No abstract

Urethralstricture remains one of the most discussed problemsin pediatric urology. Despite a significant number of articles and the existence of a wide variety of methods for treating urethral strictures and their modifications, every new generation of urologists encounters this problem.Treatment of urethralstricture often takes a long time and requires multiple surgical interventions. Treatment techniques continuously improve, therefore it is appropriate to regularly summarize new data. Such methods as bougienage, balloon dilation and urethralstenting are still being used, although as early asin the beginning of the 19th century the first types of such modern method as optical internal urethrotomy were developed. In relation to optical internal urethrotomy, discussions on indications, techniques, duration of catheterization, necessity of combination with intermittent catheterization, use of hormonal drugs continue. The question of the number of attempts to perform urethrotomy also remains controversial.In this review, we tried to clarify the problem of use of minimally invasive techniques for urethral stricture treatment in children in the context of current scientific data and historical aspects.

The study objective is to present a clinical observation of a 17-year-old boy with post-traumatic venous malformation of the spongy urethra. Clinical case. The patient was hospitalized in an urgent order with complaints of urethrorrhagia. Medical history showed that the first episode of urethrorrhagia happened at 3 years of age and could be caused by a self-injury of the urethra due to mentally traumatic events in the family. After catheterization of the bladder, urethral bleeding stopped, but in the early morning blood seeped past the catheter. Urethroscopy showed an area of modified urethra distally from the penoscrotal junction in the form of pockets with partitions of scar tissue 3 × 1 cm in size that we considered a post-traumatic abnormality. Ultrasound of the corpus spongiosum and magnetic resonance imaging of the genitals didn’t provide additional information. Repeat urethroscopy performed during erection allowed to visualize pathologically dilated vessels bulging into the urethral lumen which were the source of bleeding. Spongiosography allowed to visualize a pathological vascular tree. Diagnosis of post-traumatic venous malformation of the spongy urethra was made. The pathological area was resected with preservation of the fibrous tunic of the corpus spongiosum. The defect was substituted by a flap of the inner preputial leaf. Follow-up observation lasted for 1 year with no urethrorrhagia episodes, the patient didn’t experience any discomfort during sex or micturition.Conclusion. Due to the rarity of this pathology and complexity of diagnosis, the whole spectrum of diagnostic methods should be applied, with urethrocystoscopy and spongiosography being the most informative. Selection of treatment method depends on many factors. If the malformation is located near the urethra, electrocoagulation and angioembolization are ineffective. Resection of the venous malformation within normal tissue and substitution urethroplasty with preputial flap allowed to achieve good clinical and functional result.

BACKGROUND: Bladder exstrophy is one of the most difficult for the reconstruction of malformations. AIM: This study aimed to evaluate the outcomes of delayed bladder closure in exstrophy in comparison with procedures in newborns and to test the hypothesis that the reliability of bladder closure does not decrease without closing the fascial defect between the rectus abdominis muscles and that the postoperative period is more favorable. MATERIALS AND METHODS: Delayed closure of exstrophy without osteotomy, convergence of pubic bones, or flap movement was performed in 46 patients with classic bladder exstrophy. Among them, 34 were primary patients, and the remaining patients, who had a complete relapse of exstrophy as a result of suture divergence, had undergone unsuccessful surgery in other clinics 14 times (n = 12). In total, 25 were boys and 21 were girls who underwent surgery from 2006 to 2021. RESULTS: Delayed bladder closure was successful in all 46 children (100%). No signs of acute pain were noted. Serious complications such as dehiscence of the sutures in the bladder and proximal urethra were not observed. Minor complications occurred in five patients, which resolved promptly. DISCUSSION: In the treatment of exstrophy, successful primary bladder closure is critical to achieving future urinary continence. The elimination of the defect between the rectus abdominis muscles with the convergence of the pubic bones has significant drawbacks, including an increase in the operating time and trauma, need for blood transfusion, risk of orthopedic and neurological complications, and a more difficult postoperative period. The vast majority of the patients develop rediastasis. The authors proposed a more reliable method of delayed closure of exstrophy. CONCLUSIONS: The presented method of bladder closure was 100% successful. The procedure was simplified technically, the surgery time was reduced, and the postoperative period proceeded more easily without prolonged pain syndrome, prolonged use of analgesics, and, in most cases, without blood transfusions.