Cryptorchidism: a comprehensive assessment of the terminology and classification

The analysis of literature data (PubMed database, Google Scholar) is presented, devoted to the problematic study of the cryptorchidism's terminology and classification. The literature periodically calls for systematization terms used in describing the position undescended testis. Due to the confusion in terminology, it is difficult to generalize and analyze the data obtained. The same position of the undescended testis is described differently by various authors, which led to the appearance of many authors' cryptorchidism classifications at the beginning of the 21st century. This review of the literature states the fact that, over time, no consensus has been found regarding the classification of undescended testicles. Currently, there is a need to generalize the available data to select the optimal treatment algorithm. If the treatment algorithm for the palpable testicles is well studied, then the choice of a treatment method for the cryptorchidism non-palpable forms remains debated in the surgical community

Snodgrass procedure for distal penile and mid-shaft hypospadias repair in children

Introduction. Hypospadias is one of the most frequent penile malformations in newborn boys. Warren Snodgrass developed the «tubularized incised plate» (TIP) urethroplasty that is the most often procedure used in the surgical treatment of distal hypospadias for the last 20 years. Despite the great popularity of the technique, its no less famous Grafted TIP (GTIP) modification appeared. The technique is aimed at filling the defect in the urethral site with a foreskin free flap followed by tubularized urethroplasty.Purpose of the study. To compare the outcomes of TIP and GTIP procedures in our clinic which have been performed in the last 10 years.Materials and methods. One hundred-fourteen boys with hypospadias (aged 6 mo – 15 years) were operated on using the TIP technique and its modification GTIP during 2010 – 2020 (Sochi Center of Motherhood and Childhood Protection). The patients were: boys up to 1 year – 27 (23.7%), from 1 to 3 years – 57 (50%), 4 – 7 years – 19 (16.7%), from 8 to 14 years – 14 (12.3%). Primary repair was done in 112 cases (98.2%), the second procedure was done in 2 (1.8%) cases. There were 94 (82.5%) boys with distal hypospadias and 20 (17.5%) children with mid-shaft hypospadias. All patients were examined 3 and 12 months after surgery. We assessed the degree of skin scar process on the penile shaft, the location of the meatus and the quality of urination during the examination.Results. We observed 27 (23.7%) complications after urethroplasty out of 114 treated boys. There were 13 (11.4%) cases of urethral fistula, which were secondary repaired 6 months later. Meatal stenosis was observed in 2 (1.8%) cases, which required secondary meatoplasty. Repeat urethroplasty was done in 10 (8.7%) cases due to neourethral suture failure. There were also 2 (1.8%) cases of secondary penile curvature that required repeat surgery. The good cosmetical and functional results were achieved finally in all children.Conclusion. The analysis of our ten-year experience of using TIP-urethroplasty and its GTIP modification did not reveal significant differences in the overall incidence of postoperative complications. Yet, using the TIP procedure is associated with more fistulas. There were more cases of urethral suture failure in children whom the GTIP technique was performed. Our data suggest the need for a selective approach in the formation of indications for using TIP and GTIP procedures, along with research aimed at finding criteria for patient selection

Lower pole obstructive megaureter of duplex kidney: an exception to the Weigert-Meyer rule

Introduction. Anatomical features of the urinary tract in patients with duplicate kidneys are described using the Weigert-Meyer rule, since the orifice of the upper ureter has an ectopic location (inferomedial) and the orifice of the lower ureter has an orthotopic location (superolateral). However, there are rare cases of violation of this rule, complicated by obstructive megaureter, ectopic ureteral orifice, the presence of ureterocele.Objective. To report the rare clinical case of a lower pole obstructive megaureter as a violation of the Meyer-Weigert rule in the patient with complete ureteral duplication and to describe the use of ureteroureterostomy as an effective and safe method of surgical correction of the presented anomaly.Clinical case. We present a case of the infant (5 months old) with a lower pole obstructive megaureter. This pathology was identified through intravenous urography and voiding cystourethrography. Laparoscopic proximal end-to-side ureteroureteroanastomosis was chosen as a surgical treatment. Postoperative control intravenous urography showed the effectiveness (a reduction in the lower pole collecting system of the duplex kidney was revealed) and the safety of this method of correction.Conclusion.  There are only several clinical cases about exceptions to the Weigert-Meyer rule reported in literature, and most of them are about adult patients. The main surgical method of treatment in such cases is heminephrectomy. To our knowledge, this is the only reported case of using ureteroureterostomy in the patient with a lower pole obstructive megaureter. This technique has shown its effectiveness and safety for restoring the patency of the urinary tract, confirmed during the control postoperative examination

Diagnostics of testicular torsion using the TWIST scale (Testicular Workup for Ischemia and Suspected Torsion)

