Iliya M. Kagantsov

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.

In children, perineal soft-tissue infections in a state of severe cytopenia due to high-dose chemotherapy and in the early post-transplant period (0–100 days after hematopoietic stem cell transplantation, HSCT) are among the most dangerous infectious complications: in a retrospective analysis of treatment outcomes in 399 children after HSCT, a perianal infection site significantly increased sepsis-related mortality before engraftment (30.8%, p=0.029). The clinical course of such infections in immunocompromised children differs substantially: they are more often polymicrobial (75% vs 58% in immunocompetent patients), and typical pain is frequently blunted, delaying diagnosis. Mortality in necrotizing soft-tissue infections in children reaches 16%. Cases of fulminant spread of inflammation from the external genitalia to the scrotum, perianal tissues, thighs and anterior abdominal wall within 36 hours have been reported. Surgical treatment plays a key role in controlling such infections, yet the specialized surgical literature on the subject is limited mostly to isolated observations and small case series, and current clinical guidelines do not detail surgical tactics for this condition. Given these gaps, we conducted a study using a modified Delphi method aimed at developing consensus recommendations on the surgical management of perineal soft-tissue infections in children in the early post-transplant period. The goal of the work was to standardize the diagnosis and treatment of such patients using contemporary methods, including negative pressure wound therapy. The working group comprised 39 leading pediatric oncosurgeons and transplant specialists from our country; the first-round questionnaire was completed by all 39 experts. The results include 39 statements, of which 37 reached a strong level of consensus, one a moderate level, and one a weak level (published owing to its practical relevance). The recommendations cover the minimum diagnostic work-up for suspected perineal infection after HSCT, principles of the primary operation and staged debridements, wound management and negative pressure wound therapy, indications for colostomy, referral to allied specialists, and timing of reconstructive procedures. We hope that this work will help improve the quality of surgical care for children in the early post-HSCT period and reduce complication and mortality rates.

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.

Congenital clubfoot is one of the most common musculoskeletal disorders in children. Timely diagnosis and early management via Ponseti method allow to achieve good and excellent results in 98% of all cases. Neonatologists and pediatricians frequently encounter children with this condition in their outpatient practices. Parents of these children often ask questions about congenital clubfoot management to nonspecialized doctor. This article provides detailed description of clinical examination of a child with congenital clubfoot, features of Ponseti method treatment process, challenges patients and their parents face during treatment, and answers to frequently asked questions during outpatient visits.

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.

Pheochromocytoma is a rare neuroendocrine tumor that originates from the chromaffin cells of the adrenal medulla and is capable of synthesizing catecholamines. In this regard, pheochromocytoma leads to the development of significant disorders of the cardiovascular system, primarily causing significant increases in blood pressure, being an urgent problem for pediatric oncologists and surgeons. The prevalence of pheochromocytoma (together with paraganglioma) is 1 case per 300,000, with children and adolescents accounting for 20% of cases. Adrenalectomy is the “gold standard” treatment for patients with pheochromocytoma. Surgical treatment includes both traditional open techniques and minimally invasive ones, such as laparoscopy and robotic surgery. One of the main factors limiting the use of minimally invasive surgery is the large size of the tumor. However, modern researchers from around the world are increasingly using minimally invasive techniques. The article presents a clinical case of successful use of robotic adrenalectomy in a 12-year-old patient with a giant pheochromocytoma. The described clinical case demonstrates the effectiveness and safety of robotic adrenalectomy in a patient with a giant pheochromocytoma, highlighting the need for further research and exploration of the possibilities of minimally invasive surgery in pediatric oncology.

Congenital anterior dislocation of the tibia is a rare orthopedic disorder with an incidence of 1 per 100,000 newborns. Due to its low prevalence and a limited number of studies, no unified algorithm for surgical treatment of this condition has yet been developed when conservative treatment fails. A search of recent scientific data was conducted in PubMed, Scopus, eLIBRARY.RU, CyberLeninka, and Web of Science databases using the following keywords: врожденный передний вывих голени / congenital dislocation of the tibia, хирургическое лечение врожденного переднего вывиха голени / surgical treatment of congenital anterior dislocation of the tibia, and врожденный вывих коленного сустава / congenital dislocation of the knee joint. A total of 150 sources were analyzed, and 40 publications containing data on surgical treatment of congenital anterior dislocation of the tibia were selected. Various surgical techniques are currently employed, but their effectiveness remains debatable. The article presents an analysis of existing surgical methods for the treatment of congenital anterior dislocation of the tibia, examines their advantages and limitations, and identifies key challenges requiring further investigation. Surgical correction of this condition is most often employed in resistant and syndromic forms, which are frequently associated with knee stiffness, tibial flexion contracture, and weakness of the extensor mechanism. Therefore, when planning the use of surgical treatment techniques, it is crucial to consider the individual characteristics of the patient, such as the severity of the dislocation and the presence of concomitant somatic and orthopedic condition.

