SOVREMENNAYA PEDIATRIYA.2018.2(90):26-30; doi 10.15574/SP.2018.90.26

Dmytriakov V. A., Svekatun V. M., Stoyan M. S., Kornienko H. V.
Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine
CI «Zaporizhzhia City Multidisciplinary Children's Hospital No. 5», Zaporizhzhia, Ukraine

Objective: to assess the effectiveness of segmental-selective partial nephrectomy as the method of organ sparing surgery for terminal stages treatment of congenital hydronephrosis in children.
Material and methods. Since 1987 and up to date, 32 children with terminal stages of congenital hydronephrosis aged from 1 to 17 years (the average age was 4 years and 2 months) have been treated at the clinic of paediatric surgery in Zaporizhzhia; there were 13 boys (40.63%) and 19 girls (59.37%). The patients were evaluated according to a four&score system: score «excellent' had 8 (25%) patients, «good» — 10 (31.25%), «satisfactory» — 11 (34.375%) patients, and «unsatisfactory» was observed in 1 case. Long-term results were evaluated during the period of 5 to 20 years. An unsatisfactory outcome was observed in one child who had primary nephrectomy on the basis of intraoperative data. X-ray, ultrasound, urodynamic studies were carried out.
Results. The conducted study confirmed irregularity, lesion locality of renal structures due to segmental renal dysplasia, differences in blood supply of particular areas of the kidney, heterochronicity of the kidney segments. Even in the advanced stages of hydronephrosis, the areas of normally functioning renal structures are preserved in children that allow developing and performing their functions. The proposed technique allows restoring the passage of urine and pre-serves the kidney. A positive result was achieved in 31 (96.88%) patients.
Conclusions. The proposed technique is an alternative to nephrectomy, allows significantly reducing the number of unsatisfactory outcomes of surgical treatment in children with the advanced stages of the disease. The functional capacity of the operated kidney is largely determined by the adaptive process severity in the operated organ and the organism as a whole.
Key words: children, selective-segmental resection, organ sparing surgery, hydronephrosis.

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