[Surgical tactics in multiple obstructions of the urinary tract in children]

One the basis of the results of surgical treatment of 84 children the authors identified 5 main groups of multiple obstructions: 1) obstruction of the vesicourethral segment in combination with obstructions of segments located above--37 (44.1%) patients; 2) unilateral obstruction of the ureterovesical and ureteropelvic segments--11 (13.1%) patients; 3) bilateral obstruction of the ureterovesical segments--19 (22.6%) patients; 4) bilateral obstruction of the ureteropelvic segments--11 (13.1%) patients; 5) other variants of obstructions of the ureterovesical and ureteropelvic segments--6 (7.1%) patients. It was established that urodynamic disorders conducive to the occurrence and progress of chronic pyelonephritis in multiple obstructions of the urinary tract in children are determined not only by the nature of congenital morphologic changes in the urodynamic segments, but by the features of their functions, interaction, and mutual influence, which should be taken into account in choosing the tactics of surgical intervention. In combination of obstruction in the vesicourethral segment, as well as in the ureterovesical segments, operative treatment should be started on the vesicourethral segment because urodynamics in the ureterovesical segments in children under 3 years of age may become normal without a surgical intervention on them. Correction of obstruction in the ureterovesical segment facilitates restoration of urodynamics in the ureteropelvic segment in unilateral obstructions, which determines the sequence of the operative intervention.