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The results of solitary renal cysts (SRC) treatment in children have been analysed. Laparoscopic and puncture methods have been used. The algorithm of SRC patients' management is proposed. Ninety children with simple renal cysts aged 1 to 15 years were treated in Moscow city N.F. Filatov children's hospital N 13 in 1996-2007. The diagnosis was made basing on the findings of ultrasound investigation, computed tomography and radionuclide scintigraphy. Surgical treatment was applied only in case of large cysts (2.5 cm and more), connection with collective renal system and clinical manifestations. In small-size cysts and normal urodynamics the patients were followed up. Laparoscopic excision of the cyst was performed in 71 cases. The punctures were made under ultrasonic guidance with catchment or without it. The cyst content was aspirated with following sclerosing and administration of 96% ethanol into the cyst cavity. There were no postoperative complications. Good results (cyst disappearance) were achieved in 64 patients after laparoscopic and in 13 after paracentetic treatment; satisfactory results (cyst size reduction and relieve of clinical symptoms) were obtained in 6 children after laparoscopic and in 4 after percutaneous puncture. Laparoscopic treatment failed in 1 case of intraparenchymatous cyst which relapsed. It is recommended to begin treatment of simple renal cysts with use of the paracentetic method with catchment and following sclerosing proving positive results after original surgery.

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The experience with 72 laparoscopic nephrectomies and nephrouretherectomies in children aged from 13 days to 14 years is reviewed. 51 children were under 3 years of age, 2 patients - under 1 month of life. Pathological changes of the kidneys with complete loss of function were indications for endoscopic surgery. Complex of examinations in the preoperative period included repeated USE, cystography, urography, scintigraphy, angiography. Time of surgery was 30-150 min (45 min, on the average). Blood loss during surgery was less than 50-60 ml and didn't require hemotransfusion. There were no complications during surgery. Fast recovery of physical activity after surgery, a decrease of hospital stay were seen. There were no postoperative complications and lethality. Laparoscopic nephrectomy and nephrouretherectomy are low-traumatic, safe and effective surgeries in children of any age in different diseases of the kidneys.

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BACKGROUND: The technique of the laparoscopic treatment of varicocele in children is described, and its outcome is discussed. METHODS: A total of 180 patients from 6 to 14 years of age were studied. All of them had left-sided varicocele; 10 of them were recurrences after treatment by other methods. Varicocele was diagnosed on physical examination and confirmed by Doppler ultrasonography. The laparoscopic procedure included obligatory dissection and preservation of the spermatic artery and tinted lymphatic vessels, followed by double ligation of the spermatic veins. RESULTS: There were no intraoperative or postoperative complications and only one case of recurrence (0.6%). CONCLUSION: The suggested technique for laparoscopic varix ligation is a highly effective and reliable method for the treatment of pediatric varicocele. It provides the minimal invasiveness of the approach, effective microsurgical quality of visualization, and dissection with guaranteed preservation of the spermatic artery and lymphatic vessels, along with very low rates of complication and recurrence.

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The analysis of the authors' own results of surgical treatment for hydrohephrosis in 81 children after the Anderson-Haines-Kucher has revealed that the most common complication is stenosis of the anastomosis made. The authors' modified operation has indicated that the use of a less traumatic access to the pelvioureteral portion, of optic magnification, a microsurgical instrument, 7/0 synthetic suture material, drainage of the renal collecting system with a pyelostomic tube of original design allows the optimal conditions to be created for formation of the pelvioureteral anastomosis and the good results of hydronephrosis treatment to be obtained in children.

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A total of 4 renal autotransplantations were performed in children in the hospital. The indications for the surgery were ureteric injury (n = 2) and megaloureter associated with distal ureteric stenosis (n = 2). In all cases, autotransplantation was conducted into the ipsilateral iliac fossa after perfusion cooling of the kidney for an average of 28 min. No postoperative complications were observed. There was a complete recovery of renal function in all cases.

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Obstruction in the pyeloureteral region is often combined with an obstacle of an anatomical or functional character in the distally located parts of the ureter. The authors treated by operation 80 patients with congenital hydronephrosis in the period from 1986 to 1991. An additional distally located stricture of the ureter was found during intraoperative catheterization in 10 cases. In 9 of 10 cases the obstacle was at a distance of 1.7-2.0 cm from the pelvioureteral junction. Due to the small distance between the strictures the affected segment could be resected and an Andersen-Haynes anastomosis formed. The authors believe that the presence of double obstructions indicates marked dysplastic changes of the ureteral wall. In view of this, the use of optic magnification, microsurgical instruments, and ultrathin suturing material in the formation of the anastomosis is recommended. In 3 children operated on by the above discussed method the postoperative course was uneventful. A clinical case is given in illustration. It is suggested in the discussion that the indications for retrograde pyelography may be widened so as to identify additional strictures of the ureter at the diagnostic stage.

