Vol 30, No 2 (2026)

BACKGROUND: Varicocele is one of the most common conditions in pediatric urology. Modern approaches to surgical treatment vary, including both traditional surgical techniques and endovascular methods for correction. The question of choosing the optimal method for surgical correction of varicocele in children, including identifying possible causes of recurrence and complications, remains relevant.

AIM: To conduct a clinical analysis of patients with left-sided varicocele and evaluate surgical treatment outcomes.

METHODS: A single-center prospective cohort study of 218 patients diagnosed with left-sided varicocele was conducted at the Urology Department of the Ivano-Matreninskaya Children's Clinical Hospital (Irkutsk) from September 2022 to September 2025. If there were signs of aorto-mesenteric compression of the left renal vein and moderate venous hypertension, laparoscopic ligation of the testicular vessels (a laparoscopic analogue of Palomo-Erokhin surgery ) (66.1%, n = 144) or open retroperitoneal ligation of the testicular vessels by Palomo-Erokhin technique (10.5%; n = 23) were performed. In other cases, varicocelectomy was performed using the subinguinal approach (23.4%; n = 51). For a comparative analysis, patients were stratified into two groups: without disease recurrence (95.9%; n = 209) and with its recurrence (4.1%; n = 9). In the follow-up period, 30 patients who had ligation of the left testicular vessels and had moderate hypertension of the left renal vein, were thoroughly examination to detect nephropathy.

RESULTS: Patients' median age was 15 (14; 16) years. 47 (21.5%) adolescents complained of pain or discomfort in the left scrotum. Grade 2 and Grade 3 varicoceles were most common, 96.3% (n = 210). Also, a statistically significant relationship was established between varicocele degree and age (r = 0.254; t = 3.83; p = 0.00017). Signs of left testicular hypotrophy were observed in 36.2% (n = 79). In the postoperative period, relapse of the disease was observed in 9 (4.1%) patients. The cause of relapse in 3 (1.38%) cases was a developed additional collateral of the left testicular vein; in 1 (0.46%) case ― May-Thurner syndrome; in 5 (2.3%) patients, a reliable cause of relapse was not identified. It has been found out that body weight deficiency is a statistically significant factor associated with relapse of the disease. So, the risk of varicocele recurrence in adolescents with underweight increases by 3.3 times (OR 3.29; 95% CI 0.8–13.53; p = 0.033). Over the entire observation period (up to 38 months), none of the 30 examined patients who underwent testicular vein ligation for moderate hypertension had clinical or laboratory signs of nephropathy (proteinuria, hematuria, or renal dysfunction). This important observation demonstrates the safety of the chosen treatment strategy for children with left-sided varicocele.

CONCLUSION: The study utilized a differentiated approach to surgical management based on the presence of aortomesenteric compression, which resulted in a low recurrence rate. Weight loss was a statistically significant predictor of recurrence, while the hormonal status and standard ultrasound parameters showed no prognostic value.

Spondylolysis and isthmic spondylolisthesis are common causes of chronic low back pain, particularly among young and physically active individuals. Surgical repair of the pars interarticularis is considered a motion-preserving alternative to spinal fusion in patients with unsuccessful conservative treatment. Despite the variety of available techniques, their comparative effectiveness remains a matter of debate.

Aim is to compare the principal techniques of direct spondylolysis repair, identify the most effective approach, and determine the patient characteristics associated with optimal outcomes following pars interarticularis repair.

