bacteriuria. Conclusion: MRI and retrograde urethrography made it possible to visualize changes in the bulbous part of the urethra, and ureteroscopy was the leading imaging modality. These studies was applied precisely because of the suspicion of the presence of a cavity communicating with the urethra. Minimally invasive surgical treatment for double-chamber CS was successful with no resulting complications.

[Balloon dilation treatment of primary obstructive megaureter in children].

PURPOSE: Investigation of the results of ureteral stricture single balloon dilation in children with primary obstructive megaureter. MATERIALS AND METHODS: Since 2012 to 2020 79 children (65 boys and 15 girls) with primary obstructive megaureter of II and III grades who had 92 affected ureters were operated on by method of ureteral stricture balloon dilation. Duration of postoperative stenting period was Me=68 [48; 91] days, bladder catheterization period - Me=15 [5; 61] days. Follow-up was from 1 to 10 years. RESULTS: There were no intraoperative complications in the group of investigation. Pyelonephritis exacerbation in the early postoperative period occurred in 15 cases (18,98%). Control comprehensive examination revealed that urodynamics of 63 children (79,74%) tended to normalization what persisted in the future. There was no positive dynamics in 16 cases (20,25%). Vesico-ureteral reflux was revealed in 4 cases. DISCUSSION: Assessment of impact of various predictors (passport, urodynamic, infectious, anatomic, operation and postoperative period characteristics) on the treatment results proved that the effectiveness of the procedure depends on the following factors: ureteral stricture length (M-U Test U=202,5 p=0,0002) and features of the stricture rapture during ballooning (Fisher exact p=0,0006). There was significant difference in results in the group of up to 10 mm inclusive stricture length and the longer stricture group (Fisher exact p=0,00001). High activity of pyelonephritis in postoperative period was the predictor of adverse outcome (Fisher exact p=0,00001). CONCLUSION: Practically 80% of children with primary obstructive megaureter may be reliably cured by the method of ureteral stricture balloon dilation. The risk of intervention failure is greatly increased in case of the stricture length is more than 10 mm and technical difficulties of ballooning indicating a high resistance of the narrowed portion of the ureter to dilation.

Kidney triplication with ectopic ureterocele: a case report.

BACKGROUND: Kidney triplication is a rare urological abnormality. Association of triplex kidney and ureterocele is out of ordinary. Treatment of such patients usually implies heminephrureterectomy of the upper moiety. We report a case of a saved function of the upper moiety after minimal invasive surgical procedure. CASE PRESENTATIONS: 5-year old girl complained for continuous wetting. Examination revealed 3 - segmented left kidney with pelvi-ureteric dilation of the upper moiety, IV grade vesicoureteral reflux in the upper moiety, cervical ectopic ureteral orifice of the upper moiety and a commune ureteral orifice of the lower segments. An endoscopic laser dissection of ureterocele was performed. Drainage of the upper moiety of triplex kidney was restored. Examination 18 months later showed no wetting and infection symptoms. Pelvi-ureteric dilation of the upper moiety and cavity of ureterocele decreased to minimal. Grade of vesicoureteral reflux decreased to I. CONCLUSION: Minimal invasive elimination of obstruction of the upper moiety of triplex kidney was successful and led to regress of vesicoureteral reflux, urinary incontinence and let to avoid heminephrectomy.

[Long-term results of organo-safe operation in obstructive ureterohydronephrosis of terminal stage].

A comparative analysis of efficacy of two methods was the purpose of the research. Politano-Leadbetter technique was applied in 41 cases and nipple way was used in 13 cases. The investigation included 45 patients aged from 2 months till 17 years with congenital obstructive ureterohydronephrosis of terminal stage (the pathology was diagnosed from both sides in 15 children). A follow-up period was from 1 till 6 years. Recurrent intervention was required in 31 cases. An analysis of overall results allowed determining the outcome as positive in 26 cases after Politano-Leadbetter operation. There were a vesicoureteral reflux in 6 cases and signs of obstruction appeared in 9 cases. The application of nipple operation had positive results in 9 cases, at the same time, the complication such as vesicoureteral reflux was noted in 2 cases, the signs of obstruction were in 2 cases. The authors prefer using the nipple method of reimplantation in spite of identical results of two different methods.

[Endoscopic plastic operations for vesicoureteral reflux in children].

A 10-year experience with endoscopic treatment of vesicoureteral reflux (VUR) was analyzed in 712 patients. Short hospital stay, high percentage of positive results of the gel endoplasty of the ureterovesical segment, the practical absence of complications characterize endoscopic plastic operations as the first choice method for VUR in children. It allows refusal to use antibiotics for a long time and to perform open surgical interventions.

[Secondary uroliths after surgical correction of urinary bladder extrophy].

The analysis of long-term results of complex surgical correction of urinary bladder extrophy in 83 patients has shown that 21 (25.3%) patients had concrements in the urethra. Multiple bacteriological tests detected urease-producing flora which was managed with specific antibacterial therapy. Two patients were exposed to extracorporeal shock-wave lithotripsy. Low-invasive lithotripsy was low effective and all the patients were operated. Chemical structure of the removed concrements was determined with x-ray difractometry. Recurrent concrements were found in 7 (33.3%) of 21 patients who had not received specific antibacterial therapy. All the stones detected were struvite. Thus, struvite concrements' risk in patients after surgical correction of urinary bladder extrophy can be reduced under the following conditions: suppression of urease-producing flora activity, catheterization regime compliance, systemic sanation of the artificial urinary bladder.

