Testicular torsion is a severe variant of postnatal gonad pathology in children. The speed of development of irreversible ischemic disorders determines not only the medical, but also the social significance of the problem and determines the need for accurate and rapid diagnosis and prompt provision of adequate care to the patient. The only objective method for diagnosing testicular torsion in children is ultrasound. At the same time, the characteristics of the child’s body: the small size of the object of study, low rates of intratesticular blood flow and restless behavior during the study sharply reduce the diagnostic value of the Doppler study or make it technically impossible. Thus, seroshkal ultrasound is the first stage of diagnosis of this complex emergency pathology, based on the results of which it is possible to diagnose testicular torsion with great accuracy. The publication summarizes our own experience of 110 echographic observations of postnatal testicular torsion in children older than 2 months, all cases were verified intraoperatively. A quantitative method for estimating the deformity of a twisted testicle is proposed and its statistical reliability is proved. The options presented for gray-scale changes in the structure of damaged gonads and determined their prognostic significance. The publication contains a review of the literature and is extensively illustrated.
Epididymal cysts in children are rare, and, as a rule, their detection is an incidental finding, the course is asymptomatic, the surgical treatment is not carried out. Isolated torsion of these cysts is extremely rare in both children and adults, causing acute pain syndrome and swelling of the scrotum. Due to its rarity and lack of specificity of clinical and echographic manifestations, this condition leads to a delay in the accurate diagnosis of the disease, which is carried out only intraoperatively. The rare case of combined testicular torsion and torsion of a large appendage cyst in a 12-year-old teenager is presented in the publication.
Introduction. The small size of the bladder plate is a poor prognostic sign for successful treatment of exstrophy. Primary closure in newborns and infants with microcystisis often accompanied by complications and relapses; there for, the approach to the treatment of this group of patients requires a more detailed analysis. The aim of the study. Identify advantages and disadvantages of delayed primary closure surgery in patients with bladder exstrophy and microcystis. Materials and methods. During the period from 1994 to 2020, 265 children with bladder exstrophy were subjected to surgery, 123 patients were newborns. There were 37 children with microcystis (bladders plate <3 cm). In 30 children, primary closure was performed at the newborn age. Seven patients with microcystis were subjected to everyday manual and mechanical stretching of the bladder and injections of botulinotoxin type A into the bladder plate (2-3 times) for 1-2 years. In 5 children the size of the bladder plate was increased from 3 cm to 6 cm, they were underwenteded delayed primary closure at the age of 1-2 years, supplemented by ureteroneoimplantation, bladder neck reconstruction, with bilateral osteotomy. Results. Complications of primary closure in patients operated on during the neonatal period (30) such as relapse of the exstrophywere observed in 10 patients (33.3%) and partial wound dehiscence in 3 children (10%). In patients with microcystis that underwent delayed primary closure after stretching the bladder, there was no relapse of exstrophy, and growth of the bladder was observed. Conclusions. In our opinion, delayed primary closure of the bladder in children with microcystis after mechanical stretching of the bladder plate in combination with injections of botulinum toxin type A into the detrusor can improve the results of correction of exstrophy.
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