Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care

BACKGROUND: Extracorporeal shock wave lithotripsy remains the first-line therapy in children with renal stones up to 2 cm. Recently, retrograde intrarenal surgery has become an alternative technology for fragmenting stones located in the renal pelvis and calyces.

AIM: The work aimed to perform a retrospective analysis of the outcomes and complications of flexible ureterorenoscopy in children with urolithiasis.

METHODS: The study included 63 children (65 renal units) who underwent retrograde intrarenal surgery. A total of 70 procedures were performed, including nephrolithotripsy in 59 cases (84.3%) and flexible ureterolithotripsy in 4 cases (5.7%). Nephrolithoextraction and ureterolithoextraction with a flexible endoscope were also performed. Stone size, volume, and density were assessed. The statistical association between the stone-free rate after retrograde intrarenal surgery and other parameters was analyzed using the Mann–Whitney test, Spearman correlation, and logistic regression.

RESULTS: The median age of the patients was 11.8 years. Computed tomography revealed a median stone size of 13.2 mm and density of 1481 HU. After primary retrograde intrarenal surgery, complete stone clearance was achieved in 49 children (77.81%); after repeat intervention for residual fragments, the overall stone-free rate reached 93.66% (59 patients). Only 2 patients (3.17%) developed ureteral colic due to residual ureteral fragments after stent removal, requiring urgent intervention. Statistically significant predictors of residual fragments included initial stone size >1.6 cm on computed tomography and simultaneous stone location in both the pelvis and calyx (p < 0.05). No association was found between stone-free rate and patient age.

CONCLUSION: The method of retrograde intrarenal surgery in children demonstrated a high stone-free rate and a low incidence of significant complications.

BACKGROUND: Determining clear indications for surgical correction of varicocele in pediatric patients remains a relevant clinical problem.

AIM: The work aimed to identify parameters serving as indications for surgical treatment of varicocele in children.

METHODS: A prospective study was conducted on 86 patients diagnosed with left-sided varicocele. The observation period was from September 2024 to April 2025. Patients were divided into two groups: group 1 included 54 (62.8%) surgically treated children; group 2 comprised 32 (37.2%) adolescents under outpatient follow-up. The study was conducted at the Irkutsk City Ivano-Matreninskaya Children’s Clinical Hospital.

RESULTS: The median age of children in both groups was 15 [14; 16] years. The median body mass index was 19.4 [17.6; 21.5] kg/m²; underweight was identified in 30 (34.9%) adolescents. The cause of varicocele was aorto-mesenteric compression of the left renal vein in 65.1% of cases. Complaints of pain or discomfort in the left hemiscrotum were reported by 20 (23.3%) adolescents. Left testicular hypotrophy was found in 22 (40.7%) children undergoing surgery and in 4 (12.5%) patients under follow-up (p = 0.03). Differences between groups were observed in the diameter of pampiniform plexus veins (p = 0.00001). Reflux in the pampiniform plexus veins during stress tests was detected in 30 (55.5%) patients in group 1 and in 6 (18.7%) patients in group 2 (p = 0.0046). Increased flow velocity >30 cm/s occurred in 44.4% of surgically treated cases and 18.7% of those under follow-up (p = 0.048). Logistic regression analysis identified five combined factors defining precise indications for surgical correction of varicocele in children: scrotal pain or discomfort complaints (β = 0.251 ± 0.087; t(77) = 2.87; p = 0.00532); resistance index of the left testicular artery <0.5 or >0.6 (β = –0.368 ± 0.078; t(77) = –4.72; p = 0.00001); left testicular volume ≥20% smaller than the right (β = 0.276 ± 0.091; t(77) = 3.02; p = 0.00345); pampiniform plexus vein diameter >3.9 mm under stress tests (β = 0.192 ± 0.058; t(77) = 3.26; p = 0.00167); compression of the left renal vein at the aorto-mesenteric junction >8 points (β = –0.502 ± 0.141; t(77) = –3.55; p = 0.00066).

CONCLUSION: Decision-making regarding surgical treatment of varicocele requires a comprehensive and personalized approach to the examination of the child. The study results provide precise criteria for surgical correction of scrotal varicose veins in adolescents, including physical examination, patient complaints, and mandatory ultrasound with testicular vessel Doppler imaging.

BACKGROUND: Bladder exstrophy is a rare congenital urological anomaly affecting the bladder, genitalia, pelvic floor, and pelvic bones. Skeletal abnormalities associated with bladder exstrophy include external rotation of the iliac bones, shortening and hypoplasia of the pubic rami, and retroversion of the acetabulum. The main challenge in defect closure is pubic diastasis.