[Surgical treatment of children with autosomal dominant polycystic kidney disease]. / Khirurgicheskoe lechenie detei s polikistozom pochek autosomno-dominantnogo tipa.

The authors dealt with 59 children with different variants of polycystic kidney disease. The age of the patients was from 1 month to 19 years. The autosomal dominant type of inheritance was noted in 52 patients, in 24 of them percutaneous ignipuncture, lumbotomy with ignipuncture and dissection of the cysts, endovideosurgical opening and dissection of the cysts transperitoneally and retroperitoneally were performed. Long-term results were followed during the periods from 6 months till 17 years. Good results were obtained in 12 patients, satisfactory--in 2 patients, unsatisfactory--in 7. The most effective methods are traditional lumbotomy and endovideosurgical correction which are not followed by growth of cysts in the operated kidneys at the postoperative period.

[The surgical treatment of vesicoureteral reflux in kidney duplication in children]. / Khirurgicheskoe lechenie puzyrno-mochetochnikovogo refliuksa pri udvoenii pochek u detei.

The examination of 41 patients with a complete renal duplication and vesicoureteral reflux (VUR) into 57 ureters has shown a direct dependence of morphological immaturity of the parenchyma of the double kidney segment and functional insufficiency of the obturative apparatus of the ostium of the corresponding ureter on the degree of its dislocation corresponding to the normal localization on the inner surface of the urinary bladder. For patients with marked lateral position of the main ostium of the organ saving operations are senseless because of high degree of VUR and deep dysplasia of the renal tissue. In cases with moderate lateralization of the ureter ostium it is expedient to fulfil such antireflux interventions as Lich-Gregoir operations in a "single block" or the endoscopic correction of the ostium with a synthetic medical siloxan rubber or polyacrylamide gel "Interfall".

[The choice of the method for the surgical treatment of bladder exstrophy]. / Vybor metoda operativnogo lecheniia ékstrofii mochevogo puzyria.

129 children with exstrophy of the bladder underwent primary surgical reconstruction according to G. A. Bairov. Morphofunctional findings in these children gave grounds for determination of three degrees of the bladder congenital defects. 39 patients had defect of the 1st degree, 53 of the 2nd and 37 of the 3d degree. The results of plastic reconstruction of the bladder with local tissue support the validity of such procedure only for patients with the congenital defect degree I. For degree II the benefit is relative. In degree III plastic surgery in contraindicated.

[The treatment of vesicoureteral reflux in children]. / Lechenie puzyrno-mochetochnikovogo refliuksa u detei.

The authors summed up the 9 years-long experiences with treatment of 2588 children with vesicoureteral reflux. Conservative methods were successful in treatment of 74% of the patients. Of great importance were antibacterial therapy and treatment of the urinary bladder. Surgical interventions were fulfilled in 26% of the patients. Good effects were noted after Lich-Gregoir, Cowen operations, reimplantation of the ureter in 91.4%, 100% and 94.7% of the patients correspondingly.

[Reconstructive-plastic surgery in bladder exstrophy]. / Rekonstruktivno-plasticheskie operatsii pri ékstrofii mochevogo puzyria.

Among 234 children with exstrophy of the urinary bladder 112 were subjected to reconstructive-plastic operation after G. A. Pair. A good result was produced in 71 cases. In 27 children a satisfactory result was attained only after repeated operations. Reconstructive-plastic interventions had no positive effect in 14 children. By means of electrophysiological and morphological methods three degrees of underdevelopment of the muscular coat of an urinary bladder affected by exstrophy were distinguished. In I degree plastics of the bladder with local tissues is indicated, in II degree the indications are relative, in III degree a plastic operation is not indicated. Choice of the operative method on basis of the morphofunctional condition of the bladder with exstrophy, the use of microsurgical techniques, the formation of a closed pelvic ring, and antireflux operations on the ureters improve the immediate and late-term results of reconstructive-restorative surgical interventions.

[Surgical treatment of complete epispadias in children]. / Operativnoe lechenie polnoi epispadii u detei.

The operative treatment was used in 46 children with total epispadia. In 37 patients operations were made by the Derzhavin method (in eight of them it was one-step plasty of the ureter and penis with local tissues), in 9 patients the operations were made after Savostitski--Young. Long-term results were observed in 38 patients. Good long-term results were obtained in 25 patients (22 following the Derzhavin operation, 3 following the Savostitski--Young operations). The Derzhavin operation is considered to give better results when performed at the age of 6-7 years.

[Results of diverting the urine into the intestines in bladder exstrophy in children]. / Rezul'taty otvedeniia mochi v kishechnik pri ékstrofii mochevogo puzyria u detei.

An analysis of immediate and long-term results of urine elimination into the intestine in exstrophy of the urinary bladder in 100 children has shown sigmocystoanastomosis to be the optimal method which reliably restores continence of urine and prevents the development of urinary infection and pyelonephritis.