Objective: To study the therapeutic effect of laparoscopic ureteral end-to-side anastomosis at pelvic level for duplicate ureteral malformation. Methods: Clinical data of 10 children with unilateral ureteral duplication, who received laparoscopic ureteral end-to-side anastomosis at pelvic level at Department of Urology, Affiliated Children′s Hospital of Nanjing Medical University from September 2016 to November 2017 were reviewed.There were 6 boys and 4 girls with an average age of 13.9 months(1 month and 21 days to 3 years and 9 months). Ultrasonography, intravenous pyelography and magnetic resonance urography were performed before surgery.There were 6 cases of duplication with hydronephrosis in the upper moiety. The rest 4 cases were complicated with ureteroceles.Presentations included urinary dripping and symptoms caused by urinary tract infections.Urine test, ultrasonography, intravenous pyelography were performed during the 3-16 months follow-ups for all the patients after surgery. Results: The laparoscopic ureteral end-to-side anastomosis was performed successfully in all patients at the pelvic level, the average ope-rating time was 98 minutes (60-125 minutes) and mean hospital stay was 7.3 days(7-8 days). All the presentations disappeared after surgery.All the patients were followed up for 3 to 6 months with relieved hydronephrosis.Postoperative examination of intravenous pyelography in 10 cases showed that there was no anastomotic obstruction. Conclusions The laparoscopic ureteral end-to-side anastomosis can be used for duplicate ureter, and it is a safe and effective method for the treatment of ureteral duplication.

Objective: To explore the application of penile base staggered flap in the operation of severe hypospadias with penoscrotal transposition. Methods: Twenty-three cases with severe hypospadias with penoscrotal transposition were corrected by urethroplasty and staggered flap plasty in our department from May 2013 to June 2016. After urethroplasty, the skin at the junction of the penile base and scrotum was transversely cut by 1.5-2.0 cm, and then sutured with Z-plasty to reconstruct the angle of the penis and scrotum. Results: After the operation, infection and cracking at the suture of the staggered flap occurred in one child and was cured after dressing change and symptomatic treatment. Two cases suffered from urine leakage at the suture of the staggered flap. One of the cases realized self-healing and the other received a repair operation for urinary fistula. Three children suffered coronary sulcus fistula and was cured by urethroplasty. All the patients were followed up from 10 to 30 months with normal penis scrotal position and satisfactory appearance. Conclusions The application of penile base staggered flap can be used for severe hypospadias in one stage with penoscrotal transposition surgery. It is a simple and satisfactory method for the treatment of hypospadias with penoscrotal transposition.

A retrospective analysis was conducted on the clinical data of three cases of traumatic ureteropelvic junction (UPJ) injury in children treated at the Nanjing Children′s Hospital from May 2021 to May 2022.The clinical characteristics and diagnosis and treatment principles of traumatic UPJ injury in children were analyzed.All three patients had complete rupture of the UPJ, diagnosed at the age of 3 days, 10 days, and 3 months, respectively.The primary repair was attempted in all patients.The first patient underwent primary repair successfully, while the second and third patients developed anastomotic stenosis after surgery.After secondary anastomosis surgery, urinary tract patency was ultimately restored.There were no characteristic clinical manifestations in the early stage of traumatic UPJ injury in children.Most imaging examinations can not accurately diagnose the injury.Retrograde pyelography is an effective method for diagnosing ureteral injury in children.Early diagnosis is positively correlated with the prognosis of pediatric patients with traumatic UPJ rupture.Pyeloplasty is the preferred surgical procedure for this type of injury, and subcalyceal ureterostomy is an optional procedure for treating complex pediatric traumatic UPJ injuries.

Objective To investigate the clinical outcome of modified laparoscopic extravesical ureteral reimplantation for primary obstructive megaureter(POM).Methods A retrospective analysis was made on 11 cases of POM treated with modified laparoscopic extravesical ureteral reimplantation(Lich-Gregoir method)from December 2020 to October 2023.The patients were aged from 7 months to 10 years and 5 months old(mean,57.6±41.9 months).Intraoperatively,a tunnel was created longitudinally from the posterior bladder wall and the ventral end of the new tunnel was used as the ureteral anastomosis.Results All the 11 laparoscopic operations were successful with no intraoperative complications and no conversions to open surgery.The operation time was 105-145 min(mean,125.5±13.9 min).The 11 cases were followed up for 4-25 months(mean,16 months).None of them had difficulty in urination or urinary tract infection.The distal ureter maximum diameter and hydronephrosis were significantly reduced at 3-6 months after surgery than those before surgery[the distal ureter maximum diameter reduced from(23.0±10.0)mm to(5.2±3.4)mm(P=0.000),and the maximal separation value of the renal collecting system reduced from(35.2±21.1)mm to(11.6±6.9)mm(P=0.001)].Conclusion Modified laparoscopic extravesical ureteral reimplantation is easy to perform and can be one of the treatment options for primary obstructive megaureteropathy in children.

