SUPPORT FROM THE EARLIEST YEARS: AT THE RESEARCH INSTITUTE OF UROLOGY, HELPED A LITTLE PATIENT WITH EPISPADIAS AND VESICOURETERAL REFLUX

A 5-year-old patient from the Kemerovo region with a complex congenital condition — total epispadias — was admitted to the Pediatric Urology Department of the N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology. This is a rare anomaly in which the anterior wall of the urethra is absent. In such children, the penis is split, and urine is discharged not through the tip, but higher — for example, from the base of the shaft. «Epispadias is difficult to detect via ultrasound during pregnancy, so parents often only learn about the condition after the child is born», – explains pediatric urologist Jamalutdin Aliev from the Pediatric Uroandrology Department. «In addition to the absence of the anterior urethral wall, the child also had damage to the bladder sphincter — the circular muscle that holds urine — which led to constant leakage».

Later, an examination revealed another complication — vesicoureteral reflux, in which urine flows back from the bladder into the ureter and kidney. Over several years, the boy underwent a series of complex reconstructive surgeries aimed at restoring the urinary tract. After these stages, it was possible to achieve the formation of a fully functional urethra, and the external appearance of the penis became anatomically normal. However, the doctors still had to address one more issue — eliminating the reflux. «Reflux is insidious because it may not show symptoms for a long time. But if left untreated, it causes inflammation and damages the kidneys», – explains the doctor.

At the final stage of treatment, the surgeons performed an endoscopic correction of the ureteral orifice. This operation is done without incisions or punctures, through the natural urinary tract. «We injected a special bulking gel under the ureteral orifice. It helps reduce the diameter of the ureteral opening and prevents urine from flowing back into the kidney», – explains Jamalutdin Aliev. The procedure takes only a few minutes, and recovery is quick. The effect develops gradually over six months. The material does not dissolve, but a repeat correction may be required as the child grows and their organs grow as well. Therefore, doctors will monitor the progress closely. «Our institute is one of the first in Russia to start performing such minimally invasive surgeries in children. We treat vesicoureteral reflux in both boys and girls and achieve excellent results», – concludes the head of the pediatric urology team, Professor Yuri Rudin.