Pediatric Uroandrology Department

Reconstructive plastic surgery of the ureteropelvic junction. The narrowed ureter is excised and ureteropieloanastomosis is formed intracorporeally (inside the human body). Miniature instruments 3-5mm and suture materials 6/0 (Monocryl) are used. The urinary tract is drained with an internal stent or pyelostomy. Diagnostics of hydronephrosis has been improved, functional tests with lasix are performed. Modern laparoscopic and retroperitoneal ureteral plastic surgery is performed with mandatory optical magnification. These innovations improve the results by reducing surgical trauma, surgical intervention is performed through small incisions and provides urine diversion by internal stents or external stent- pyelostomy. Pain is reduced, children become active quickly and are discharged sooner.

Resection of the kidney. To preserve the functioning part of the duplex kidney, the inflamed and non-urinating part of the kidney and ureter is excised. Laparoscopic access allows this to be done as sparingly as possible, without dissecting the muscle mass, without rough postoperative scars. To prevent bleeding in the resection area of ​​the kidney, surgeons have modern devices for coagulation and reliable resection of parenchymatous organs (Ligashu and Harmonic).

The pathology is caused by compression of the ureter by the inferior vena cava. The essence of the surgical intervention is laparoscopic mobilization of the ureter and its movement above the vein. To do this, the ureter is dissected in the compression area, the pathological area is excised and reconnected in an anatomically correct position. The ureter is drained using an internal stent. This is a laparoscopic surgery.

The most modern high-tech one-stage operations are successfully applied in the treatment of megaureter in infants (over 10 months of age). Modeling (narrowing of the ureter), intravesical (pneumovesicoscopic) and extravesical (laparoscopic) antireflux surgeries are performed through small punctures. Previously, these patients were treated mainly in several stages with the formation of temporary urinary fistulas on the skin (ureterocutaneostomy). Progress has now been made in the treatment of this malformation.

Laparoscopic reimplantation is performed for obstructive megoureteritis in 10-11 month old infants with resection of the dysplastic part of the narrowed ureter and implantation of the ureter into the bladder. The antireflux mechanism is created using the Gregoire technique (formation of a submucosal tunnel by dissecting the detrusor muscles to the mucosa and immersing the ureter into the formed groove with interrupted sutures). In case of vesicoureteral reflux (VUR), only antireflux surgery is performed with preservation of the orifice in its original place.

Pneumovesicoscopic (filling the bladder with air) reimplantation of the ureter is possible in children 11 months of age and older with a large bladder. The antireflux mechanism is created according to the Cohen technique by forming a submucosal tunnel in the bladder and creating the ureteral orifice in a new location.

Multicystic kidney (instead of a kidney with parenchyma, there are multiple cysts without renal tissue) is not an urgent pathology and surgery is not necessary for newborns and children of the first months of life. Surgery is performed at the age of 1-2 years in the absence of reduction (decrease in size) of cysts according to ultrasound and the presence of minimal kidney function. An indication for surgery is the risk of developing nephrogenic hypertension or oncologic degeneration. Nephrectomy is performed by laparoscopic or retroperitoneoscopic access through 3 incisions.

Small cysts (up to 2-3cm) require observation. Cysts larger than 2.5-3 cm with signs of active growth are operated. It is possible to treat them by making a puncture injecting a sclerosing agent or by excision of the cyst wall with laparoscopic or retroperitoneoscopic (retroperitoneal) access. Cysts stop growing or disappear completely.

In rare cases after removal of the kidney and wide ureter (obstructive megaureter), a dilated distal ureter remains, where infected urine may accumulate. Periodic discharge of purulent urine from the ureteral stump worsens the urine analysis results. The residual ureteral stump can also be removed laparoscopically.

A rounded protrusion of the bladder mucosa beyond its contour, resulting from a defect in the muscular wall. Diverticula most often occur in the area of the ureteral orifice and are called paraureteral diverticula. A bladder diverticulum may have a wide base, in which case there is no impairment of its emptying during urination. Bladder diverticulum of a large volume (of more than 30-40ml) and disorder of its emptying require surgery. There are open and laparoscopic (pneumovesicoscopy) intravesical operations with diverticulum excision and extravesical (laparoscopic), when the diverticulum is excised from the outside without opening the bladder. N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology uses mainly pneumovesicoscopic access for diverticulum removal.

All surgical interventions for pathologies of the genitourinary system in children are done with a comprehensive treatment approach. Varicocele (a common disease in children, which is characterized by an increase in the lumen of the veins in the area of the testicles and seminal canals), cryptorchidism (not dropped testicle), hydrocele (testicular hydrocele in a child), pathologies of the vaginal outgrowth of the peritoneum, inguinal hernias are treated with the use of modern minimally invasive techniques without stretching the testicular vessels and disruption of blood circulation of the gonads.