AIM: The work aimed to present a novel pelvic osteotomy technique for the treatment of bladder exstrophy.

METHODS: The study included 30 patients with classical bladder exstrophy who underwent pelvic osteotomy using the proposed technique. The cohort comprised 24 boys and 6 girls, aged from 1 day to 17 years, operated in various clinics in St. Petersburg (Russia), Tashkent (Uzbekistan), and Minsk (Belarus).

RESULTS: After 30 surgical procedures for classical bladder exstrophy with pelvic osteotomy performed according to our technique in children aged from 1 day to 17 years, a complication occurred in only one case—postoperative wound infection—which was treated conservatively using broad-spectrum systemic antibiotics and local therapy. This complication occurred in the group of patients who underwent reoperation after prior surgical bladder repair without pelvic osteotomy. No patient developed an increase in pubic diastasis in the postoperative period.

CONCLUSION: The proposed pelvic osteotomy technique is effective for abdominal wall closure and bladder reconstruction. This is confirmed by the low complication rate (3.3%), involving both orthopedic and urological aspects, as well as the absence of postoperative pubic diastasis in all patients. Moreover, this pelvic osteotomy technique is an effective procedure due to its excellent correction of the disrupted pelvic ring and preservation of this correction.

Neonatal sepsis remains a significant cause of mortality and long-term complications in newborns. However, evidence-based approaches to the rehabilitation of children surviving sepsis remain insufficiently developed, highlighting the need to synthesize available data. This review summarizes current evidence on the long-term outcomes and rehabilitation opportunities in children who experienced sepsis during the neonatal period. A scientific data search covering 2019–2024 was conducted in PubMed and eLibrary.ru databases using keywords related to rehabilitation, sepsis, and neonates. After removing duplicates and applying multi-stage screening for relevance to the review topic, 55 publications were included for analysis. The review revealed a high risk of long-term multi-organ sequelae after neonatal sepsis, including neurological impairments (cognitive deficits, cerebral palsy), sensory deficits, bronchopulmonary dysplasia, and cardiovascular dysfunction. It also highlights the lack of unified criteria and methodology for diagnosing neonatal sepsis, as well as protocols for assessing immediate and long-term outcomes in newborns who survived sepsis, and convincing evidence regarding the effectiveness of specific rehabilitation methods. The challenge of implementing modern rehabilitation in neonates is emphasized, since most existing scientific and practical approaches are based on extrapolation of data obtained from the rehabilitation of preterm infants or patients with other conditions, and are not supported by high-quality randomized controlled trials specifically in the population of children after sepsis. The review outlines the current three-stage rehabilitation model (in the intensive care unit, during inpatient care, and in outpatient settings) and discusses several key directions: neurorehabilitation (neuroprotective agents, kinesiotherapy, sensory integration), nutritional support (enriched feeding, optimization of protein–energy balance, prebiotics and probiotics), and psychological support (family-centered early intervention model). Promising approaches that require further investigation include novel neuroprotective agents (xenon, darbepoetin, topiramate, melatonin, caffeine, metformin, hydrocortisone, RLS-0071, stem cells, and sovateltide) and mesenchymal stromal cell secretome therapies. Despite the importance of this issue, the rehabilitation of children after neonatal sepsis remains a field with a low level of evidence. This review systematizes the available evidence, highlights the need for further research to develop evidence-based rehabilitation programs, and to establish individualized rehabilitation trajectories aimed at improving long-term outcomes and quality of life in neonates.

Congenital anterior dislocation of the tibia is a rare orthopedic disorder with an incidence of 1 per 100,000 newborns. Due to its low prevalence and a limited number of studies, no unified algorithm for surgical treatment of this condition has yet been developed when conservative treatment fails. A search of recent scientific data was conducted in PubMed, Scopus, eLIBRARY.RU, CyberLeninka, and Web of Science databases using the following keywords: врожденный передний вывих голени / congenital dislocation of the tibia, хирургическое лечение врожденного переднего вывиха голени / surgical treatment of congenital anterior dislocation of the tibia, and врожденный вывих коленного сустава / congenital dislocation of the knee joint. A total of 150 sources were analyzed, and 40 publications containing data on surgical treatment of congenital anterior dislocation of the tibia were selected. Various surgical techniques are currently employed, but their effectiveness remains debatable. The article presents an analysis of existing surgical methods for the treatment of congenital anterior dislocation of the tibia, examines their advantages and limitations, and identifies key challenges requiring further investigation. Surgical correction of this condition is most often employed in resistant and syndromic forms, which are frequently associated with knee stiffness, tibial flexion contracture, and weakness of the extensor mechanism. Therefore, when planning the use of surgical treatment techniques, it is crucial to consider the individual characteristics of the patient, such as the severity of the dislocation and the presence of concomitant somatic and orthopedic condition.