A systematic review was conducted in accordance with the PRISMA guidelines. Literature searches were performed in the PubMed and eLIBRARY databases covering the period from 2006 to 2026. Studies investigating surgical treatment of spondylolysis and/or isthmic spondylolisthesis using the Buck, Tokuhashi-Matsuzaki, U-rod techniques, and their modifications were included. A narrative synthesis of the data was performed. Study quality was assessed using the JBI and NOS appraisal tools. Fifty-two studies involving 781 patients were included in the final analysis. The Tokuhashi-Matsuzaki and U-rod techniques were the most frequently utilized. The overall mean computed tomography-confirmed fusion rate was 84.9%. The highest fusion rate was observed with the U-rod technique (97.0%). Clinical outcomes were favorable, with return-to-activity rates ranging from 73.9% to 97.0% and mean recovery times between 2.8 and 8.5 months. Complication rates were low, with infection rates up to 1.9% and implant-related complications up to 1.0%. Minimally invasive approaches demonstrated comparable effectiveness while being associated with reduced blood loss and shorter hospital stays. Surgical repair of spondylolysis is an effective and safe treatment option in carefully selected patients. Techniques providing greater biomechanical stability achieve superior radiological and clinical outcomes. Treatment success appears to depend primarily on appropriate patient selection, whereas the choice of a specific repair technique plays a secondary role.

Liver hemangioma is the most common benign tumor of the liver. Most frequently presents as an asymptomatic mass that is found incidentally during imaging modalities. Giant hepatic hemangiomas are rare, but giant pedunculated hemangiomas are even rarer what makes their clinical and visual diagnosis challenging for surgeons. In the available literature, we found only one description of a giant pedunculated hemangioma without torsion in a newborn.

A 2-month-old boy admitted with complaints on discomfort and stool retention. He was hospitalized with suspected intestinal intussusception. The diagnostic stage included laboratory tests, X-ray, ultrasound, spiral computed tomography of the abdomen with intravenous multiphase contrast. Upon admission severe anemia, hypoproteinemia, signs of paralytic ileus and a solid mass of ovoid shape with single pixels of blood flow in left subphrenic space between liver and the spleen were diagnosed. During diagnostic laparoscopy torsion and necrosis of the accessory spleen was suspected. Conversion to oblique laparotomy in left subcostal region was made. A mass lesion with signs of necrosis on thin torsioned peduncle coming from left lobe of the liver was seen. A peduncle was transected and the mass was removed. The postoperative diagnosis of torsion and necrosis of pedunculated liver hemangioma was confirmed by histological examination verifying hemangioma with total hemorrhagic necrosis and massive hemorrhages. Postoperative period was uneventful. The child was discharged on the 6th day after the operation.

A case of a rare form of liver hemangioma, complicated by torsion, in an infant is presented. Despite the complex of examinations performed the cause of abdominal pain syndrome could only be diagnosed intraoperatively. In the available international literature, this is the first published case in the World of torsioned giant pedunculated liver hemangioma in an infant.

Valery Aleksandrovich Kudryavtsev is a professor, Honored Doctor of the Russian Federation, and the founder of the pediatric surgical service in the Arkhangelsk region. The results of his scientific research are presented in more than 120 scientific papers and publications. V.A. Kudryavtsev's main areas of scientific activity cover a wide range of areas of pediatric surgery: emergency and general pediatric surgery, pediatric traumatology and orthopedics, pediatric urology-andrology, resuscitation and anesthesiology, ultrasound diagnostics in pediatric surgery, and the organization of specialized care for children in the North. V.A. Kudryavtsev introduced the basic principles and aspects of providing surgical care to children with a wide range of congenital malformations. He developed a system of staged treatment for children with malformations, as well as principles for providing surgical care to newborns, children with severe injuries, and purulent-septic diseases. V.A. Kudryavtsev was the chief pediatric surgeon of the Arkhangelsk region (1971–2000) and rector of the Arkhangelsk State Medical Institute (1988–1993). His accomplishments include the opening of the regional children's hospital, the establishment of a pediatric faculty at the medical institute, and the creation of a pediatric surgery department at the Medical Institute. Kudryavtsev's role as an educator and organizer is noted, having created a system for training medical personnel and a scientific and practical school in the European North that remains relevant to this day.

The article reflects the inextricable link between Kudryavtsev's scientific achievements, practical healthcare, and his teaching activities.