Vladimir V. Sizonov

In recent years, there has been a steady increase in the detection rate of congenital hydronephrosis, driven by advances in prenatal and postnatal diagnostic methods. The rising number of verified cases naturally corresponds to a growing volume of surgical interventions for this condition. The relevance of the study is determined by the need to systematize current approaches to managing patients with congenital obstruction of the pyeloureteral segment. Aim: The aim of the study was to optimize long-term clinical outcomes by standardizing diagnostic and therapeutic approaches to hydronephrosis based on the experience of operating surgeons. Materials and methods: The study included a survey consisting of 42 single- and multiple-choice questions. Among participants were 102 surgeons from various regions of the Russian Federation, all holding current accreditation in the following specialties: pediatric urology-andrology, pediatric surgery, and urology. Results: The study analyzed current clinical guidelines, the results of international studies, and the practical experience of leading specialists in the Russian Federation. Particular attention is paid to the choice of a surgical approach, including minimally invasive techniques, antibacterial therapy, and methods for assessing the effectiveness of treatment in the long term. Conclusion: The study results allow the development of standardized management algorithms that will improve the quality of medical care and long-term clinical outcomes in congenital hydronephrosis.

Introduction. Robot-assisted extravesical ureteral reimplantation (RAEUR) is one of the most performed procedures on the da Vinci Xi robotic platform in children with ureterovesical junction pathology. Robot-assisted extravesical transverse ureteral reimplantation represents the most frequently performed intervention using the da Vinci system in this patient population. We report our initial experience with RAEUR using the da Vinci Xi system, which forms the basis of this communication. Objective. To analyse our experience with robot-assisted extravesical ureteral reimplantation in children using the da Vinci Xi robotic platform. Materials & methods. The study included 12 patients with a mean age of 3.9 ± 2.9 years (minimum age 7 months). Mean anthropometric parameters were: height 101.4 ± 20.4 cm, body weight 17.4 ± 7.7 kg. Gender distribution: 8 boys (66.7%) and 4 girls (33.3%). Mean anteroposterior renal pelvic diameter was 21.7 ± 7.1 mm. Ureterovesical junction pathology was detected antenatally in 5 patients (41.7%) and postnatally in 7 (58.3%). Urinary tract infection was noted in 4 (33.3%) patients. The nosological spectrum included ureterovesical junction obstruction (UVJO) in 11 (91.7%) patients and vesicoureteral reflux (VUR) in 1 (8.3%) patient. The procedure was performed with the patient in the supine position, using three 8-mm trocars for the optics and robotic instruments and one 5-mm trocar for assistant instruments. Results. No conversions occurred. Operative time for the initial cases was 175 minutes. In the most recent cases in the series, operative time remained approximately the same, with a mean duration of 170.4 ± 31.5 minutes. Mean docking time was 22.5 ± 2.4 minutes, and mean console time was 99.2 ± 28.6 minutes. Mean anteroposterior pelvic diameter decreased from 21.8 ± 7.1 mm preoperatively to 11.1 ± 4.3 mm postoperatively after cessation of drainage. Conclusion. Analysis of our initial experience with RAEUR demonstrates its advantages over other ureteral reimplantation techniques, particularly the preservation of the surgeon's physical condition throughout the procedure, enabling precise intracorporeal ureteral tapering and anastomosis formation while avoiding the ergonomic challenges and operator fatigue associated with laparoscopic extravesical reimplantation. Our findings confirm the safety and efficacy of RAEUR in children and support its broader adoption into routine clinical practice.

