Influence of surgical correction of inguinal hernia and hydrocele on testicular blood flow in children

Inguinal hernia and hydrocele affect the blood circulation of the testicle. Surgical trauma may change testicular blood flow. Objective. To study changes in blood flow parameters in children with pathology of the processus vaginalis, requiring surgical correction, using the analysis of ultrasound data. Materials and methods. We observed 87 boys from 3 to 17 years old, operated for congenital inguinal hernia and hydrocele. As a control group we examined 34 boys without pathology of the reproductive system. Patients held Doppler ultrasound the day before surgery, at 1 and 7 days after. Peak systolic flow velocity, end-diastolic flow velocity and resistance index were studied. Results. The resistance index on the affected side was higher compared with the control group before operation (p<0,05). The values of peak systolic and end diastolic blood flow velocities were lower than in the comparison group (p<0,05). Resistance index increased compared with preoperative period 1 day after surgery (p<0,05). Values of flow velocity parameters decreased to 4-9 % compared to values before the operation. The resistance index decreased (p<0,05) to near baseline figures a week after the operation. Peak systolic and end-diastolic flow velocity raised to 15-21 % compared to the preoperative period. However, the intensity of the blood flow in the affected testicle remained lower than in the control group (p<0,05). Conclusions. The blood flow of affected testicle in children with inguinal hernia and hydrocele is initially decreased. Early postoperative period is characterized by intensification of testicular parenchyma’s ischemia. Postoperative blood flow in the affected testicle is improved a week after surgery, but the lack of blood supply to the testicle is retained

Prolonged drainage of the lower urinary tract in the treatment of refluxing megaureter in children

The main purpose. To substantiate the need for conservative therapy as the first stage of treatment refluxing megoureter in newborns and infants. Materials and methods. Analyzed result s of treatment 19 children (25 ureters) with different levels of the disease. The evaluation criteria were the ultrasonographic researchers, determining the degree of dilatation of the ureters, the cup-and-pelvis system and the thickness of the kidney parenchyma, as well as the presence of an urinary tract infection. Treatment based on prolonged drainage and lower urinary tract catheter Folleya (up to 1 month), with the interleave instrument natural urination (also up to 1 month, or until the secondary acute pyelonephritis). Medication support was in an antibiotic therapy, taking into account with the sensitivity of microflora and preventive treatment uroseptics. There were regularly monitoring the degree of activity of the secondary flow of pyelonephritis and excretory function of the kidney. Excretory urography and cystography used in suspected degradation of structural parameters and renal function. Indications for surgical treatment were indestructible inflammatory process within one month, the progression of dilatation of the ureters and renal pelvis system, thinning and disruption of parenchymal renal excretory function. Results. In 6 (31,6%) of children to the age of 2 years were revealed a complete disappearance of dilatation of the ureter. In 3 cases of them survived vesicoureteral reflux 1- 2 degrees without renal impairment and without bladder syndrome, which can be considered as a positive treatment outcome. Conclusion. Treatment the newborns and infants with refluxing megaureter should begin with conservative therapy, including prolonged drainage of the lower urinary tract