Pathogenetic substantiation of minimally invasive methods of urinary system heterochrony correction

Abstract

Heterochrony – is the timing of the formation and the rate of organs development in descendants of humans, animals and plants in comparison with their ancestors. Relevance. Anomalies of the urinary system organs development make up more than 40% of congenital childhood diseases. Violation of urodynamics and associated changes of intraorganic blood and lymph circulation create conditions for the nonspecific inflammation occurrence. Using of the standard treatment methods in a large percentage of cases leads to unsatisfactory outcomes and as a result to surgical removal of an organ. Objective: Pathogenetic justification of the low-invasive techniques using for the urinary system organs heterostructure correction. Differential diagnosis between dysplasia and heterochroism of the urinary system organs. Development and implementation of methods aimed at minimally invasive elimination of urodynamic disturbances and reduction of the possible complications level. Materials and methods. Based on the heterochrony theory in the clinic of pediatric surgery at the PI «ZCMCH» № 5 it has been developed and implemented in practice since 2008 year the method of obstructive uropathy endoscopic treatment, which resolves urinary retention with the help of endoscopic technology. Technique for megaureter surgery: urinary bladder was filled via catheter by 0.9 % sodium chloride solution. The state of both ureters mouths was estimated. Into stenotic mouth with some effort a plastic conduit with a diameter of 1mm was entered. Balloon dilatator or Fogarty catheter 4,5 Fr was conducted through stenotic area of the ureter via conduit. The high-stenting was increasingly used. Area of stenosis was determined by ultrasound scanning. The same methodology was used in cases of hydronephrosis. Results. The proposed tactics of treatment have been used in the clinic of pediatric surgery since 2008. The results have been obtained: 72 children from 3 months up to 7 years were treated. The evaluation of results was made according to four-point scale in a year after the start of treatment: excellent – 25 (34.7%) good – 22 (30.5%), satisfactorily – 11 (15.3%); unsatisfactorily – 14 (19.4%). A positive result was achieved in 59 (81.9%) patients. Further diagnostic and therapeutic programs are being practiced. Conclusions. Endoscopic restoration of urodynamics helps to make a differential diagnosis between heterochronia and dysplasia of tissue using the time factor. The advantages of proposed method of obstructive uropathies treatment in children are: technical simplicity, low invasiveness, maximal physiological and reducing the postoperative complications rate.