A unique clinical case of a combination of malformations of the anterior abdominal wall (omphalocele of large size) and malformation of the lymphatic system (congenital chyloperitoneum) is presented. Each of these defects can lead to a fatal outcome, and the combination of them has greatly increased the risk of developing an unfavourable outcome. The use of immunosuppressive therapy with Sirolimus used for the first time during the newborn period made it possible to completely stop the chyloperitoneum. This clinical example shows that in the treatment of surgical patients with multiple congenital malformations, a multidisciplinary approach and observation is necessary for timely response to the patient’s condition.

The article presents a modern view on the prognostic factors of spontaneous resolution and effectiveness of treatment of children with vesicoureteral reflux (VUR). The most frequently used predictors of successful treatment of VUR (grades of reflux, distal ureteral diameter ratio to the distance of the lumbar vertebrae, reflux induction phase on mictional cystourthrography), delayed removal of contrast from the upper urinary tract, gender, age, antenatal hydronephrosis). Methodology, statistical significance, advantages, disadvantages of the described prognostic factors are analyzed.

Predicting the outcome of endoscopic correction of vesicoureteral reflux (VUR) is an urgent problem in pediatric urology because the identification of predictors for the effectiveness of endoscopic treatment of VUR will optimize the strategy for examination and treatment of the disease. The purpose of the research was to evaluate the statistical impact of various predictors on the success of endoscopic correction of VUR; to predict the clinical outcome by creating a mathematical model. Materials and methods used: a single-center experimental uncontrolled study was conducted in Sept. 2017 - Feb. 2022. The results of treatment of 150 pediatric patients (240 renal units) aged from 1 month till 7 years old who underwent endoscopic correction of VUR are presented. The following indicators were evaluated as predictors: gender, age of the disease manifestation, bilateral/unilateral VUR, grade of VUR, ureteral diameter ratio (UDR), cystography initial confirmation of VUR, expansion of the pelvicalyceal system and ureter according to ultrasound, the presence of urinary tract infection. Results: according to the data obtained, when comparing the grade of VUR, cystography initial confirmation of VUR, UDR, expansion of the pelvis and ureter depending on the result of treatment, the statistically significant differences have been found (p<0.001). A prognostic model has been developed to determine the probability of the outcome of endoscopic correction of VUR using the binary logistic regression method. The area under the ROC curve was 0.985±0.007 with 95% CI: 0.967-1.000. The resulting regression model was statistically significant (p<0.001). The sensitivity and specificity of the model were 96.4% and 95.3%, respectively. Conclusion: the results of the research show that UDR and the initial confirmation of VUR have greater predictive power for the success of the endoscopic urethroplasty compared to the grade of VUR alone. The use of the predictors and predictive modeling can help improving the selection of candidates for the endoscopic correction of VUR and developing personalized treatment tactics.

The purpose of the research was to evaluate the efficacy of the high-pressure balloon dilatation (HPBD) of the vesicoureteral segment (VMS) as treatment of primary obstructive megaureter (POM) in pediatric patients aged 1 month to 2 years old and to identify the clear indications for its practical application. Materials and methods of the research: a single-center experimental uncontrolled open study was conducted in 2019 - 2022; 97 children with POM who underwent HPBP of the VMS: 47 boys and 50 girls. The study involved patients aged 1 month till 2 y/o. Patients underwent targeted retrograde pyelography and were assessed for the parameters of the zone of ureteral stenosis before and after the HPBP of the VMS: the length of the stenosis, its diameter and area. The follow-up period for the patients was 1 year. Results: the overall effectiveness of treatment was 92.8% as 7 ineffective cases were reported that required further reimplantation of the ureter. The most statistically significant predictors for the successful treatment were the length of the stenotic area of less than 1.7 mm, its diameter of more than 0.6 mm and the area of stenosis of less than 96.8%. Also, recovery was predicted if the difference in the diameter of the stenosis zone before and after the HPBP of the VMS was 2.4 mm, and the difference in the stenosis area before and after the HPBP of the VMS was above 49.8%. Conclusion: the HPBP of the VMS is an effective treatment for POM in infants. At the same time, the assessment of the obstruction zone during the HPBP is a necessary diagnostic procedure that serves as a reliable method for predicting the success of the treatment. Upon the receipt of parameters that cannot provide high probability of the positive result of treatment the authors suggest the ureter reimplantation.

The short bowel syndrome (SBS, or simply short gut) is the most common cause for the chronic intestinal failure (CIF). The purpose of the study was to present the results of treatment of infants at risk for the development of post-resection SBS and the formation of CIF. Research materials and methods: 22 children threatened by the formation of post-resection SBS were treated in the Surgical Department of Newborns and Infants of the National Medical Research Center for Children’s Health (Moscow, Russia) from 2017 to 2021. Results: All patients have undergone the surgical treatment. The scope of the surgical intervention included adhesiolysis with the imposition of an interintestinal anastomosis. Simultaneous imposition of multiple interintestinal anastomoses (more than 4) was performed in 7 patients (32%). As a result, the CIF formation was avoided in 8 patients (36%) by maintaining the total length of the remaining small intestine. The follow-up period ranged from 12 to 46 months. Currently, 2 patients (9%) receive partial parenteral nutrition, and in 17 patients (77%) it was possible to achieve completely autonomous enteral nutrition. A lethal outcome was stated in 3 patients (14%) due to the development of a catheter-associated infection. Conclusion: in the course of this work, the principles of surgical treatment of patients threatened by the development of post-resection SBS and the formation of CIF were developed. Adequate parenteral and enteral nutrition can optimize intestinal adaptation and improve the nutritional status of the pediatric patient.