Fibro-adipose vascular anomaly is a relatively rare and only recently described disorder with distinctive clinical, radiological, and pathomorphological features. It is crucial for physicians to be fully aware of this condition to ensure timely diagnosis and early initiation of treatment. This article presents the clinical case of a 17-year-old female with fibro-adipose vascular anomaly of the right leg. At the age of 7, she developed a painful lesion in the leg. Over time, the lesion progressively increased in size, accompanied by limb hypotrophy and restricted ankle joint mobility. At the healthcare facility of her place of residence, multiple ultrasound examinations and computed tomography angiography were performed, which led to the diagnosis of mixed angiodysplasia of the right leg. Conservative measures, including physical therapy, compression garments, and orthopedic footwear, were ineffective. Disability was established at the age of 13. At 17, the patient was admitted to the Russian Children’s Clinical Hospital (Moscow). Examination revealed shortening of the right leg and foot, a firm painful mass in the upper third of the leg, hypotrophy of the thigh and calf muscles, and ankle contracture. Ultrasound examination revealed a hyperechoic lesion with indistinct outer margins in the muscles of the upper third of the leg, containing abnormally formed venous vessels with multiple phleboliths. Magnetic resonance imaging of this area confirmed the presence of vascular malformation. Angiography was additionally performed to clarify the angioarchitecture of the lesion and determine the possible extent of resection, leading to the diagnosis Q27.8—fibro-adipose vascular anomaly of the right leg. Given the impossibility of radical surgery due to subtotal involvement of the posterior muscle group of leg, the high risk of progression, pain, and impaired function, anti-proliferative therapy with sirolimus was initiated. Rehospitalization was scheduled after one year to assess treatment efficacy and reconsider surgical options. This case illustrates the challenges of delayed diagnosis, where long-term unrecognized disease progression resulted in disability and precluded one-stage radical treatment.

Congenital ureteral stricture in the mid-portion is a rare cause of upper urinary tract obstruction in children, and currently no established protocols for its surgical treatment exist. A retrospectively analyzed medical history is presented of a 2-year-old patient diagnosed with right mid-ureteral stricture, accompanied by impaired urinary outflow and reduced renal function. Ultrasound scanning and contrast-enhanced computed tomography were used to establish the diagnosis. Surgical treatment was performed using robotic assistance with resection of the stenotic segment and ureteroureterostomy. Intraoperatively, the proximal ureter was transected at the level of the narrowing toward the distal portion. The length of the resected healthy ureter corresponded to the diameter of the dilated segment. The ureteral anastomosis was created over a stent previously placed in the renal pelvis by cystoscopy. After preparation of the ureteral ends, the anastomosis was completed with subsequent drainage. The procedure was successful, with no intraoperative complications. Total operative time was 180 minutes, including 15 minutes for robotic docking. The entire operation was performed robotically without conversion to laparoscopy or open surgery. The stenotic segment measured approximately 8 mm. Postoperatively, the patient was monitored in the intensive care unit for 12 hours. He was discharged home 10 days after surgery, one day after Foley catheter removal. Histological examination of the stenotic segment revealed expansion of the submucosa with fibrosis, lymphocytic inflammation, and thickening of the muscular layer with fiber destruction. Four weeks after surgery, the ureteral stent was successfully removed by cystoscopy. In the long-term postoperative period, ultrasound examination revealed narrowing of the upper ureter to 4 mm. No stenosis was detected at the site of the ureteroureterostomy during follow-up. Robot-assisted laparoscopic ureteroureterostomy is a reliable and effective minimally invasive approach to the treatment of congenital mid-ureteral stricture, with no adverse short- or long-term outcomes during follow-up.

