Extravesical reimplantation of an extravesical-ectopic ureter from the upper pole of a duplicated kidney

Extravesical ureter ectopia is a rare cause of urinary incontinence. We are reporting a case of a 3-year-old girl with urinary incontinence. The girl was observed and treated for recurrent urinary tract infection (UTI) against the background of left-side duplication of the upper urinary tract and vesicoureteral reflux (VUR). Two-time endoscopic treatment using a dextranomer/hyaluronic acid allowed to eliminate VUR on both sides and achieve stable clinical and laboratory remission of UTI. After potty training, the child had a constant drip of urine along with normal urination. The examination revealed extravesical ureter ectopia of the left duplicated kidney upper pole and a bladder space-occupying mass with hyperdensive inclusions in the projection of the vesical trigone on the left, which we regarded as a result of the migration of the implant and the appearance of histopathological changes in it. The presence of a bladder space-occupying mass determined the choice of the surgical technique in favor of the formation of a ureterocystoanastomosis with a duplicated ectopic ureter and the removal of a bladder space-occupying mass. When managing patients after endoscopic treatment of VUR, it should be considered the possibility of morphological changes in the bulking agent due to the accumulation of calcium and uric acid salts

Contact ureterolithotripsy of a giant ureteral stone in a 3-year-old child

Giant ureteral stones in young children are extremely rare and their surgical treatment tactics are variable. The present case describes a case of effective and safe endoscopic treatment of giant ureteral stones in a young child. The patient is a 3-year-old male child. Examination findings of abdominal pain and fever verified a left distal ureteric stone up to 30 mm complicated by ureterohydronephrosis. The first treatment stage was ureteral stenting, in which the stone migrated to the middle ureteral third. The second treatment stage was contact ureterolithotripsy with a 9 Ch semi-rigid ureteroscope («Richard Wolf» GmbH, Knittlingen, Germany) and Swiss LithoClast® 2 pneumatic lithotripter («E.M.S. Electro Medical Systems» S.A., Nyon, Suisse), ureteral stenting (2-way PigTail, 4.5 Ch). The third treatment stage in the delayed period was extracorporeal shockwave lithotripsy of the steinstrasse using the Dornier Compact Sigma («Dornier MedTech» GmbH, Weßling, Germany) and stent removal. Residual stones were not revealed according to the follow-up examination. No treatment complications were registered. The multimodal staged treatment of a giant ureteral stone resulted in its complete elimination. Next-step ureteral endoscopy made it possible to identify concomitant pathology of the proximal ureter, which required its evaluation in the delayed period. Ureteral stenting contributed to the restoration of renal function. The result achieved reflects the maximum efficiency and high safety of the surgical technique applied

Pyeloplasty effectiveness in cases of ureteropelvic junction obstruction in children: methodology and assessment parameters

The article presents the analysis of published data (Scopus, Web of Science, PubMed/MedLine, The Cochrane Library, and eLIBRARY databases) devoted to the study of existing criteria for assessment of pyeloplasty effectiveness. Published sources most often refer to the dynamics of reduction of the renal collecting system (RCS) and postoperative renal functional status as the assessment criteria. However, there are no consistent values, which could be employed as assessment criteria indicating success as soon as they are registered. The tools used to estimate RCS reduction are not standardized in terms of research techniques, projection of RCS dilatation measurement, and the locations between which renal and pelvic anatomic structures are measured. A variety of approaches to measuring the anteroposterior renal pelvis dimension in children with hydronephrosis tends to blur the analysis of actual pyeloplasty results. This review of published sources demonstrates the lack of agreement as regards the criteria for assessment of pyeloplasty effectiveness. There is a pressing need for appropriate steps to harmonize ultrasonography methods, to standardize the anatomic landmarks for measurement, and to define the criteria to be used to assess the effectiveness of pyeloplasty

CURRENT APPROACHES TO TREATMENT OF VESICOURETERAL REFLUX IN CHILDREN (REVIEW)

Although of existing guidelines and a lot of scientific publications of the management and care in patients with vesicoureteral reflux (VUR), up to now there isn’t the universally accepted algorithm for ideal treatment in children with such disorder. In during 70 years of intensive study of the problem of reflux, the balance periodically tends either towards the conservative, or to the surgical approach, was accumulated sufficient experience in open, minimally invasive surgery, and in the conservative treatment. The 10-years using of the recommendations of the European Association of Urology (EAU) provided experience and allowed to transform approaches to the selection of treatment for patients with vesicoureteral reflux

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

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

Extravesical ureteral ectopia from an iliac dystopic hypoplastic left kidney in a girl

Extravesical ureteral ectopia (EUE) is a rare cause of urinary incontinence (UI) in girls. In 80% of cases, ectopia is associated with ureteral duplication.  We are reporting a case of a 17-year-old girl with UI by EUE from an iliac dystopic hypoplastic left kidney. The girl received outpatient treatment for UI and left kidney agenesia since the age of 5, when her parents for the first time noticed the UI with background normal urination. The child underwent a complete range of medical tests: CT, cystoscopy, renal nuclear scan, uroflowmetry, ureteral cystometry and profilometry. Although the examination revealed no proof of renal tissue existence on the left side, a pad test with a dye was performed to exclude an EUE. The test gave a positive result, which determined further diagnostic search. Vascular CT was performed and made it possible to visualize a severely hypoplastic left kidney dystopic towards the iliac vessels. Laparoscopic nephrectomy was performed and UI manifestations were corrected. Availability of a wide range of visualisation methods in the urologist's toolkit does not always allow to verify hypoplastic renal dystopia when the kidney is drained by a ureter with an extravesical ectopic orifice. When a reasonable suspicion of an EUE is combined with lack of information about its location and dimensions after visualizing tests, a pad test with a dye appears appropriate prior to a diagnostic laparoscopy in our opinion. Once the UU is confirmed by the dye test results, further diagnostic search using laparoscopic access is justified and can be transformed into a treatment procedure if the kidney is revealed

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

Complications after surgical treatment of cryptorchidism

In our study we presents data from the pediatric urology department (Regional children’s hospital, Rostovon- Don) and literature review which are devoted to the complications of surgical treatment of children with cryptorchidism.В работе представлены данные детского уроандрологического отделения (ГБУ РО «ОДКБ» г. Ростов-на-Дону), а также данные литературы, посвященные осложнениям хирургического лечения детей с паховой и абдоминальной ретенцией при крипторхизме

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