Таргетирование процессов гетерохронии в рациональном подходе к диагностике и лечению обструктивного уретерогидронефроза у детей

Abstract

The final formation of the child’s functional systems completed during postnatal ontogeny. To create optimal conditions for the functioning of the body is necessary either to decrease the level of functional requirements to the immature system, or the creation of new operating conditions under which the extended maturation time factor. Currently, the most common treatment for obstructive uropathies is surgical treatment. A promising alternative to open surgical treatment of obstructive megaureter is endoscopic stenting of the ureter, based on an assessment of the phenomena of growth imbalances and dysfunction, tissue and maturation of the urinary system.Objective: rationale and introduction of minimally invasive endoscopic draining techniques aimed at restoring urodynamics by using a PVC intraluminal drainage (stent).Materials and methods. The possibility of stenting with determination of the size of the mouth of the ureter was investigated. The study involved 32 children aged from birth to three years. A retrospective analysis of previously treated 41 patients with obstructive ureterohydronephrosis was performed.Results. The study found that the optimal age for endoscopic correction of the intramural ureter is up to 3 months of life, when telescopic bougienage with dilation of the intramural compartment of the compromised ureter can be performed with calibration of the mouth and stent of the ureter with a corresponding stent.Retrospective analysis of previously treated patients allowed us to determine the same dependence. Thus, out of 41 patients with obstructive ureterohydronephrosis positive result was achieved in 29 children (70.73%) up to 1 year and 6 (14.63%) over 1 year. The impossibility of performing endoscopic correction of the orifice and stenting of the ureters in the age group up to 1 year was noted only in 1 patient (2.43%), whereas in the group from 1 year to 3 years – in 5 patients (12.19%).Conclusions. The proposed tactics of treatment of obstructive uropathy in children has advantages in terms of open surgical techniques in the technical simplicity, minimally invasive, maximum physiological, reducing the incidence of postoperative complications. It should be remembered that the effectiveness of endoscopic stenting of the lower parts of the ureter depends on the age of the child.The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies.