HYDRONEPHROSIS IN CHILDREN (LOOK THROUGH THE PRISM OF TIME)

Abstract

Introduction. The introduction of ultrasonic research into everyday perinatal practice in 1980s, the use of radioisotope and radiotherapeutic techniques, as well as minimally invasive methods of surgical correction of hydronephrosis, significantly changed our view of this malformation in a number of ways. The causes of dilatation of the collection system in the fetus and newborn can be both obstructive and non-obstructive in character. Material and methods. A work analyzes modern methods of diagnosis and treatment of hydronephrosis in children. The attitude to radiopaque methods of research (excretory urography, cystography, CT) in newborns and infants is emphasized to have changed also. In this regard, the emphasis was shifted to ultrasound, radioisotope methods of diagnosis and MRI. The antenatal detection of hydronephrosis transformation was noted to contribute also to the early implementation of the surgical correction of the defect. At the same time, there is considered the need for a well-structured approach to the surgical treatment, taking into account a number of factors in children with pyelectasis, visualized in a screening ultrasound examination in pre- and postnatal periods. The modern algorithm of diagnostics and tactics of the management of patients is considered. There is discussed a number of such issues relevant to the children’s urologist as: how probable is spontaneous resolution of obstruction of the ureteropelvic segment? What criteria indicate to the non-obstructive nature of the expansion of the collection system? The prospects of using technique of robotic pyeloplasty in children are analyzed. Is surgery necessary and at what age? What kind of the access and method of prompt correction should be preferred? Will the kidney function be restored after the operation? There are considered questions of laparoscopic and retroperitoneoscopic way of the elimination of hydronephrosis, indications and contraindications to the performance of each type of access. Based on the own experience the necessity and methods of drainage of the collection system of the kidney after the operation are discussed. The prospects of using robotics pyeloplasty in children are analyzed. Conclusion. Obstruction in the region of the ureteropelvic segment will continue to cause discussions in terms of the appropriateness of selection patients which can be observed in dynamics until the main process will be resolved naturally. Laparoscopic pyeloplasty in hydronephrosis is the “gold standard” in the world and its successful implementation in children with the use of endovideosurgical technologies largely depends on the manual skills of the operator, the experience of performing similar operations, teamwork in the person of an assistant, anesthesiologist and operating nurse.