Introduction. Ureteropelvic junction obstruction and hydronephrosis remain among the most common indications for reconstructive surgery of the upper urinary tract in children. Yet the wording of current clinical guidelines leaves room for ambiguous interpretation of when pyeloplasty is truly indicated. Objective. To trace how thinking about indications for pyeloplasty in children with hydronephrosis due to ureteropelvic junction obstruction has evolved, to contrast international and national guidance, and to underscore the need for a holistic appraisal of imaging, functional, and clinical data—and their trajectories—when charting a treatment course and deciding on surgery. Materials & methods. We performed an analytical review of clinical guidelines, national textbooks, and landmark publications on pyeloplasty indications, focusing on ultrasound criteria, functional metrics, their longitudinal changes, and symptomatology. Results. Over time, the threshold for pyeloplasty has moved away from relying on a static snapshot of hydronephrosis grade toward a multifactorial paradigm that weighs split renal function, progression of dilatation, diuretic renography findings, and clinical presentation. Most international guidelines caution against using any single ultrasound parameter as a stand-alone trigger for operation. Even so, the phrasing of European Association of Urology recommendations—and how they are sometimes read in national documents—still allows an overly liberal reading, in which a high SFU hydronephrosis grade and/or an enlarged anteroposterior pelvic diameter may be mistaken by themselves as sufficient grounds for pyeloplasty. Conclusion. Contemporary evidence supports a decision-making model in which paediatric pyeloplasty is offered not based on one morphological sign, but on an integrated, dynamic assessment of imaging, function, and symptoms. National guidelines would benefit from clearer wording that guards against overinterpretation and helps ensure surgery is reserved for those who truly stand to gain.

Vesicoureteral reflux (VUR) is a common condition in paediatric urology that increases the risk of urinary tract infection (UTI), which in turn may result in renal scarring and the development of chronic kidney disease in children. A first episode of UTI is often the trigger for the diagnosis of VUR. Antibiotic therapy remains the mainstay of UTI management, while continuous antibiotic prophylaxis is used to prevent recurrence and infectious complications in children with VUR. However, prolonged antibiotic use is associated with important risks, including the development of antimicrobial resistance. This review evaluates the efficacy and safety of contemporary antibiotic treatment and prophylactic strategies in children with VUR. Particular emphasis is placed on optimizing patient management and on current guideline-based recommendations aimed at reducing recurrence rates and improving clinical outcomes.

Introduction . The most widely used operative technique for distal hypospadias is tubularized incised plate (TIP) urethroplasty. Despite its relative technical simplicity and favourable outcomes, TIP may be complicated by scarring of the distal urethra, meatal stenosis and urethrocutaneous fistulae, which may be related to a small glans and a narrow urethral plate. A grafted TIP (Grafted-TIP) modification has been proposed to address these issues; however, clear indications for its use in primary urethroplasty for distal hypospadias in children are lacking in the literature. Objective . To assess the variability of urethral meatal anatomy and its impact on postoperative outcomes in boys undergoing repair of distal hypospadias. Materials & methods . Between 2021 and 2022, 43 boys aged 10 months to 8 years underwent primary repair of distal hypospadias using the TIP technique. Intraoperative measurements of glans and urethral meatus dimensions were obtained with a calliper and ruler, recorded in a standardized datasheet, and subjected to subsequent statistical analysis. Based on published data on normal meatal anatomy in healthy boys (vertical meatal length 5.4 ± 1.0 mm), patients were stratified into two groups according to meatal size: group 1, meatal length < 0.05). The mean urinary flow rate was also higher in group 1, meatal length Results . The mean urethral plate width was significantly greater in group 2 than in group 1 (8.5 ± 1.7 vs 5.6 ± 2.6 mm, p< 0.05). The mean urinary flow rate was also higher in group 2 compared with group 1 (9.4 ± 2.1 vs 7.8 ± 3.3 ml/s). Postoperative complications were more frequent in group 1, although the difference was not statistically significant; the fistula rate was similar between groups, whereas no cases of wound dehiscence or cicatricial meatal stenosis occurred in group 2. HOPE score analysis showed no statistically significant difference between the groups (p > 0.05). Conclusion . A vertical meatal length of 5 mm or greater appears to allow creation of a neomeatus comparable in size to that of healthy boys. This threshold is associated with a statistically significant improvement in urinary dynamics, reflected by higher mean urinary flow rates. Continued follow-up of this cohort will facilitate further evaluation of how anatomical characteristics of the penis in hypospadias influence long-term surgical outcomes.