Excellent cosmetic and functional results have been obtained in the treatment of all forms of hypospadias in children and adults. Modern author’s one-stage methods of malformation correction are successfully applied when one surgery can eliminate the curvature of the cavernous bodies, create an extended section of the artificial urethra and bring out the external opening at the top of the head. The latest two-stage methods of treatment of proximal hypospadias with improved cosmetic results, without disturbing the flow of urine in the immediate and distant period have been introduced into practice. The department also performs surgical treatment of children with hidden penis, new techniques allow to remove the penis from the surrounding tissues and clearly form its contour. Excellent long-term results have been obtained.

Successful experience has been gained in the treatment of bladder exstrophy and epispadias. In addition to the creation of the bladder, sphincter and bosom bones, the penis is lengthened and the defect in the anterior abdominal wall is easily closed. In stages, the bladder volume can be increased, satisfactory urinary retention can be achieved and a normal appearance of the penis can be achieved by maximizing the mobilization of the cavernous bodies. A great deal depends on the initial bladder size. In the case of microcystis (small bladder), operations to increase its volume with a segment of small intestine are used.

Operations are aimed not only at creating the urethra, but also at eliminating the deformity – straightening and lengthening the corpora cavernosa of the penis by doing plastic surgery of the white membrane. Children with complete urinary incontinence undergo bladder neck plastic surgery with bilateral iliac osteotomies and without osteotomies.

Destruction of kidney stones (including coral stones), ureter, bladder stones.

• Remote lithotripsy – destruction of stones by shock-wave method.
• Contact lithotripsy (percutaneous, mini-percutaneous nephrolitholapaxy).
• Endoscopic removal and destruction of stones from the ureter, bladder and kidney.

(hydronephrosis, megaureter, doubling of the upper urinary tract, renal cysts):

• Treatment of vesicoureteral reflux (endoscopic correction – insertion of high-quality durable implants of volumizing products)
• Laparoscopic ureteropelvic junction plastic surgery (hydronephrosis)
• Laparoscopic nephrectomy, nephroureterectomy (non-functioning kidney, multicystic kidney)
• Laparoscopic kidney resection – heminefrureterectomy (non-functioning half with complete doubling of the upper urinary tract)
• Laparoscopic excision of bladder diverticulum
• Laparoscopic ureteral reimplantation for megaureter and VUR
• Retroperitoneoscopic and laparoscopic excision of solitary renal cysts
• Percutaneous endopyelotomy (in case of recurrence of UPJ stricture or ligature nephrolithiasis).
• Laparoscopic removal of urogenital sinus (proximal hypospadias)
• Laparoscopic removal of hypoplastic testicle (cryptorchidism)
• Laparoscopic removal of ureteral stump
• Endoscopic treatment of posterior urethral valve (PUV)
• Pneumovesicoscopic ureteral reimplantation for megaureter with intravesical ureteral modeling.
• Pneumovesicoscopic excision of ureterocele, bladder diverticulum

• Primary bladder closure (repeated operations) with bilateral iliac osteotomy of the pelvic bones.
• Plastic surgery of the penis and urethra in epispadias with increasing the length of the corpora cavernosa by mobilizing them from the bones of the pelvis.
• Bladder neck plastic surgery with iliac osteotomy of pelvic bones
• Increasing the volume of the bladder (augmentation) – enterocystoplasty + appendicostomy.
• Creation of an artificial bladder from a segment of intestine + appendicostomy

• Hypospadias, epispadias, hidden penis
• Correction of cavernous body deformation with plastic surgery of the tunica albuginea using free flaps of the foreskin (grafting)
• Plasty of the urethra in trunk, scrotal and perineal hypospadias, augmentation of the penis head, implantation of a free flap of the mucous lip (cheek, foreskin). Treatment of all types of complicated hypospadias
• Correction of urogenital sinus of large size (laparoscopic removal).
• Treatment of penoscrotal transposition. Transposition of the scrotum to an anatomically correct position
• Treatment of hidden penis. Formation of anatomically correct contour of the penis
• Feminizing surgeries in girls with false female hermaphroditism (adrenocortical syndrome ADCS).

• Varicocele (microsurgery using optical magnification)
• Cryptorchidism (laparoscopy)
• Testicular hydrocele (laparoscopy)
• Phimosis (use of optical magnification, precision suturing)
• Inferior inguinal hernia (laparoscopic)