Objective. To assess treatment outcomes in children with posterior urethral valve (PUV). Patients and methods. We analyzed treatment outcomes in 60 children with PUV within a non-randomized, retrospective, single-center, pilot study. Sixty patients have undergone PUV ablation; 8 of them required repeated ablation. Endoscopic treatment of vesicoureteral reflux (VUR) was performed in 31 ureters; 5 children had botulinum toxin therapy. Results. Type 1 PUV was diagnosed in 49 patients (81.6%), whereas type 3 PUV was identified in 11 patients (18.3%). VUR was detected in in 65 ureters (54.1%); obstructive ureterohydronephrosis was diagnosed in 40 ureters (33.3%). Ablation of the valve flaps improved lower urinary tract (LUT) urodynamics in 27 children. Thirty-three patients had valve bladder syndrome (VBS). Improvement of the upper urinary tract (UUT) condition was achieved in 54 cases. Fifteen children have undergone nephroureterectomy. There was a significant decrease in the activity of pyelonephritis in children after endoscopic ablation of the PUV. Fifty-three patients (88.3%) demonstrated severe UUT urodynamic disorders. The baseline grade of UUT lesions affected treatment outcome (p = 0.0009). Children with VBS symptoms had progressive UUT pathology and persistent urinary incontinence. Six patients eventually required replacement therapy. Conclusion. The majority of PUV children (88.3%) presented with severe UUT impairments. More than half of the patients (55.0%) had VBS symptoms. Their treatment should be comprehensive and include long-term monitoring of urodynamics and kidney function. Key words: posterior urethral valve, valve bladder syndrome, vesicoureteral reflux
Bladder diverticulum in children is rarely encountered in the practice of a pediatric urologist. If the bladder diverticulum has clinical manifestations (pain, urinary tract infection, hematuria, voiding dysfunction, vesicoureteral reflux, or obstruction of the ureterovesical anastomosis), then surgical treatment is indicated. Recently, more and more publications began to appear on the removal of the bladder diverticulum using laparoscopic or vesicoscopic access. Several foreign publications report on the removal of a bladder diverticulum in children using a robotic approach. A 9-year-old boy with a diagnosis of bladder diverticulum underwent surgical intervention in the volume of robot-assisted bladder diverticulectomy in January 2020 at the Almazov National Medical Research Centre. Ports da Vinci 12 and two 8 mm were used, as well as an assistant 5 mm port, which were installed in typical places for lower abdominal surgery. The duration of the operation was 135 minutes. Console time - 75 minutes. The volume of blood loss is 20 ml. The patient was in the intensive care unit for a day. The urethral catheter was removed on the 7th day after the operation. Urination independent, free; phenomena of delay, incontinence were not noted. The patient was discharged on the 9th postoperative day in a satisfactory condition. At the control examination after a year at the place of residence, she does not complain, urination is not disturbed, there are no pathological changes in the ultrasound of the kidneys and bladder. Robot-assisted bladder diverticulectomy in children is a feasible, effective and safe treatment option in expert centers with extensive experience in robotic surgery. The described clinical case of bladder diverticulectomy is the first in Russia performed using a robotic system in pediatric practice.
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