Introduction. Self-insertion of foreign bodies into the urethra represents a rare urological emergency involving a wide variety of objects. In many cases, diagnosis and treatment are delayed due to the patient’s embarrassment, shame, or reluctance to disclose the incident. Clinical case. We report a unique clinical case requiring surgical intervention in a fourteen-year-old child diagnosed with intravesical foreign bodies. The patient was treated in the Department of Urology at the Regional Children’s Clinical Hospital of Rostov-on-Don. Results. During a cystoscopy, a foreign body consisting of multiple metal balls was detected in the bladder lumen. Given the technical difficulties associated with the small size of pediatric endoscopic instruments and the multiple magnetic foreign bodies, their shape, interconnectedness, and significant magnetic force, the decision was made to forego endoscopic removal and perform a cystostomy. Conclusions. Modern evidence indicates that foreign bodies of the urinary bladder and urethra in children represent a rare yet clinically and socially significant condition that requires not only timely urological intervention but also mandatory psychiatric and psychological assessment. Only a comprehensive multidisciplinary approach can effectively reduce the risk of complications, recurrence, and adverse psychosocial outcomes.

Introduction. Obstruction of the pyeloureteral junction (PUJO) of the horseshoe kidney is a very rare disease both in adults and children. This is the reason for the small number of scientific works on the subject of pyeloplasty for this pathology in children. Isthmus crossing and nephropexy followed by dissecting pyeloplasty have been suggested as one of the surgical treatment options. There are no convincing data on the feasibility of this procedure in the literature. The aim of our work was to evaluate 25 years of experience in the treatment of PUJO of horseshoe kidney in children. Materials and Metods. A few small cohort studies have reported the efficacy of pyeloplasty for horseshoe kidney in children, and a limited number of studies have compared different operative treatments. It was these facts that prompted us to perform this work. We retrospectively evaluated the results of 112 pyeloplasties in 105 children from 1999 to 2024. Patients were divided into 3 groups according to the method of surgical intervention: open pyeloplasty with isthmotomy, open pyeloplasty without isthmotomy, laparoscopic pyeloplasty. We also divided the patients into 4 groups according to the method of urinary tract drainage. Resulrs. Clinical data and outcomes were further analyzed. We obtained positive results when performing pyeloplasty in 92.9% of patients. There was no significant difference in pyeloplasty results between the groups. We also found no statistically significant differences in the methods of urinary tract drainage. Conclusion. Today, preference should be given to minimally invasive method of treatment in children, even in such a complex malformation as hydronephrotic transformation of the horseshoe kidney, taking into account comparable results with the open method of treatment and the unconditional advantages of laparoscopic access in the form of early rehabilitation of the child, minimal pain syndrome and cosmeticity of this method.

Introduction. The problem of hypospadias in children is still one of the most relevant topics in reconstructive pediatric urology-andrology. There are a number of clear proponents of various surgeries for distal and proximal forms of hypospadias, as well as methods of correction of penile curvature. There is still no universal approach to surgical treatment, and many factors influence the choice of surgical tactics. Purpose of the study: to analyze the current trends in the treatment of children with hypospadias in the Russian Federation. Materials and methods: We developed a 35-question questionnaire that took into account the demographic characteristics of the respondents, personal preferences in choosing the optimal age for surgical treatment, the method of choice for correction of distal, trunk, and proximal forms of hypospadias, the method of penile curvature elimination, preferences in choosing suture material, prescription of antibacterial and hormonal therapy, and aspects of postoperative management of patients with hypospadias. 128 pediatric urologists and pediatric surgeons from all 8 federal districts of the Russian Federation participated in the survey. Results. According to the conducted study, the majority of pediatric urologists in the Russian Federation prefer TIP surgery for distal hypospadias, for proximal hypospadias – 2-stage Bracka surgery, and the percentage of postoperative complications directly depends on the form of the malformation: in the correction of distal form, our data correspond to the world indicators, but for proximal form, according to our data, a rather low percentage of complications was noted. Conclusion. Nowadays a surgeon operating hypospadias no longer has to have a wide range of operations from more than 300 proposed techniques. Today, most pediatric urologists prefer 2-3 operations, good command of which allows to obtain a predictable result. It is necessary to continue research in this area to standardize and unify the methods of hypospadias correction and to assess surgical complications in children in the Russian Federation.

