[Dynamic transperineal ultrasonography as indication criteria for biofeedback therapy in children with dysfunctional voiding].

Disorders of pelvic organs' evacuation function, manifested by difficulty in urination and constipation, in conjunction with incontinence, and childhood stool smearing is an urgent medical and social problem. The study presents results of treatment of 36 children (mean age 7,2 +/- 2,3 years) with non-neurogenic variants of pelvic organ dysfunction. The choice of treatment was based on an attempt to form managed urination. Indications to treatment were defined both by traditional methods, and by transperineal ultrasonography - the method developed by the authors. Increased rear urethrovesical angle at rest and during functional tests with retention and straining, the deviation of the bladder neck and urethra to sacrum, shortening of urethra and bladder neck, lack of bladder neck and urethra movement, or the inability to perform volitional exercises were seen as signs of pelvic floor paradoxical movements. Analysis of the results of clinical trials showed, that the method is a reliable, non-invasive and does not require expert class ultrasound equipment. The treatment consisted of biofeedback therapy sessions performed in outpatient settings. 25 children were found to have positive changes, 7 of them fully recovered from voiding dysfunction.

[Coupling between the hemodynamic parameters and the morphological changes in the kidney in children with congenital hydronephrosis].

The data of renal ultrasonographic and Doppler studies were comparatively assessed in children with congenital hydronephrosis. The degree of renal B-mode ultrasound hemodynamic parameters was used as the basis for grouping of the children. The resistance index (RI) of all branches of renal arteries receives attention. Morphological studies were carried out on renal biopsy specimens from 29 children from different groups and on 12 removed kidneys; the expression of TGF beta1 and alphaSMA was revealed using the streptavidin-biotin-peroxidase method. Morphological changes as hypoplasia or dysplasia became more pronounced from Group 1 to Group 3, RI increasing to peak in Group 3. Vascular changes were confined to compensatory processes following the pattern of remodeling that was manifested by vascular wall thickening and a gradual increase in RI. Failing compensatory processes resulted in the development of renal functional and hormonal decompensation and in the elevation of RI. There was a coupling between the magnitude of morphological changes and RI increases. A set of the findings emphasizes the undoubtedly important role of renal ultrasound study that makes it possible to judge the state of the vascular bed and to suggest renal structural problems in congenital hydronephrosis.

[Simple renal cysts in children: analysis of surgical treatment].

The results of solitary renal cysts (SRC) treatment in children have been analysed. Laparoscopic and puncture methods have been used. The algorithm of SRC patients' management is proposed. Ninety children with simple renal cysts aged 1 to 15 years were treated in Moscow city N.F. Filatov children's hospital N 13 in 1996-2007. The diagnosis was made basing on the findings of ultrasound investigation, computed tomography and radionuclide scintigraphy. Surgical treatment was applied only in case of large cysts (2.5 cm and more), connection with collective renal system and clinical manifestations. In small-size cysts and normal urodynamics the patients were followed up. Laparoscopic excision of the cyst was performed in 71 cases. The punctures were made under ultrasonic guidance with catchment or without it. The cyst content was aspirated with following sclerosing and administration of 96% ethanol into the cyst cavity. There were no postoperative complications. Good results (cyst disappearance) were achieved in 64 patients after laparoscopic and in 13 after paracentetic treatment; satisfactory results (cyst size reduction and relieve of clinical symptoms) were obtained in 6 children after laparoscopic and in 4 after percutaneous puncture. Laparoscopic treatment failed in 1 case of intraparenchymatous cyst which relapsed. It is recommended to begin treatment of simple renal cysts with use of the paracentetic method with catchment and following sclerosing proving positive results after original surgery.

[Surgical correction of multiple ureter obstructions in children]. / Khirurgicheskaia korrektsiia mnozhestvennykh obstruktsii mochetochnikau detei.

Obstruction in the pyeloureteral region is often combined with an obstacle of an anatomical or functional character in the distally located parts of the ureter. The authors treated by operation 80 patients with congenital hydronephrosis in the period from 1986 to 1991. An additional distally located stricture of the ureter was found during intraoperative catheterization in 10 cases. In 9 of 10 cases the obstacle was at a distance of 1.7-2.0 cm from the pelvioureteral junction. Due to the small distance between the strictures the affected segment could be resected and an Andersen-Haynes anastomosis formed. The authors believe that the presence of double obstructions indicates marked dysplastic changes of the ureteral wall. In view of this, the use of optic magnification, microsurgical instruments, and ultrathin suturing material in the formation of the anastomosis is recommended. In 3 children operated on by the above discussed method the postoperative course was uneventful. A clinical case is given in illustration. It is suggested in the discussion that the indications for retrograde pyelography may be widened so as to identify additional strictures of the ureter at the diagnostic stage.

[Reconstructive microsurgery in the combined treatment of children with spinal cord disorders]. / Rekonstruktivnye mikrokhirurgicheskie vmeshatelstva v kompleksnom lechenii detei so spinnomozgovoi patologiei.

The use of microsurgical techniques in operations for autoneuroplasty with intercostal nerves in patients with congenital abnormality of the spinal cord makes it possible to adequately approximate of the interrupted roots of the spinal cord and creates promising prerequisites for restoration of pelvic and motor functions. Observations have shown that the functions of the pelvic organs in children are gradually restored and active movements appear in the lower extremities. The use of the omentum on a nutrient pedicle made it possible to arrest hydrocephalic phenomena. Due to its obvious efficacy, the suggested method can be recommended for wider use in pediatric neurosurgery.

[The treatment procedure in vesicoureteral reflux in young children]. / O taktike lecheniia puzyrno-mochetochnikovogo refliuksa u detei mladshego vozrasta.

A group of 54 children with vesicoureteral reflux recognized in the first 3 years of life was analysed. All of them received adequate nonoperative treatment including prolonged antibacterial therapy and management of cystitis and urodynamic disorders of the lower urinary tract. According to the degree of vesicoureteral reflux (VUR), the children were divided into two groups. Group 1 consisted of 29 children with Degrees I-II VUR in 37 ureters. Nonoperative treatment was effective in 75% of cases. Retrospective appraisal of urograms revealed no signs of cicatricial-sclerotic changes in the parenchyma of the kidneys. In five children with Degree II VUR of long duration the kidneys were smaller than the normal size of their age. Group 2 was made up of 24 patients with Degrees III-V VUR into 34 ureters. No changes were found in the renal parenchyma on urograms made during the first examination. During follow-up, however, signs of reflux-nephropathy (RN) were detected, which according to the recommendations of the International group for reflux study were evaluated as Degree I RN--10 cases, Degree II RN--12 cases, Degree III RN--8 cases, and Degree IV RN--4 cases. The authors believe nonoperative treatment of children with Degrees I-II VUR to be justified, patients with Degrees III-V VUR call for active surgical intervention from the moment that the reflux is recognized.

[The surgical treatment of congenital hydronephrosis in children]. / Operativnoe lechenie vrozhdennogo gidronefroza u detei.

Available are the results of surgical treatment (Andersen-Hynes operation and its modifications) of 85 children with hydronephrosis bor the period 1981-1987. The patients' age ranged from 6 months to 14 years. Anastomotic stenosis occurred in 12% of the procedures as a result of: urethral or pelvic trauma when suturing, wound channels due to the needle perforating puncture, catgut unwanted properties, tissue strain at the anastomosis site, inadequate renal drain. This necessitates modification of the operative technique: surgical manipulations restricted to the operated on pelvic part and pelvic-urethral segment, optical amplification, microsurgical instruments, synthetic suture. An original pyelostoma made of silicon rubber was used in draining. Out of 34 surgical cases, good results were achieved in 31, satisfactory in 3. No complications were recorded.

[Formation of a urinary reservoir from a small intestinal graft in children with exstrophy of the urinary bladder]. / Sozdanie mochevogo rezervuara iz tonkokishechnogo transplantata u detei c ékstrofiei mochevogo puzyria.

The authors suggest a new approach to the treatment of patients with exstrophy of the urinary bladder-the formation of an urinary reservoir from a detubulerized intestinal graft after II Kocks' method. This method, as well as its analogues, is mainly used in adults after radical cystectomy. Improved surgical techniques have been suggested on the basis of experimental works which allow the age features and the peculiarities of the functional condition of the formed reservoir to be taken into account. Analysis of the results of clinical use of the suggested method showed it to be effective in solving the problem of rehabilitation of patients with exstrophy of the urinary bladder, which allows it to be recommended as the operation of choice in the management of this developmental anomaly.

[Anatomical causes of functional failures after surgery of anorectal malformations]. / Anatomicheskie printsipy funktsional'nykh neudach v khirurgii anorektal'nykh porokov razvitiia.

The authors observed 54 patients with clinico-functional disorders who had been operated upon for anorectal anomalies. The complex program of examination of these patients shows that the leading etiological moment in the development of different complications is pathology of the external sphincter of the rectum which was observed in 87.3% of children.

[Use of suspended catheters (stents) during surgery of hydronephrosis in children]. / Primenenie podvesnykh kateterov (stentov) pri operatsiiakh po povodu gidronefroza u detei.

The application of hanging catheters (stents) in operations for hydronephrosis in children has considerable advantages over classical (open) methods of drainage. Bacteriological investigations of analyses of urea performed in open and closed closed systems of drainage have shown less incidence of infection of the upper urinary tracts with intrahospital gram-negative flora after operation on patients operated upon with using stents, which gave less amount of postoperative complications.