[Principles of surgical correction of congenital developmental defects of pelvi-ureteral and vesico-ureteral segments in children].
A total of 426 children with hydronephrosis, 410 with fourth-degree reflux (506 ureters), and 233 with primary megaureter (307 ureters) were operated on. By the moment of surgery the patients' ages varied from 4 months to 14 years. The results of correction of the pelviureteral segment were studied in all patients in periods of 1-25 years and of vesicoureteral segment in periods of 1-29 years postoperation. The studies and analysis of remote results of surgical treatment indicate that irreversible structural changes in the ureter wall, mainly congenital (developmental defect), play a decisive role in the pathogenesis of urodynamic disorders at various levels of the ureter. Qualitative characteristics of these changes are identical at different levels of the ureter and in different types of dysplasia. The pattern of developmental defect was determined by quantitative ratios of structural involvement of the muscular, connective tissue, and elastic elements of ureteral wall. All this gave grounds for performing similar operations whose basic element was resection of the defective ureteral segment and its replacement by a morphologically and functionally full-value fragment. Such operations were resection of the pelviureteral segment with Anderson-Hynes-Kucera's anastomosis plasty in hydronephrosis and resection of the distal compartment of the ureter with its neoimplantation into the bladder by the antireflux method in dysplasia of the distal part of the ureter. In correction of hydronephrosis good results were attained in 97.8% cases, in fourth-degree reflux in 98% cases, and in primary megaureter in 90.2% cases. High efficiency of resection methods confirms that these operations were pathogenetically justified.
Cheskis
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Vinogradov
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D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008297:Male; D010388:Pelvis; D017410:Practice Guidelines as Topic; D014513:Ureter / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D014515:Ureteral Diseases / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D001743:Urinary Bladder; D014567:Urography; D013520:Urologic Surgical Procedures / Q000379:methods*