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Six operations for kidney autotransplantation into the ipsilateral iliac fossa were conducted on children aged from 2 to 14 years. In 2 children the operation was performed for a posttraumatic defect in the ureter of a considerable length. Severe neuromuscular dysplasia of the ureter in maintained function of the kidney was the indication for operating on 4 children. No complications occurred in 5 operations. One transplanted kidney had to be removed because of renal artery thrombosis resulting from damage inflicted to the endothelium during washing of the kidney. Operation for autotransplantation of the kidney is a permissible alternative of the traditional methods of replacement or plastics in long posttraumatic strictures and congenital developmental anomalies of the ureter.

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A group of 54 children with vesicoureteral reflux recognized in the first 3 years of life was analysed. All of them received adequate nonoperative treatment including prolonged antibacterial therapy and management of cystitis and urodynamic disorders of the lower urinary tract. According to the degree of vesicoureteral reflux (VUR), the children were divided into two groups. Group 1 consisted of 29 children with Degrees I-II VUR in 37 ureters. Nonoperative treatment was effective in 75% of cases. Retrospective appraisal of urograms revealed no signs of cicatricial-sclerotic changes in the parenchyma of the kidneys. In five children with Degree II VUR of long duration the kidneys were smaller than the normal size of their age. Group 2 was made up of 24 patients with Degrees III-V VUR into 34 ureters. No changes were found in the renal parenchyma on urograms made during the first examination. During follow-up, however, signs of reflux-nephropathy (RN) were detected, which according to the recommendations of the International group for reflux study were evaluated as Degree I RN--10 cases, Degree II RN--12 cases, Degree III RN--8 cases, and Degree IV RN--4 cases. The authors believe nonoperative treatment of children with Degrees I-II VUR to be justified, patients with Degrees III-V VUR call for active surgical intervention from the moment that the reflux is recognized.

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Available are the results of surgical treatment (Andersen-Hynes operation and its modifications) of 85 children with hydronephrosis bor the period 1981-1987. The patients' age ranged from 6 months to 14 years. Anastomotic stenosis occurred in 12% of the procedures as a result of: urethral or pelvic trauma when suturing, wound channels due to the needle perforating puncture, catgut unwanted properties, tissue strain at the anastomosis site, inadequate renal drain. This necessitates modification of the operative technique: surgical manipulations restricted to the operated on pelvic part and pelvic-urethral segment, optical amplification, microsurgical instruments, synthetic suture. An original pyelostoma made of silicon rubber was used in draining. Out of 34 surgical cases, good results were achieved in 31, satisfactory in 3. No complications were recorded.

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The authors suggest a new approach to the treatment of patients with exstrophy of the urinary bladder-the formation of an urinary reservoir from a detubulerized intestinal graft after II Kocks' method. This method, as well as its analogues, is mainly used in adults after radical cystectomy. Improved surgical techniques have been suggested on the basis of experimental works which allow the age features and the peculiarities of the functional condition of the formed reservoir to be taken into account. Analysis of the results of clinical use of the suggested method showed it to be effective in solving the problem of rehabilitation of patients with exstrophy of the urinary bladder, which allows it to be recommended as the operation of choice in the management of this developmental anomaly.

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The authors observed 54 patients with clinico-functional disorders who had been operated upon for anorectal anomalies. The complex program of examination of these patients shows that the leading etiological moment in the development of different complications is pathology of the external sphincter of the rectum which was observed in 87.3% of children.

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The paper is concerned with a detailed description of an algorithm for picturing functional imaging of the kidneys based on the calculation of parenchymal transport time (PTT). The authors discuss the results obtained in a group of patients aged 4 to 14 with conditional normal indices. The method permits quantitative and qualitative assessment of the function of the minimum amount of nephrons of each kidney and facilitates an analysis of gamma scintigraphy results. Clinical importance of the method is discussed.

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The renal blood circulation was studied in 17 children aged 3 to 14 using a method of adaptive simulation of the organ blood flow. The main condition for radiorenoangiography is to place correctly a gamma-chamber of the heart, lungs and kidneys in the field of vision of the crystal. It is a requisite condition for the calculation of absolute and relative renal perfusion depending on the cardiac ejection. If a patient's body size does not make it possible to have the heart and kidneys in the field of vision of the collimator at a time, one can choose the spleen as the "model" organ. The analysis of angiographic results has shown that the share of the cardiac ejection which is responsible for the renal circulation and organ function respectively, is quite a stable value that is not associated with a patient's age and body mass. Irrespective of the state of the central hemodynamics and a patient's age, the most objective information on renal perfusion proceeds from an analysis of relative indices (or perfusion indices) that are calculated on the basis of the cardiac ejection expressed in percentage (or another model organ).

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The determination of the relative blood flow in organs is sometimes of greater diagnostic importance than the estimation of respective absolute indices. A detailed analysis of indispensable mathematical calculations is presented. The authors propose an algorithm and optimum sequence of calculations of relative organ perfusion using computer. The paper can be of wide applied importance.

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