Persistent Mullerian duct syndrome is a rare disorder of sex differentiation characterized by the presence of a uterus, fallopian tubes, and a vaginal outgrowth of the urogenital sinus in boys with a 46,XY karyotype. One variant of persistence of Mullerian duct derivatives in a child with male external genitalia is the mosaic chromosomal anomaly 45,X/46,XY, which clinically manifests as an inguinal hernia or cryptorchidism. This article presents a rare clinical case of failure of Mullerian duct regression in a phenotypically male child with a unilateral nonpalpable testis. A 17-month-old boy was admitted electively to the surgical department of Children’s City Clinical Hospital No. 9 in Yekaterinburg with left-sided nonpalpable testis syndrome. Diagnostic laparoscopy revealed a rudimentary uterus and left fallopian tube with a structure resembling an ovary. Postoperatively, the child underwent further evaluation (histopathological examination, hormonal status assessment, karyotyping, molecular genetic testing, and urethrocystoscopy). The clinical diagnosis was established as “disorder of sex development caused by chromosomal abnormality 45,X/46,XY, mixed gonadal dysgenesis.” In cases where persistent Mullerian ducts are detected intraoperatively, current practice is limited to biopsy of the abnormal gonad, urethrocystoscopy for visualization of the urogenital sinus, and, when possible, catheterization of the rudimentary uterus with a ureteral catheter to visualize its location in the pelvic cavity. For diagnostic confirmation, karyotype analysis, molecular genetic testing, hormonal profiling, and evaluation by a geneticist and endocrinologist are performed. The final decision regarding the child’s sex assignment, after all additional examinations, is made by a medical board in consultation with the parents.

The 10th Anniversary Forum of Pediatric Surgeons of Russia was held on October 23–26, 2024, in Moscow at the Vega Izmailovo Hotel Complex. On the eve of the official opening, a Pre-Forum session took place, dedicated to the treatment of children with chest wall malformations. Among the speakers were leading experts from Russia as well as representatives from Argentina, Turkey, Switzerland, South Korea, and Kazakhstan. The plenary session of the Forum on October 24 included the ceremonial awarding of the S.D. Ternovsky Prize “For Outstanding Contribution to the Development of Russian Pediatric Surgery” to Professor Parshikov. His keynote lecture, “Pediatric Surgery—Notes of a Department Chair”, was devoted to the history of the specialty in Nizhny Novgorod and current challenges in the training of pediatric surgeons. The session opened with Kozlov’s report “Robot-Assisted Surgery—A New Reality in Pediatric Surgery.” A presentation by Razumovsky was dedicated to the memory of Professor Anatoly Fedorovich Dronov. The plenary concluded with a lecture by Morozov entitled “The Pediatric Surgical Service of the Russian Federation: The Work of the Institute of Chief Specialists.” The “How I Do It” video session featured 20 presentations showcasing original medical technologies. At the end of the first day, a meeting of the Pediatric Surgery Expert Commission of the Ministry of Health of Russia, chaired by Morozov and Razumovsky, was held. An unresolved issue for the participants was the discussion of the format and legal framework for involving general surgeons in providing emergency care for children. In total, the Forum program included: the plenary session, a video session, 14 symposia, 3 round tables, 2 master classes, a training session, a lecture, 3 thematic reports, an interactive panel discussion, a quiz, 4 Pre-Forum sessions, a meeting of the Pediatric Surgery Expert Commission of the Ministry of Health, a meeting of the Scientific Council of the Russian Association of Pediatric Surgeons, and a young researchers’ competition. The Forum was attended in person by 630 specialists. A total of 1,472 participants were registered. Online broadcasts of the events reached a total duration of 36.2 hours. On the final day, the traditional competition of young researchers’ scientific works was held. The 10th Forum of Pediatric Surgeons of Russia became an important milestone in the development of pediatric surgery in the Russian Federation, bringing together not only pediatric surgeons but also physicians from other specialties. The discussion of current issues in the format of live debate and online broadcasting enabled participants to outline directions for further development of pediatric surgery and opportunities for implementing modern medical technologies in daily practice.

Russian pediatric surgery has suffered a great loss: on August 1, 2025, Alexey B. Okulov, Doctor of Medical Sciences, Professor, an outstanding physician, renowned pediatric surgeon, and one of the founders of Russian pediatric urology-andrology, passed away. Alexey B. Okulov was born in 1937 in Moscow. After graduating from the I.M. Sechenov Moscow Order of Lenin Medical Institute and completing his residency, his entire professional life was associated with the Central Institute for Advanced Training of Physicians (now the Russian Medical Academy of Continuous Professional Education). Within the team of talented staff of the Department of Pediatric Surgery under the leadership of Academician Doletsky, Okulov was formed as a surgeon, scientist, and teacher. Through his perseverance and dedication, he was able to develop new directions in pediatric surgery and operate at Rusakovskaya (now St. Vladimir) and Tushinskaya (now Z.A. Bashlyaeva) hospitals. His scientific legacy includes more than 500 publications. Without exaggeration, Alexey B. Okulov was a living legend of the Russian school of pediatric surgery, one of the pioneers of surgery for disorders of sex development in Russia, and a true mentor to many pediatric surgeons and urologists.