Ectopic ureter (EU) is a rare urinary tract malformation often found in patients with a duplex kidney. Abnormal location of the ureteral orifice in a non-duplex kidney is observed in 20–25% cases of all ectopias. The paraurethral EU is described in very few publications. An 8-year-old female patient complained of periodic abdominal pain, inflammatory changes in the urinary sediment, and periodic urinary incontinence. The child had not been examined earlier. Ultrasonography findings: left kidney size 41 × 20mm; the ureter was dilated along its entire length and has bends; the diameters of its upper and thirds were 16 mm and up to 23 mm, respectively. Cystography showed no evidence of vesicoureteral reflux. Contrast-enhanced computed tomography findings: the orifice of the left ureter was not visualized; there was a significant decrease in the function of the left kidney and dilation of the left ureter. Findings of cystoscopy under anesthesia: the orifice of the left ureter was in the bladder; the bladder neck was not visualized. During the examination of the area between the urethra and the vagina, we found the orifice of the left ureter located to the left of the midline. The patient underwent laparoscopic left-sided nephroureterectomy. Six months postoperatively, the patient had no urinary incontinence and no urinary syndrome. Static renal scintigraphy showed that the index of integral uptake on the right was 108; the total volume of the functioning parenchyma was not reduced. Key words: ectopic ureter, nephroureterectomy, children.

Cross-dystopia is a rare type of congenital anomaly, characterized by a displacement of the kidney to the opposite side, as a result of which both of them are located on the same side and in about 85% of such cases, a fusion of the parenchyma of two kidneys can be observed. We have not found descriptions of cases from practice when an orthotopic cystic dysplastic kidney with a lack of function associated with the pathology of the ureterovesical segment (ureterocele) was fused with the lower pole of a cross-dystopian normally formed kidney in literature.The patient, 8 d.o., a preliminary diagnosis - agenesis of the right kidney, doubling of the left kidney, cystic dysplasia, doubled left kidney whiyh ureterohydronephrosis lower half and ureterocele. In order to restore the outflow of urine and function of the lower half of the presumably doubled left kidney, a cystourethroscopy was performed. In a typical place on the right there is a correctly formed ureteral orifice, ureterocele on the left, which occupies half volume of bladder. With a holmium laser, an artificial orifice was formed in the ureterocele in order to restore the urine passage. At 9 m.o., tomography urinary tract was performed - cross-dystopia of the right kidney with fusion of the lower pole with a cystic dysplastic orthotopic left kidney.Laparoscopic nephrureterectomy of a non-functioning orthotopic kidney was performed.The control examination indicate complete clinical remission and social adaptation of the patient after discharge. Cross-dystopia of the kidney with fusion with cystic dysplastic kidney and a formed ureterocele is a rare congenital anomaly that requires timely examination in a specialized clinic and drawing up an individual treatment plan. The surgical manual should be focused on a symptomatic urological problem with an emphasis on preserving kidney function.

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Background. One of the main reasons for the incorrect differentiation of obstructive and non-obstructive disorders of the upper urinary tract (UUT) is age-related morphofunctional immaturity of the kidney and its structures in children of the first three years of life. Aims to investigate to determine the peculiarities of urodynamic disorders of the UUT in infants with congenital hydronephrosis using diuretic pyeloehography (DРG) method. Methods. There were studied DPG data of 55 patients aged 336 months with unilateral hydronephrosis of IIII grades SFU, which were divided into groups in accordance with the variant of violation of the urodynamics of the UUT (obstructive, obstructive-hypertensive and disadaptive). The variants established according to the parameters of the DPG (transient coefficient PUJ (Kpus), the coefficients of postfurosemide adaptation (Ka) and the efficiency of emptying (Ko) pelvis). The obtained data are compared with the conclusions of morphometric studies of the operated 20 children with ureteropelvic junction obstruction (UPJO). Results. The obstructive-hypertensive variant was determined in 18 patients, obstructive in 20, and disadaptive in 17. The severity of pelvic dysfunction (according to Ka and Ko) did not correlated to the grade of UPJO (according Kpus) in most cases. Intergroup and intragroup variability in the values of the DРG coefficients is confirmed by the results of PUJ and pelvis morphometry. The correlation between hystological modification in the pelvis and DPG parameters was revealed. Obtained data allowed to introduce a new indicator urodynamic indicator of quantitative assessment of functional insufficiency of the UUT. And the score gradation of each DРG coefficient (from 0 to 4 points) in accordance with deviation from the reference values was developed. The total indicator functional insufficiency is expressed by the sum of points (SP) for each coefficient (Ka, Ko, Kpus). When SP is less than 3 points light, 46 moderate, 79 expressed and 1012 severe grade of violation of urodynamics. The severity of dysfunctions of the UUT in 88% of children (n = 15) with a disadaptive variant corresponded to light degree, in 75% of patients (n = 14) with an obstructive-hypertensive variant expressed (50%) and severe (25%) grades. Moderate degree of dysfunction revealed in 65% of patients (n = 13) with an obstructive variant. Conclusion. The severity of urodynamic dysfunction of the UUT in this age group can be determined by the score gradation of the DPG parameters which reflects the functionality of the pelvis/PUJ and the grade of their violation adaptive reactions in response to diuretic.