[Postpartum fecal incontinence. State of the problem]. / Poslerodovoe anal'noe nederzhanie. Sostoyanie problemy.

A review of the current national and foreign literature is devoted to epidemiology, risk factors, causes, diagnosis and modern treatment approaches for fecal incontinence (FI). Incidence of FI in early and delayed period after childbirth is 30% or more. At the same time, up to 87% of postpartum injuries of anal sphincter remain undiagnosed. Importantly, routine caesarean section does not reduce the risk of incontinence. In addition to typical complaints of spontaneous gas and stool, diagnosis of FI after childbirth includes transrectal ultrasound, MRI, anorectal manometry and pudendal nerve terminal motor latency testing. Survey of proctologists from different regions of Russia revealed a high demand from medical community for educational programs devoted to diagnosis, treatment and rehabilitation of patients with postpartum perineal injuries.

[E.coli bacterial suspension in the treatment of hemorrhoids]. / Vozmozhnosti ispol'zovaniya preparatov suspenzii kul'tury bakterii E.coli v lechenii gemorroya v svete sovremennykh kontseptsii.

Hemorrhoidal disease is the most common proctologic disease and the search for new treatment methods, as well as an in-depth understanding of the mechanisms underlying effects of well-known agents on disease pathogenesis still remain relevant. There have been long recognized the effects of the E.coli bacterial culture suspension (BCS) as a therapeutic means eliciting decreased exudation during inflammation, wound healing, tissue regeneration, and stimulated immunity. Here, based on recent findings related to innate and adaptive immune cells, we set out to present mechanisms accounting for some effects coupled to commensal bacteria, particularly inactivated E.coli BCS, which are important for understanding pathogenesis-related action of drug Posterisan and Posterisan forte, and outline their broad application in therapy of hemorrhoids. Based on the analysis, it was concluded that such effects are mediated via multi-pronged and complementary interactions between diverse human receptors expressed in the anorectal region cells and microbial components: NOD ligands, metabolites, enzymes, heat shock proteins and nucleic acids, which lead to production of pro-inflammatory cytokines by anodermal colonocytes, innate and adaptive immune cells, neurons in the submucosal plexus covered by transitional zone epithelium, and hemorrhoid plexus endothelium. Based on current concepts, it may be plausible that E.coli BCS-derived biologically active components contained in drug Posterisan are capable of exerting both positive local and systemic effects, which extend our understanding and substantiate its use in hemorrhoidal disease. The effectiveness of using Posterisan and Posterisan forte is corroborated by their indications in real-life clinical practice, both as a conservative therapy as well as after surgical interventions.

[Choice of optimal treatment strategy for acute perianal thrombosis. Results of online survey]. / Vybor metoda lecheniia ostrogo perianal'nogo tromboza. Rezul'taty oprosa vrachei.

OBJECTIVE: To study the factors influencing the physicians' choice of treatment strategy in patients with acute perianal thrombosis. MATERIAL AND METHODS: A survey was conducted among 124 Russian colorectal surgeons. RESULTS: This survey showed that the choice of treatment strategy varies between private and state clinics. Conservative approach is preferred in government clinics (p=0.024). The time factor is more important for professionals. Hemorrhoidectomy is preferred in private clinicians, thrombectomy - in public clinics. The majority of physicians note that pregnancy significantly affects choice of treatment tactics. The most important factors to refuse surgery are pregnancy (r=0.796), age over 70 years (r=0.655), duration of thrombosis over 4 days (r=0.791). Large thrombosed node (2-3 cm), severe pain syndrome (r=0.858) and duration of disease less than 3 days (r=0.901) determine preferable surgical approach. CONCLUSION: The choice of treatment of acute perianal thrombosis depends on not only duration of disease, severity of pain syndrome, age and pregnancy, but also on the type of the hospital. Conservative treatment is preferable in the majority of national state hospitals. Moreover, most surgeons prefer less aggressive treatment options in the state clinics. Further research is needed to determine any important factors limiting more effective surgical treatment besides pain and patient's attitude toward the disease.

[Duodenal neuroendocrine tumors]. / Neiroéndokrinnye opukholi dvenadtsatiperstnoi kishki.

Significant augmentation of the incidence of duodenal neuroendocrine tumors duodenum has been observed in recent decades. There are 5 histological types of these tumors: gastrinoma (50-60%), somatostatin-producing tumor (15%), inactive serotonin-containing tumors (20%), poorly differentiated neuroendocrine carcinoma (<3%) and gangliocytic paraganglioma (<2%). The majority of tumors are localized within the bulb and postbulbar part of duodenum, 20% are found in periampular area. Treatment strategy depends on dimensions, localization, histological class, stage and type of tumor. It is believed that endoscopic resection is permissible for small inactive tumors (G1) located above major duodenal papilla. The majority of other neoplasms requires surgical resection. Personal experience of various surgeons is limited by small group of patients. Therefore, it is necessary to summarize results for selection of optimal treatment.