Introduction. Ureteropelvic junction obstruction (UPJO) is the most common indication for surgical intervention in the upper urinary tract in paediatric patients. We conducted a comparative analysis of outcomes following robotassisted laparoscopic pyeloplasty (RAP) using the da Vinci Xi system versus conventional laparoscopic pyeloplasty (LaP). Objective. To comparatively evaluate the outcomes of RAP and LaP in children. Materials & Methods. The study included 40 patients who underwent pyeloplasty. Patients were divided into two groups: Group 1 comprised 20 patients treated with RAP, and Group 2 comprised 20 patients treated with LaP. All procedures were performed by the same surgeon. Results. There were no conversions in either group. In the RAP group, the mean operative time was 144.2 ± 25.9 min; docking time averaged 21.7 ± 2.6 minutes; and console time for the surgeon was 87.8 ± 20.4 min. In the LaP group, the mean operation duration was 121.8 ± 39.9 min; average surgeon time was 90.0 ± 20.0 min. The mean postoperative hospital stay was 6.6 ± 1.4 days after RAP and 7.5 ± 2.8 days after LaP (p = 0.198). At six months post-pyeloplasty, the mean anteroposterior renal pelvic diameter was 18.3 ± 11.3 mm in Group 1 and 19.7 ± 6.1 mm in Group 2 (p = 0.632). Conclusion. Comparative analysis of the efficacy and safety of RAP and LP for UPJO in children reveals comparable results in operative duration and postoperative regression of pelvicalyceal dilatation in both groups. A key advantage of RAP over LaP is the preservation of the surgeon’s physical condition throughout anastomosis formation, enabling maximal precision and avoiding compromises between desired intracorporeal suture quality and actual outcomes, which are otherwise limited by the inevitable physical fatigue associated with laparoscopic access.

Introduction. Robotic pyeloplasty represents the most frequently performed surgical intervention globally utilizing the da Vinci robotic platform in pediatric patients. The present study introduces the initial experience of executing robot-assisted laparoscopic pyeloplasty (RALP) employing the da Vinci Xi robotic system.Objective. To conduct a comprehensive analysis of the experience in performing RALP in pediatric patients using the da Vinci Xi robotic platform. Materials & methods. Between July and October 2024, a total of 14 robot-assisted laparoscopic pyeloplasties (RALP) were successfully performed. The patient cohort consisted of an equal distribution of 7 boys (50%) and 7 girls (50%). The mean anthropometric parameters of the patients were as follows: height 131.2 ± 22.1 cm and body weight 29.7 ± 15.0 kg. The severity of hydronephrosis, assessed using the Society for Fetal Urology (SFU) grading system, revealed that 11 patients (78.5%) presented with SFU grade 3 hydronephrosis, while 3 patients (21.5%) exhibited SFU grade 4 hydronephrosis. The etiology of the ureteropelvic junction obstruction (UPJO) was determined as follows: an UPJO internal cause was identified in 6 patients (43%), whereas an external cause (‘conflict’ vessel) was detected in 8 patients (57%).All patients underwent robot-assisted dissecting pyeloplasty without reduction resection of the renal pelvis. The surgical procedure was executed with the patient positioned on the side contralateral to the site of obstruction. The laparoscopic access was established using three 8 mm trocars for the insertion of optics and robotic instruments, complemented by a single 5 mm trocar for the assistant’s instrumentation.Results. No conversions were observed throughout the case series. The operative time demonstrated a significant reduction over the study period: initially, the total operative time was 195 min, which decreased to 110 min by the study’s conclusion. The mean operative time across all cases was 146.7 ± 29.3 min. The docking time exhibited a notable learning curve, decreasing from 60 minutes during the initial stages to an average of 25.0 ± 10.8 min as proficiency improved. Similarly, the console time reduced from 150 min initially to 70 min by the study’s end. The mean console time varied based on the etiology of obstruction: for internal causes of OPUS, it was 82.0 ± 16.0 min, while for external causes, it was 93.0 ± 27.0 min. Postoperatively, only one patient experienced stent dysfunction, which was successfully managed without the need for stent replacement.Conclusions. The initial experience with RALP reveals a significant advantage over conventional laparoscopic pyeloplasty (LP). Specifically, RALP allows for the preservation of the operator’s physical conditioning throughout the entire process of anastomosis formation. This preservation enables the formation of an anastomosis with maximum precision, thereby eliminating the compromise between the desired quality of intracorporeal suturing and the actual surgical outcome that often occurs due to operator fatigue with laparoscopic access. The current findings indicate that our accumulated two decades of experience in laparoscopic pyeloplasty substantially speeds up mastering the robotic platform. This prior expertise facilitates the optimization of console time duration and enables the rapid attainment of the performance plateau, achieving optimal surgical efficiency in the shortest possible timeframe.