Objective To discuss the efficacy of laparoscopic ureteroureterostomy for upper pole hydronephro-sis and ureteral dilatation in children with complete duplex kidney.Methods The clinical data of 14 patients (15 units in total)who underwent laparoscopic ureteroureterostomy from April 2016 to October 2017 were retrospectively analyzed. Nine out of 14 cases had repeated urinary tract infections(UTI)and other symptoms[6 cases in group A:patients without vesicoureteral reflux(VUR)but presenting urinary tract infection (UTI)symptoms,3 cases in group C:patients diagnosed with VUR];5 cases of asymptomatic patients were selected as group B.All the 14 cases had upper pole hydronephrosis and ureteral dilatation.Preoperative examinations included ultrosonograpy,urinary magnetic resonance urography(MRU), intravenous pyelography (IVP),voiding cystourethrogram(VCUG),and nuclear renal scanning.It was found that 4 cases had ureterocele;3 cases had recurrent cystoureteral reflux (group C)before operation,and 1 case had cystoureteral re-fluxed after replantation.Results Laparoscopic surgery was successful in all of 14 children.None of them were shifted to open surgery because of abdominal viscera injury bleeding.The operation duration was 85－140 min.The average posto-perative hospital stay was 5.58 days.There was neither urinary anastomotic leakage nor UTI.Fourteen cases were followed up and the postoperative follow－up period was 7－23 months.No cases developed urinary tract infection except 2 cases with vescioureteral reflux.Ultrasound examination showed that the upper renal parenchyma of 5 children was thicker,ul-trasonography showed that upper pole hydronephrosis was better and ureteroceles were smaller.There was no complication such as lower pole hydronephrosis.The symptoms of urinary tract infection disappeared after operation.Conclusions Laparoscopic ureteroureterostomy can treat renal duplication with less trauma,and it is safe and effective.It can be one of therapeutic regimen to treat low－functional upper pole hydronephrosis and ureteral dilatation in renal duplication.Howe-ver,this procedure cannot be used for vescoureteral reflux cases because of high rate of stump infection.

Objective:To explore the clinical value of single-hole laparoscopic percutaneous extraperitoneal closure operation using a Kirschner wire assisted double-hook water-injection hernia needle in treating complicated pediatric oblique inguinal hernia.Methods:The clinical data of 366 children with oblique inguinal hernia treated in the Department of Urology Surgery, Children′s Hospital of Nanjing Medical University from December 2020 to October 2021 were retrospectively analyzed.According to the surgical methods, the children were divided into the ordinary crochet needle group and the Kirschner wire assisted group.Children treated by a single-port laparoscopic double hook water-injection hernia crochet needle (309 cases) were classified into the ordinary crochet needle group.Children treated by a single-port laparoscopic Kirschner wire assisted double hook water-injection hernia crochet needle (57 cases) were included in the Kirschner wire assisted group.The independent sample t-test and rank sum test was used to compare the relevant clinical indicators between the two groups. Results:Compared with the ordinary crochet needle group, children in the Kirschner wire assisted group were younger at surgery[(2.87±1.88) years vs.(4.91±2.39) years] and had larger hernia sacs [17 303.89(8 622.49, 37 295.42) mm 3vs.9 650.97(3 849.24, 17 539.51) mm 3]. The differences in the age at surgery and hernia sac volume were statistically significant ( t=-5.407, Z=-4.218; all P<0.001). There was no significant difference in body mass index between the 2 groups ( P>0.05). Taking hernias with sac volume >10 000 mm 3 as huge hernias, there were 70.18%(40/57 cases) and 47.25%(146/309 cases) of huge hernias in the Kirschner wire assisted group and the ordinary crochet needle group, respectively.The overall operation time of the Kirschner wire assisted group was significantly longer than that of the ordinary crochet needle group[(20(15, 20) min vs.15(15, 20) min] ( Z=-2.842, P<0.05). However, the operation time for huge oblique hernias with sac volume >10 000 mm 3 was not statistically significant between the 2 groups ( P>0.05). No recurrence in both groups was found during 6-16 months of follow-up. Conclusions:For complicated oblique inguinal hernia in children with a huge hernia or obvious retroperitoneal folds at the internal ring and heavy scar adhesion between the hernia sac and abdominal wall, the insertion of a Kirschner wire can help the hernia crochet needle to traverse the vas de-ferens and spermatic cord vessels smoothly.As a single port laparoscopic operation, the Kirschner wire assisted hernia crochet needle requires no addition of trocar holes and leaves only a small surgical scar.With good feasibility and safety, it is applicable for clinical popularization.

Objective To analyze the prognostic factors of adrenal tumor in children under 12 years of age. Methods A total of 90 children with 97 adrenal tumors admitted from June 2006 to August 2017 were selected in Children's Hospital of Nanjing Medical University.The age distribution,tumor type,biochemistry and tumor indicators, treatment,stage classification and prognosis were analyzed.Results There were 46 males and 44 females in 90 cases. Ages ranged from 4 days to 11 years and 1 month,with an average of (38.1 ± 31.3)months.The main clinical mani-festations were abdominal mass,fever and abdominal pain.Eighty cases (82.5%)underwent surgery,while 17 cases (17. 5%)did not.Open resection was performed in 48 cases,open partial resection in 11 cases,laparoscopic surgery in 10 cases,and just biopsy in 11 cases.The pathological examination showed 43 cases with neuroblastoma,13 cases with ganglioneuroblastoma,8 cases with ganglioneuroma,5 cases with adrenocortical carcinoma,3 cases with teratoma,1 case with pheochromocytoma,1 case with malignant rhabdoid tumor.Statistical analysis revealed that neuron－specific eno-lase(NSE)value of neuroblastoma and lactate dehydrogenase(LDH)value of cortical cancer increased significantly. The age was correlated with tumor stage,and patients had older age on stage Ⅳ.Complete resection in surgery was correlated with the stage of the tumor,as tumor in lower tumor stage seemed easier to be completely removed.Fifty－three cases (58.9%)were followed up for 2 months up to 11 years and 4 months.Forty－four cases survived and 9 ca-ses died.Higher tumor stage predicated worse prognosis.Conclusions Adrenal gland tumors need early diagnosis and active treatment.Earlier onset of age,complete surgical resection with patients have better prognosis.Complete resection of the disease was a key factor in the prognosis.