BACKGROUND: Bladder exstrophy is a rare congenital urological anomaly affecting the bladder, genitalia, pelvic floor, and pelvic bones. Skeletal abnormalities associated with bladder exstrophy include external rotation of the iliac bones, shortening and hypoplasia of the pubic rami, and retroversion of the acetabulum. The main challenge in defect closure is pubic diastasis. AIM: The work aimed to present a novel pelvic osteotomy technique for the treatment of bladder exstrophy. METHODS: The study included 30 patients with classical bladder exstrophy who underwent pelvic osteotomy using the proposed technique. The cohort comprised 24 boys and 6 girls, aged from 1 day to 17 years, operated in various clinics in St. Petersburg (Russia), Tashkent (Uzbekistan), and Minsk (Belarus). RESULTS: After 30 surgical procedures for classical bladder exstrophy with pelvic osteotomy performed according to our technique in children aged from 1 day to 17 years, a complication occurred in only one case—postoperative wound infection—which was treated conservatively using broad-spectrum systemic antibiotics and local therapy. This complication occurred in the group of patients who underwent reoperation after prior surgical bladder repair without pelvic osteotomy. No patient developed an increase in pubic diastasis in the postoperative period. CONCLUSION: The proposed pelvic osteotomy technique is effective for abdominal wall closure and bladder reconstruction. This is confirmed by the low complication rate (3.3%), involving both orthopedic and urological aspects, as well as the absence of postoperative pubic diastasis in all patients. Moreover, this pelvic osteotomy technique is an effective procedure due to its excellent correction of the disrupted pelvic ring and preservation of this correction.

Introduction. Testicular torsion (TT) is the most common emergency urologic pathology of children. Detorsion within 4-8 hours is crucial to prevent irreversible changes in testicular tissue. Ultrasound investigation plays a major role in the diagnosis of testicular torsion, but its performance is prolonging the diagnostic period and, consequently, the time of testicular ischemia. For selection of patients who really need ultrasound examination among all patients with acute diseases of the scrotum organs (ADSO), the TWIST (Testicular Workup for Ischemia and Suspected Torsion) diagnostic scale was proposed. The results of its application in the conditions of emergency care of boys in several surgical centers of Russia formed the basis of our study. Purpose. To evaluate the results of using the TWIST scale in the diagnosis of acute diseases of scrotum organs and to clarify the possibility of using additional criteria for selection of patients of medium risk group according to the TWIST scale. Materials and Methods. We prospectively analyzed the results of using TWIST scale in the diagnosis of ADSO of boys with suspected TT in five Russian clinics from 1.09.2022 to 1.01.2024. The study included 421 boys. Results. A total of 243 children were categorized as low risk group (0-2 points) according to TWIST scale, 3 (1,2%) of them were diagnosed with TT. 71 patients were categorized as high-risk group (5-7 points) according to TWIST scale, 44 (62%) of them were found to have TT. The mediumrisk group included 107 (25,4%) patients, 16 of whom were teenagers aged 13 years and older. Among the patients in the medium-risk group according to TWIST scale TT was detected in 7 (6%) boys and all of them were aged 13 years and older. Using the Pearson chi-square test, it was found that age 13 years and older is a reliably significant prognostic factor for the detection of ТТ. Analysis of ROC curves shows that the probability of TT occurrence in the medium-risk group is high already from the age of 11 («excellent» accuracy of the model). Conclusions. The data obtained in this multicenter study demonstrate the expediency of using the scale TWIST at the stage of forming therapeutic and diagnostic tactics, provided that a differentiated approach is applied in the treatment of patients with ADSO to reduce the time of testicular ischemia by avoiding unnecessary ultrasound of the scrotal organs in patients with low and high risk according to the TWIST scale. In the group of medium-risk patients aged 11 years and older, there is a high risk of TT and, consequently, it is reasonable to perform revision scrototomy without ultrasound examination in these patients.