Vol 25, No 2 (2021)

Background. After tubularized incised plate (TIP) urethroplasty meatal and urethral dilatation is a common practice. There are some complication of uretheral dilatation like urethral bleeding,urethral perforation and creating a false passage. Moreover dilating the urethra regularly is physically or psychologically painful both for the child and the parents. The aim of this study was to justify the necessity of uretheral dilatation after TIP urethroplasty.

Material and Methods. This study was a prospective, comparative study performed in Dhaka Shishu (Children) Hospital from July 2017 to June 2020. Total 60 respondents were participated in this study with maintain inclusion criteria. Respondents with primary distal and mid-shaft hypospadias where TIP urethroplasty was indicated, admitted in Dhaka Shishu Hospital during study period were included. Group 1 was assigned non dilatation group and Group 2 was assigned to regular urethral ditatation group after TIP urethro- plasty. Fistula formation, meatal stenosis and neourethral stricture were compaired between two groups. Informed written consents were taken from legal guardians. Data ware analyzed by SPSS Program.

Results. In this study there was no significant difference of ages between two groups. In Group 2 10 %( 3)respondents developed urethrocutaneous fistula, 10% (3) respondents developed meatal stenosis and 3.33% (1)respondents developed neourethral stricture. On the other hand. In Group 1 10% (3) respondents developed urethrocutaneous fistula, 6.66% (2) respondents developed meatal stenosis. None of patient in Group 1 developed neourethral stricture.

Conclusion. There was no significant difference in fistula formation, meatal stenosis and neourethral stricture in between regular urethral dilatation group and non-dilatation group after TIP urethroplasty.

Introduction. Peritoneal dialysis (PD) is considered a very effective care for newborns with severe acute renal injury , and it is a method of choice for treating newborns in the end-stage renal failure who require chronic renal replacement therapy (RRT). The classical modification of peritoneal dialysis involves the introduction of dialysis solution into the abdominal cavity, its presence there for a certain time (exposure time) and its passive evacuation from the abdominal cavity. However, this technique of peritoneal dialysis causes an increased intra-abdominal pressure leading to a number of complications. PD in premature newborns, including those with extremely low body weight, has a number of features associated with extremely immature organs and tissues. One more problem is hemodynamic instability in this category of patients. Besides, peritoneal dialysis in the classical modification accompanied by increase in the intra-abdominal pressure can cause hemodynamic and respiratory disorders. The purpose of this article is to demonstrate the effect of the modified peritoneal dialysis, developed by the authors, at the intraabdominal pressure and compare it with the classical approach.
Material and methods. A method of flow peritoneal dialysis in premature newborns has been developed, which significantly reduces the effect of peritoneal dialysis at the intra-abdominal pressure. Intra-abdominal pressure monitoring was performed using the invasive low pressure meter IInd 500/75 Triton. The values of intra-abdominal pressure in children receiving renal replacement therapy with various modifications of peritoneal dialysis were compared.
Results. Our observations show that peritoneal dialysis in the flow modification avoids sharp fluctuations in intra-abdominal pressure. Conclusion. In our opinion, flow modification of peritoneal dialysis may be the method of choice for replacement therapy in deeply premature infants with low and extremely low birth weight.

Introduction. Currently, to study long-term outcomes of feminizing genitoplasty, which is performed to girls with congenital adrenal hyperplasia, is an important step due to the limited data in literature on this topic. The purpose was to assess long-term outcomes of feminizing genitoplasty in congenital adrenal hyperplasia in girls depending on their gender identity, sexual orientation and the anatomy of external genitalia and vagina.
Material and methods. A retrospective analysis of 8 case–histories of girls who were operated on at the Arkhangelsk Regional Children’s Hospital in 2001-2004 was made. In 7 of them, who had low urogenital sinus, feminizing genitoplasty included vaginoplasty with a perineal flap; in one patient, who had a high urogenital sinus, the shortened vagina was advanced down to create a missing part with posterior skin (Fortunoff) and anterior mucous (Passerini) flaps. The Prader scores ranged from III to V. Mean age at the time of surgery was 5.6 y.o. (0.5-14). Mean follow-up period was 17.6 (16-18.5) years.
Results. All patients had female gender identity. All four sexually active women reported heterosexual orientation. Cosmetic results were good as stated by physicians, parents and patients themselves. Vaginal stenosis was noted only in one patient.
Conclusion. The results obtained have shown that the one-stage reconstruction (clitoroplasty and vaginoplasty) for congenital adrenal hyperplasia can be successfully performed in childhood; thus, there is no any reason to refuse of the accepted tactics in treating this group of patients.

