REOPERATIONS IN CHILDREN WITH ANORECTAL MALFORMATIONS

The aim of the study was to assess the possibility of using a surgical approach – anterior sagittal anoproctoplasty in children who had previously been operated with various techniques for anorectal malformations. Material and methods. The analysis of postoperative results was performed using a scale for assessing the long-term results of treatment of anorectal malformations before and after surgery. A retrospective study of the patients who was previously operated for various forms of anorectal malformations for the period from 2016 to 2019 in pediatric surgery department of State Novosibirsk district hospital was performed. The early and long-term outcomes were assessed. Results. The criteria for repeated surgical treatment were: rectal mislocated outside of the sphincter mechanism, low social adaptation, secondary changes from the perineum and external genital organs. After investigation (identification of the sphincter mechanism using a myostimulator, irrigoscopy, MRI or MSCT of the pelvic organs), all patients underwent surgical correction – the anterior sagittal anoproctoplasty. Postoperative results were assessed using Holschneider score. The results obtained in the course of this study indicate the possibility of using this method of surgical treatment. Discussion. Children previously underwent surgery for anorectal malformations but having severe functional disorders in the anorectal region, are a complex group of patients who must be determined specific criteria for the reoperations need. The efficiency of surgical treatment depends on the presence of associated congenital malformations (myelodysplasia, pathology of the sacrum and tailbone), as well as the severity of cicatricial changes in the sphincter mechanism. Surgical intervention in 33.3 % of cases led to satisfactory and in 66.7 % of cases to good results

APPLICATION OF URETHRAL STENT IN CHILDREN WITH URETHRAL STRICTURE, EARLY OUTCOMES

Background. Urethral stricture is one of the most common complications after urethroplasty. And nowadays a growing number of congenital urethral diseases is observed. It is obvious that there is a huge amount of urethroplasty needed all over the world. Material and Methods. 15 patients with urethral strictures were included in the conducted prospective research. All patients underwent a complex urology investigation consisted of uroflowmetry, urethrography and urethroscopy. Most of strictures were located in penile urethra, their length varied from 1 to 5 mm. All patients enrolled in the study had the only single stricture. After investigation internal visual urethrotomy was performed with one-time stenting using individual prepared titanium nickelide stent. Stent was in urethra for 14–21 days. It had been evacuated from urethra and uroflowmetry, urethrography and urethroscopy were performed. Results and discussion. All patients have good result of uroflowmetry in the postoperative period. The results of urethrography and urethroscopy have also showed that there were no urethral strictures. The longest follow-up has lasted for 3 years. The efficiency of treatment is 93 %. The repeated procedure was required in one case. Any complications of this way of urethral stricture’s treatment haven’t occurred. Nowadays laser urethrotomy is known to have a success rate about 84 %, but follow-up period is still rather short. And also it is estimated that 65 % of all children with direct vision urethrotomy had a recurrence of the stricture in 5 years. It is hoped that the announced way of treatment of urethral stricture will be very perspective and will help to solve such significant problem in pediatric urology as urethral stricture. Conclusions. Stenting of urethra after internal visual urethrotomy has good outcomes, and seems to be a very perspective minimally invasive way of treatment of urethral stricture