In the last decade, botulinum toxin type A (BTA) has been used in children with colorectal diseases. There are no published papers on the topic in Russia. Objective. To investigate BTA effectiveness in children with different colorectal problems. Patients and methods. 9 patients from 1.7 to 14 years old (median age 3.5 years) were treated with the new method in the Speransky Children's Hospital (Moscow, Russia). The indications for treatment were various complaints (constipation, fecal pseudo-incontinence, painful defecation, obstructive defecation), anal hypertonia (spasm). We treated children in whom conservative therapy was ineffective. Incobotulinumtoxin A was administered under general anesthesia at a dose of 3–6 U/kg at 4 points along the circumference of the anal canal. Results. The effect of therapy was obtained in 7 out of 9 patients (77.8%). A good and excellent result was recorded in 4 patients (44.4%), mild – in 3 (33.3). There was no effect in two children with genetic pathology and Hirschsprung's disease with colostomy (22.2%). Conclusion. Circumferential chemodenervation with incobotulinumtoxin A of anal sphincters is an effective and safe method of treating children with defecation disorders resistant to routine conservative therapy, but further research is needed to develop patient selection, dose calculation and create guidelines injection technique and its frequency. Key words: dyssynergic defecation, painful defecation, hirschsprung, achalasia, incobotulinumtoxin A, children

BACKGROUND: The relevance of destructive pyelonephritis in pediatric practice is determined by frequency of various complications of the disease associated with a high risk of irreversible morphofunctional changes in parenchyma of affected kidney, the lack of tactical consensus in the professional community and regulatory documents regulating the procedure for diagnostic and therapeutic support of this contingent of patients. AIM: Substantiation of the tactics of effective treatment children with destructive pyelonephritis, based on the results of a multifactorial retrospective analysis of the course and outcomes of the disease. MATERIALS AND METHODS: The results of the analysis of medical documentation of 38 patients with destructive pyelonephritis aged 3204 months (median 93.5) who received inpatient treatment in 20152019 in three specialized clinics in Moscow are presented. RESULTS: More than half of the patients (28 children) in the acute period of the disease received conservative therapy, including infusion and antibacterial, the escalation of which was carried out with the preservation or increase of manifestations of the systemic inflammatory response syndrome, as well as negative dynamics according to ultrasound or CT data. In the group of patients (n = 10), indications for surgical treatment were formulated decapsulation of the kidney, opening of apostemas and abscessed foci, drainage of the paranephral space. During the examination in catamnesis, realized in 50%. It was found that in the majority (91%) of children treated conservatively, a statistically significant decrease in the volume of the kidney on the affected side was registered. These complications were not detected among the operated patients. CONCLUSION: The pharmacy of choice for starting antibacterial therapy should be inhibitor-protected beta-lactams, carbapenems, if the etiological significance of staphylococcus is suspected, it is advisable to connect linezolid. In case of laboratory signs of hypercoagulation, it is necessary to connect anticoagulants. Surgical tactics can minimize the risk of complications associated with the purulent-destructive process, contributing to regenerative processes in the kidney parenchyma. The objectification of the results of the catamnestic examination is due to the performance of nephroscintigraphy.