Introduction. Testicular torsion (TT) is the most common pediatric emergency urological pathology. To reduce the duration of the diagnostic stage, systems for assessing the risks of testicular torsion based on anamnesis and clinical symptoms were proposed. In 2013, Barbosa et al. proposed the TWIST system (testicular examination for ischemia and suspected torsion), which became the most well-known and widespread. This system makes it possible to identify groups of patients who do not require scrotal ultrasound, which reduces the number of stages in the diagnosis of TT.Objective. To evaluate the experience of using and diagnostic significance of the TWIST scale based on available data in scientific publications.Materials & methods. Review and analysis of literature data on the use of the TWIST scale.Results. We conducted an analysis of 13 publications, in which the results of using TWIST with statistical analysis were published. In all articles, the final diagnosis was established according to Doppler scrotal ultrasound or intraoperatively. Analysis of publications shows that even in large foreign medical centers there is a problem of emergency scrotal ultrasound, which increases the time of testicular ischemia with ТТ. To use the TWIST scale, only history and physical examination data are needed. Any specialist can use the scale in his practise. The low probability of TT in the low-risk group makes it possible not to perform routine scrotal revision, and, consequently, material and human resources are saved.Conclusion. Literature analysis has shown that the use of the original TWIST scale proposed by J.A. Barbosa, in case of suspected testicular torsion, has sufficient diagnostic accuracy, high sensitivity and specificity of TT detection, which significantly reduces the need for ultrasound, reduces the diagnostic time before surgery, that increases testicular survival

Intravesical and extravesical ureteral reimplantation in children with bilateral refluxing megaureter: comparison of results

Introduction. Extravesical ureteral reimplantation is an accepted technique for the surgical treatment of high-grade vesicoureteral reflux. However, many surgeons continue to use an intravesical technique, including for the megaureter. We present our experience and outcomes with these techniques for primary bilateral refluxing megaureter.Purpose of the study. To improve the results of surgical treatment of refluxing megaureter in children.Materials and methods. A retrospective study was performed of 95 patients who underwent ureteral reimplantation between 2006 and 2019. The age of patients at the time of surgery was from 4 months to 13 years (median — 27.6 months), boys were 71 (74.7%), girls were 24 (25.3%). All patients are divided into 2 groups depending on the method of treatment. Group 1 consisted of 65 patients who underwent Cohen single-stage bilateral transvesical ureteral reimplantation. Group 2 included 30 children who underwent two-stage Barry extravesical ureteral reimplantation. The interval between operations was from 1 to 63 months (median — 5.2 months). Patient demographics, surgical technique and outcomes were recorded. A successful postoperative outcome was defined as improved hydronephrosis and no vesicoureteral reflux.Results. Median follow-up period was 3.2 years. The overall success rate was 80% for patients and 88% for ureters. Postoperative grade III – IV reflux had 15 patients (15,8%) and 16 ureters (8,4%). Persistent ureterohydronephrosis had 4 children (4,2%) and 6 ureters (3,2%). The effectiveness of treatment for patients in the Cohen group was 77%, in the Barry group — 87% (p = 0.408), for ureters — 86% and 93%, respectively (p = 0.223). The difference was not significant despite the higher effectiveness extravesical technique.Conclusion. Extravesical and transvesical ureteral reimplantation are effective methods of treatment for bilateral refluxing megaureter in children

Hypospadias repair in children: fundamental principles and latest tendencies

The article contains the analysis of publications devoted to various aspects of hypospadias treatment in children. Parallels between classical works and current trends in the treatment for this genital  malformation are drawn. New surgical techniques with a reference to the history of their emergence and development are described. The  authors discuss the use of single-stage and multi-stage surgical  procedures for proximal hypospadias. The article also provides the  analysis of currently available literature data on the complications  associated with the use particular surgical techniques. Furthermore,  the article covers the following issues: new variants of hypospadias  classification, methods for assessing defect severity prior to surgery,  and variants of cosmetic evaluation after surgical treatment.  Particular attention is paid to standardization of approaches to  surgical treatment of hypospadias, unification of methods used in  urethroplasty and penile curvature correction. The data of clinical  trials assessing various operative techniques are provided. A  suggestion regarding standardization of description methods for  clinical trials in the field of hypospadology is made

The volume of the contralateral testis in unilateral non-palpable cryptorchidism a diagnostic criterion to optimize surgical strategy

AIM: Given the need to reduce the number of unnecessary laparoscopies, this study aimed to calculate the threshold values of contralateral testicular volume in unilateral non-palpable cryptorchidism to optimize diagnosis and surgical strategy.MATERIALS AND METHODS: From 2010 to 2016, contralateral testicular volume was prospectively evaluated in 78 patients aged under nine years with unilateral non-palpable cryptorchidism. The volume of healthy testes was calculated by multiplying length * width * height * 0.71. The patients were divided into two groups. Group 1 comprised 41 (52.6%) children with inguinal or intra-abdominal testes, who underwent orchiopexy for undescended testis. The second group consisted of 37 (47.4%) patients with severely hypoplastic testes that needed to be removed, or with testicular aplasia. In both groups, we matched the age (in months) at the time of surgery and the volume of the contralateral testis. Logistic regression was used to develop the diagnostic model. For the model, the ROC-curve (Receiver Operating Characteristic) was constructed, and the threshold of the contralateral testicular volume was selected.RESULTS: All patients with contralateral testicular volume greater than 2.25 ml had testicular aplasia, or hypoplasia (sensitivity 100.0%, specificity 73.0%). All patients with a contralateral testicular volume less than or equal to 1.04 ml had inguinal or intra-abdominal testes (specificity of 100%, the sensitivity of 34%). The area under the ROC curve calculated to assess the quality of the model was 92.6%, suggesting the high predictive power of the model.CONCLUSION: Revision scrototomy is indicated in patients with testicular volume exceeding 2.26 ml, while diagnostic laparoscopy is the optimal primary intervention in patients with the contralateral testicular volume of less than or equal to 1.04 ml

Rare case of urethral duplication in the boy

A non-typical variant of Y-type urethral duplication has been described in the article. In this case, the surgical treatment decision was not difficult. Y-type urethral duplication was exposed up to the sinus, and its dissection was performed, followed by urethroplasty. This variant of Y-type urethral duplication has not been described in the world literature available to us, and, in our opinion, it is important for gaining experience in treating rare variants of congenital anomalies of the urethra

Predicting the outcomes of a single endoscopic correction of vesicoureteral reflux using a dextranomer/hyaluronic acid copolymer: selection of the optimal predictive model

Introduction. Endoscopic dextranomer/hyaluronic acid copolymer (DxHA) injection is the most commonly used minimally invasive method of surgical treatment of vesicoureteral reflux (VUR) in children.Purpose of the study. To estimate the accuracy of logistic prognostic models and artificial neural network for prediction a single endoscopic injection DxHA in VUR.Materials and methods. We used endoscopic DxHA in 582 patients (783 ureteric units) of all grades reflux (I - 20, II - 133, III - 443, IV - 187), 53 ureters had complete duplication. A total effectiveness of surgery was 53.2%. A binary logistic regression model and an artificial neural network (multilayer perceptron) were created, taking the following as independent variables: grade of reflux, the patient's age and sex, the ureteral duplication and ureteral dilatation index.Results. The univariate logistic regression showed that the selected predictors were strongly related to the outcome of the treatment. Binary logistic regression and neural network developed high accuracy of the predictions, area under ROC-curve was 0,7 for logistic regression model (a sensitivity of 70.7%, and a specificity of 66.3%) and 0.74 for artificial neural network (a sensitivity of 85.5%, a specificity of 65.3%). Synaptic neural network weights and logistic regression parameters were used in a scoring model to predict the outcome of a single endoscopic injection of DxHA in 2 independent hospitals. An outcomes analysis using predictive models in independent clinics showed a good quality of prediction both with the use of logistic regression (75% and 90% of the correct prognosis) and using a neural network (89.7% and 77% of the correct prediction).Conclusion. An artificial neural network and a binary logistic regression model are an effective tool to assist urologists in identifying and applying endoscopic treatments for VUR in children

Advancement urethroplasty for distal hypospadias repair without dismembering urethra spongy body and glans penis

Introduction. Hypospadias is one of the most common urological pathology in boys requiring surgical correction. Currently, the literature describes more than 300 different techniques for correcting hypospadias. This indicates a lack of ideal methods and standards of treatment that satisfy most pediatric surgeons and urologists. The distension methods of treatment for hypospadias have not been extremely demand in recent decades. The relatively high frequency of the meatostenosis formation in the postoperative period is one of the factors limiting the spread of the method. We suppose that the development of modifications of the surgical technique for relocating urethroplasty aimed at reducing the incidence of postoperative meatostenosis is an urgent area.Purpose of the study. To evaluate the experience of using advancement urethroplasty in the treatment of hypospadias distal forms.Materials and methods. We present a modified method for correction of hypospadias distal forms — advancement urethroplasty without dismembering urethral spongy body and glans penis. The proposed method allows you to form a meatus in a physiological position without a urethral suture, with the restoration of the integrity of the spongy body, without it cutting off during mobilization in the distal section. The standard C.A. Beck technique was used for treatment in 44 patients — group I. According to the author's method, 60 boys were operated on in the period from 2016 to 2018 — group II. Postoperative follow-up period lasted 6 - 36 months. All patients were evaluated in terms of cosmetic results and the incidence of postoperative complications.Results. The high efficiency of the proposed urethroplasty technique was shown. There was a decrease in the number of postoperative complications compared to the classical method of advancement urethroplasty. Reoperations were required in 5% of cases. The cosmetic results obtained after moving urethroplasty in both groups were identical and were assessed by parents and the operating surgeon as excellent.Conclusions. It is advisable to use moving urethroplasty in case of distal hypospadias with not prolonged urethral dysplasia proximal to the meatus and diastasis between the meatus and its physiological position not exceeding 1 cm. Relocating urethroplasty with non-dissecting spongioplasty provides a lower incidence of meatostenosis in the postoperative period compared to the classical Beck teсhnique