Minimal invasive operations in infants with congenital urinary tract disorders

Purpose.To rate retrospectively the results of using minimally invasive surgical operation in treatment of obstructive disorders in infants. Materials and methods. From 2007 to 2016 1057 patientes (257 boys and 614 girls) with a mean age of 5.5 month (range 1m – 5 years) were treated. The patients were classified on four groups: the first - 69 boys with posterior urethral valve associated urodynamics disorders; the second group – 67 patientes with duplication and ureterocele; the third group - 170 patientes with congenital nonrefluxing megaureter; the fouth - 751 patientes with VUR. In all cases minimal invasive surgeries were preferable: transurethral primary valve ablation; endoscopic incision ureterocele, one-J-stending megaureter, endoscopic correction of vesicoureteral reflux with bulking agents. Results. Transurethral resection of the posterior urethral valve was performed for all patients of the first group - for 56 (81,2%) in one step, for 13 (18,8%) in two steps. Transurethral resection of ureterocele was performed in 53 patients (79,1%) of the second group.132 patients in the third group was treated with stended of ureter, endoscopic correction of vesicoureteral reflux with bulking agents was performed for patients of the fourth group: collagen for 454 patients (605 ureters), Urodex for 122 patients (189 ureters) and Vantris for 76 patients (121 ureters). The patients were followed according with to a program with repeated US, renal scintigrams (DMSA), frequency/volume chart observation. These investigations were assessed in 4-8-12 and 24 weeks. Antibacterial prophylactics were given and recurrent UTIs were registered, In 76 cases (7,2% ) when the disorder wasn’t eliminated, minimal invasive reoperation or open surgeries were carry out. Conclusions. Minimal invasive surgical operations can be performed in babies. They allow to normalize urodynamics and high success rate can be achieved avoid complex reconstractiv operations

Результаты лечения пятидесяти детей с персистирующей клоакой в условиях одного центра

BACKGROUND: The preserved cloaca is a particular type of anorectal anomaly. The combination of urological, genital, and rectal abnormalities makes radical reconstruction difficult. MATERIALS AND METHODS: This study examined operations performed in 50 patients with persistent cloaca treated from 2010 to 2021. Two groups are presented: the first with 35 children and a short canal (3 cm), and the second with 15 children and a long canal (3 cm). We examined the prognosis for bowel control, the type of operation, the need for vaginal reconstruction, complications after surgery, and the days of hospital stay. RESULTS: Anomalies of the Mllerian ducts in the second group (94%) were higher than in the first (36%) (p 0.001). The sacral index and myelodysplasia did not differ in both groups. The sacral index in the first group was 0.62 0.14, and in the second group, it was 0.58 0.14 (p = 0.520). Myelodysplasia in the first group was 33%, and in the second group, it was 38% (p = 0.744). Total urogenital mobilization (51%) was used in the first group, and abdominal reconstruction (54%) was used in the second group. Vaginal reconstruction was required in 28% of patients in the first group and 60% in the second group. Complications were 3.5 times more likely in the first group (60% versus 17% in the second) (p = 0.003). The length of hospital stay in patients in the second group was longer than that of patients in the first group. CONCLUSION: Our study data demonstrate that the reconstruction of a persistent cloaca requires individual planning of the operation, considering the length of the canal and the state of all structures forming the cloaca.Введение. Сохранившаяся клоака особый вид аноректальных аномалий. Сочетание урологической, генитальной и ректальной аномалий затрудняет выполнение радикальной реконструкции. Материалы и методы. В настоящем исследовании изучены результаты выполнения операций 50 пациентам с персистирующей клоакой, находившихся на лечении с 2010 по 2021 г. Представлено две группы: первая с коротким каналом (менее 3 см) 35 детей, вторая с длинным каналом (более 3 см) 15 детей. Мы изучили прогноз для кишечного контроля, тип реконструкции, необходимость реконструкции влагалища, осложнения после операции и дни пребывания в стационаре. Результаты. Аномалии мюллеровых протоков во второй группе выше, чем в первой 36 против 94 % (р 0,001). Сакральный индекс и случаи миелодисплазии не различались в группах. Сакральный индекс в первой группе составил 0,62 0,14, во второй 0,58 0,14 (p = 0,520). Миелодисплазия в первой группе 33 %, во второй 38 % (р = 0,744). В первой группе использовали тотальную урогенитальную мобилизацию (51 %), во второй абдоминальную реконструкцию (54 %). Реконструкция влагалища была необходима 28 % пациентов первой группы, 60 % второй. Осложнения в 3,5 раза чаще возникли в первой группе (60 против 17 % во второй) (р = 0,003). Продолжительность пребывания в медицинском учерждении пациентов второй группы больше, чем у пациентов первой группы. Заключение. Данные нашего исследования демонстрируют, что реконструкция персистирующей клоаки нуждается в индивидуальном планировании операции с учетом длины канала, а также состояния всех структур, формирующих клоаку