Global minimally invasive pyeloplasty study in children: Results from the Pediatric Urology Expert Group of the European Association of Urology Young Academic Urologists working party.

INTRODUCTION: Minimally invasive pyeloplasty (MIP) for ureteropelvic junction (UPJ) obstruction in children has gained popularity over the past decade as an alternative to open surgery. The present study aimed to identify the factors affecting complication rates of MIP in children, and to compare the outcomes of laparoscopic (LP) and robotic-assisted laparoscopic pyeloplasty (RALP). MATERIALS AND METHODS: The perioperative data of 783 pediatric patients (<18 years old) from 15 academic centers who underwent either LP or RALP with an Anderson Hynes dismembered pyeloplasty technique were retrospectively evaluated. Redo cases and patients with anatomic renal abnormalities were excluded. Demographics and operative data, including procedural factors, were collected. Complications were classified according to the Satava and modified Clavien systems. Failure was defined as any of the following: obstructive parameters on diuretic renal scintigraphy, decline in renal function, progressive hydronephrosis, or symptom relapse. Univariate and multivariate analysis were applied to identify factors affecting the complication rates. All parameters were compared between LP and RALP. RESULTS: A total of 575 children met the inclusion criteria. Laparoscopy, increased operative time, prolonged hospital stay, ureteral stenting technique, and time required for stenting were factors influencing complication rates on univariate analysis. None of those factors remained significant on multivariate analysis. Mean follow-up was 12.8 ± 9.8 months for RALP and 45.2 ± 33.8 months for LP (P = 0.001). Hospital stay and time for stenting were shorter for robotic pyeloplasty (P < 0.05 for both). Success rates were similar between RALP and LP (99.5% vs 97.3%, P = 0.11). The intraoperative complication rate was comparable between RALP and LP (3.8% vs 7.4%, P = 0.06). However, the postoperative complication rate was significantly higher in the LP group (3.2% for RALP and 7.7% for LP, P = 0.02). All complications were of no greater severity than Satava Grade IIa and Clavien Grade IIIb. DISCUSSION: This was the largest multicenter series of LP and RALP in the pediatric population. Limitations of the study included the retrospective design and lack of surgical experience as a confounder. CONCLUSIONS: Both minimally invasive approaches that were studied were safe and highly effective in treating UPJ obstruction in children in many centers globally. However, shorter hospitalization time and lower postoperative complication rates with RALP were noted. The aims of the study were met.

[Balanoplasty in accordance with the normal anatomy--the key to successful correction of hypospadias].

The features of the normal anatomy of the balanus and distal urethra were evaluated. It was found that there is a physiological mechanism of stretching of distal urethra during urination owing to the scaphoid fossa, bridle and hippocrepiform-located corpus spongiosum of balanus. Based on these data, modified balanoplasty was proposed, which consisted in mobilization and increase the length of corpus spongiosum of wings of balanus by longitudinal incisions, followed by suturing wings of balanus with separate inside sutures on a short distance not above 3-5 mm and their dipping at a depth not above 1-2 mm. Between 2005 and 2010, 410 patients aged 1 to 18 years underwent surgeries. 90 (22%) patients underwent reoperation. Boys with glandular and coronal hypospadias (n = 69) underwent MAGPI surgery. Patients with penile hypospadias (n = 243) underwent TIP-Snodgrass (n = 72), onlay (n = 23), Mathuie (n = 123), and GTIP (n = 25) surgeries. In children with scrotal and perineal hypospadias (n = 98), method of transverse tubularized foreskin flap was used. All patients were arbitrarily divided into two groups. The study group consisted of patients (n = 210) who underwent modified balanoplasty. The comparison group consisted of 200 patients who underwent conventional balanoplasty. Complication rate after hypospadias correction was reduced from 18 to 12% in penile hypospadias, and from 28 to 18% in scrotal and perineal hypospadias. It is shown that modified balanoplasty excludes formation of obstructive ring of corpus spongiosum in the distal urethra. The results of urodynamic examinations in follow-up period showed improvement of mean urinary flow rates.

[The choice of method of urethroplasty in patients with distal and middle hypospadias].

Retrospective analysis of results of the most frequently used methods of urethroplasty: urethroplasty using tubularized dissected urethral area (TIP), urethroplasty using tubularized dissected urethral area with inset the free flap of the foreskin (GTIP) and Mathieu surgery in patients with coronary, distal and middle hypospadias (in primary and recurrent surgery), was performed. From 2005 to 2010, 300 patients aged 7 months to 19 years underwent the surgery. There were no early postoperative complications in any patient, with the exception of early accidental removal of the catheter in 4 patients. Long-term results of one-stage correction of hypospadias were followed-up during period of 6 months to 4 years. Late complications included urethral fistula and stenosis. Analysis of the results of operations led to the conclusion that the TIP urethroplasty with Snodgrass modification can be performed as either primary or recurrent surgery in case of normal size of balanus and urethral area. However, in case of changes in the urethral area, scarring and small sizes of balanus, appropriate surgery is Mathieu operation.