A literature review on the subject of varicocele in children which include historical data and question about: etiopathogenesis, epidemiology, diagnostics, treatment and long-term outcomes. The diagnostic method of varicocele unchanged until the XX century and consisted of visual examination and palpation with or without Valsava maneuver. But after entering in diagnostic protocol contrast venography, thermography of testis and ultrasound examination, this protocol have significant changes. For a long time, phlebography has been considered the «gold standard» for the diagnosis of varicocele. But the big disadvantage of this procedure is high invasiveness. Doppler ultrasound mapping has given a new impuls to the diagnosis of varicocele due to minimally invasiveand accessible. G. Liguori, C. Trombetta in their work showed that surgical treatment of varicocele should begin when the testicle size is reduced by more than 20%, or 2 ml of volume in ultrasound examination. Also, the visualization of reflux into the seminal vein is more specific in the ultrasound examination. G. Sigmund et al. introduced the concept of stop-type, shunt-type reflux into the seminal vein. However, in the case of unexplained recurrent varicocele, only antegrade venography can provide sufficient information. The review presents the classic and alternative surgical treatments of varicocele in children. Today it is safe to say that the treatment of varicocele has entered to the era of modern evidence-based medicine. A large number of studies indicate that the expansion of the testicular plexus has a progressive detrimental effect on testicular tissue and leads to a deterioration in sperm count. The methods witch used to correct varicocele earlier was traumatic, but modern surgery has brought many innovative technologies and methods of surgical correction. In addition, there have been impressive developments in bimolecular and functional sperm tests. Nowdays gold standard of surgical treatment varicocele is microsurgical subgingival varicocelectomy but this operation has one big disadvantage. This is possible damage of the testicular artery. The solution of this problem can be obtained by finding new intraoperative way of visualization and defending testicular artery and lymphatic vessels. No conflict of interest was declared by the authors. Key words: varicocele, microsurgical subgingival varicocelectomy, children.

Urethral doubling is a rare congenital anomaly of the urinary system that is more common in boys. Less than 500 clinical cases of this disease have been described in the literature, which may signal a lack of awareness among physicians. Although there are many considerations regarding the embryology of this anomaly, the etiopathogenesis of its various forms remains unclear. Sometimes doubling of the urethra is combined with other malformations, such as epispadias, hypospadias, exstrophy of the bladder, anorectal malformation, doubling of the bladder and others. In this article, we present a clinical case of a 9-year-old boy with urethral duplication and additional urethral epispadias. We found the main and additional urethra, which goes on dorsal side of the penis and led to curvature of the penis and urinary incontinence. During the operation, urethrocystoscopy was performed before the main stage, and a complete doubling of the type 2-A urethra was established according to the Effman classification, after which the additional urethra was excised as far as the pubic bones. Urethral duplication is a rare anomaly, with several forms of clinical presentation, often accompanied by other anomalies, and sometimes with difficult diagnosis. The treatment of urethral duplication should be individualized, according to its type. In this case we find urethral duplication type IIa, which has been treated as classic epispadias. Therefore, in child with congenital malformation of penis need to perform obsrvetion like urethrography, cystoscopy. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: urethral substitution, epispadias.

In the structure of male infertility, varicocele is being detected in 30–40 % cases of primary infertility, and in 80 % cases of secondary infertility. At the age of 10 years during the screening, only 1 % of boys have a varicocele, but in the pubertal period this figure increases to 15–20 %. Indications for surgery in childhood differ from those in adults, since grade III varicocele must be associated with ipsilateral testicular atrophy more than 20 % compared to contralateral, or combined with pain. Surgical methods of varicocele treatment are different. Discussions are ongoing regarding the choice of ligation of the internal spermatic vein. There is no general agreement on the technique of surgical intervention. There are about 100 different methods of internal spermatic vein ligation in the world, the most popular of which are the retroperitoneal approach according to Palomo, transinguinal access according to Ivanissevich, subinguinal ligation according to Marmar, vascular embolization and laparoscopic suprainguinal approach. Currently, there is no gold standard for surgical treatment of varicocele in pediatric surgery in contrast to adulthood, where microsurgical subinguinal varicocelectomy has already become a classic method of intervention. This is due to a lower complication rate compared to high ligation. Subinguinal varicocelectomy can sometimes lead to testicular atrophy due to damage to the testicular artery, which is difficult to visualize du­ring surgery. In childhood, Marmar operation is complicated by the small size of the spermatic cord structures, which requires the search for new methods of intraoperative visualization of vascular structures. In this article, intratesticular injection of 1% methylene blue was used for lymphatic vascular contrast and indirect visualization of the testicular artery, which allows for the use of subinguinal varicocelectomy in adolescents.

A varicocele is one of the most common causes of spermatogenesis and infertility disorders, which can be corrected. With the advent of high-quality optical operating systems, subinguinal microsurgical varicocelectomy has been added to the pediatric urologist’s arsenal. One of the most unresolved problems of using this operation in children is postoperative hydrocele and possible damage to the testicular artery due to its small size, which leads to testicular atrophy. To solve this problem, lymphatic vessel contrast with 1% methylene blue was used to verify lymphatic vessels and indirectly visualize the testicular artery. Purpose - to develop a modified technique of microsurgical subinguinal varicocelectomy with intraoperative contrast of lymphatic vessels in children; to evaluate the results of surgical treatment of varicocele using this technique. Materials and methods. The study included 65 boys aged 11 to 17 years with a confirmed diagnosis of grade III varicocele and recurrent testicular pain or testicular hypotrophy. Patients were randomized into 2 clinical groups for classical or modified varicocelectomy. The success of treatment was evaluated after 6 months. The Group I included 34 patients who underwent classical subinguinal microsurgical varicocelectomy; the Group II included 31 patients who underwent modified surgery. Results. No cases of complications and recurrence of the disease in the late postoperative period were recorded in the group using the modified technique, while in the group with the standard technique, such cases were detected in 17.6% of patients. In addition, it was found that intraoperative contrasting of lymphatic vessels made it possible to clearly identify the testicular artery in all cases in the group with the modified technique, while in the group with the standard technique it was visualized only in half of the cases. No intraoperative complications, hypersensitivity, or allergies were noted during the operation. Conclusions. A modified varicocele treatment with intraoperative lymphatic vessel contrast may be more effective and safe for patients with this disease due to vein visualization, as the artery and ductus deferens remain the only unchanged structures due to the use of a compression test and lymphatic vessel contrast. The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent was obtained from the patients for the research. No conflict of interests was declared by the authors.