Introduction. Congenital obstruction of the gastric outlet is one of the rarest surgical diseases in newborns. Its incidence ranges from 0.003% to 1% of all cases of gastrointestinal atresias. This congenital malformation has several anatomical forms and divides into antral and pyloric atresias.
Etiology. There is no any unified opinion as to the origin of atresia in the gastric outlet. Several concepts are known to suggest possible causes of the impaired patency of gastric outlet. Among them, there are genetic factors, intrauterine mesenteric ischemia, epidermolysis bullosa.
Material and methods. The analysis of 55 literary sources is carried out.
Results. The most common systematization of various forms of antral and pyloric atresia divides them into membranous forms (type I), solid forms without diastasis (type II) and forms with diastasis between segments (type III). Gastric outlet atresia can be diagnosed before birth if polyhydramnios and stomach dilatation are revealed at examination. The main diagnostic sign of the abnormality after birth is the radiographic symptom of “a single bubble”. The technique for patency restoration of the stomach distal parts is chosen depending on the anatomical type of obstruction: for pyloric and antral type I atresia, it is recommended to perform membranectomy and pyloroplasty by Heineke–Mikulicz technique; in pyloric atresia of type II and III, gastroduodenal anastomosis is put. Recently, new alternative techniques for restoring the patency of gastric outlet lumen have appeared, namely, laparoscopy and intraluminal endoscopy. Conclusion. Thus, atresia of the gastric antrum and pylorus are fairly rare congenital diseases. Surgical strategies for correcting these abnormalities envisage membranectomy or gastroduodenoanastomosis. A perspective direction in the care of elective cases of congenital gastric outlet obstruction is intraluminal endoscopy and laparoscopy

Introduction. The authors present a clinical case of an 8-year-old patient with an extremely rare Allgrove’s syndrome and cardia achalasia. By various authors, in case of this syndrome, achalasia of the cardia is diagnosed in 75% of cases, along with other symptoms. Currently, there are a number of modalities for treating achalasia of the cardia. However, the most popular one is cardiomyotomy by Heller in combination with fundoplication by Dor which recently has been successfully performed with minimally invasive laparoscopic techniques.
Clinical case. In present case, the patient had all possible minimally invasive surgical interventions. However, all attempts to apply organ-preserving techniques for treating achalasia of the cardia had failed .
Results. Finally, the child had esophageal plastic surgery – coloesophagoplasty with good clinical outcomes.

Material and methods. A retrospective analysis of medical records of two children. Anamnestic, clinical, diagnostic and intraoperative findings were analyzed.
Purpose. To describe cases of trichobezoars in children : occurrence, diagnostics and treatment.
Results. In the first case, a girl, aged 5, often swallowed her own hair after a psychological trauma; and at the age of 15 she complained of hair loss and anemia. In the second case, a boy was chewing and swallowing his own hair for 6 months under the emotional stress. Two weeks before hospitalization he complained of abdominal pain. In both cases, there were no history of intestinal obstruction. At the fibroesophagogastroduodenoscopy, foreign bodies were visualized which were diagnosed as trichobezoars. X-ray diagnostics confirmed foreign bodies in both patients. Those bodies had the shape of the stomach and had an inhomogeneous porous structure. The patients were operated: laparotomy, gastrotomy with removal of dense hair formation. Postoperative course was uneventful.
Conclusion. Psychological situations provoked in children the obsessive trichotillomania and trichophagia due to which large trichobezoars were formed in the stomach.

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