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Epididymal cysts in children are rare, and, as a rule, their detection is an incidental finding, the course is asymptomatic, the surgical treatment is not carried out. Isolated torsion of these cysts is extremely rare in both children and adults, causing acute pain syndrome and swelling of the scrotum. Due to its rarity and lack of specificity of clinical and echographic manifestations, this condition leads to a delay in the accurate diagnosis of the disease, which is carried out only intraoperatively. The rare case of combined testicular torsion and torsion of a large appendage cyst in a 12-year-old teenager is presented in the publication.

Bladder extrophy - is a difficult malformation for the treatment. Aplasia of one of the cavernous bodies of the penis is an extremely rare pathology. In the available literature, we did not meet reports of correction of bladder extrophy in children with a single cavernous body of the penis.From 1990 to 2020, 545 children (364 boys) with extrophy have been repair. Two (0.5 %) boys only had a classic bladder extrophy combined with the aplasia of one cavernous body. The first patient with classical extrophy and multiple malformations (fingers of the right hand, fingers of the right foot, aplasia of the left kidney, left cavernous body, left testicle and hypoplasia of the left half of the scrotum) the penis with the single cavernous body on the right was somewhat thinner, but formed anatomically correctly with the presence of a urethra and closed prepuce. The primary closure of the bladder was performed with bilateral iliac osteotomy and the joint of pelvic bones at the age of 1 year. The patient had the anatomically properly formed bladder sphincter and urethra, penile correction was not required. After the operation, urinary continence had been achieved.The second boy was with classical extrophy and epispadia of the single cavernous body, he was given stage treatment. At the age of 5 days (2004) the primary closure of the bladder and the connection of the pelvic bones were performed. At the age of 4 years (2008) the formation of the urethra was carried out, the correction of the dorsal deformation of the single cavernous body by excision of the chord and the application of multiple superficial cross-cutting on the tunica albuginea. Bladder neck plastic by Kelly technique in combination with bilateral osteotomy of pelvic bones was performed at the age of 7 years in (2011). The boy of 15 years (2019) had a bladder volume of 350-400 ml. Dry 4-5 hours. Urinate freely with a wide stream. Then a two-stage plastic of the distal urethra was performed. We used the Bracka technique with augmentation of the glans penis and implantation a free graft of the mucous lip. We achieved a good result.Using modern penile correction technologies help to socially adapt patients with rare and difficult malformations.

Background. Important causes of complications of hypospadias repair are the deficit of tissues for plastic surgery, grooveless and small size of glans, obliteration of the urethral platewith varying degrees of scarring. The coronal urethral fistula is the most common complication of urethroplasty. Surgeons continue to search for reliable methods of correction of complications.Materials and methods. Between 2011 and 2019, 85 children aged 2 and 17 years presented with coronal fistula of urethra after hypospadias repair. (TIP) Snodgrass – 78 (91.7 %) and Mathiue – 7 (8.2 %) procedures have been performed them earlier. In our clinic previously operated 28 (32 %) boys, primary surgery of the remaining 57 (67 %) was performed in other medical institutions.Results. All patients (85), conditionally, were divided into two groups. The first group included 39 children (45.8 %), with stitching a fistula, the second group consisted of 46 patients (54.1 %), with augmentation of the urethral plate of the glans and distal urethra with the implantation of a rectangular preputial or oral mucosa free graft. Recurrent urethral fistula after stitching was observed in 10 boys (25.6 %) of the first group, and only in 2 cases (4.3 %) in children with the augmentation of the urethral plate (p Discussion. The shape, size of the glans and the condition of the urethral plate affect to the result of urethroplasty. The connection of the wings of the glans in accordance with normal anatomy, avoid obstruction in the distal part of urethra. A wide urethra in the glans and meatal area improves urine flow. Conclusion. The augmentation of the urethral plate of the penile glans and the distal urethra with the implantation of a wide rectangular free flap in to the meatus, in our opinion, an advantage over the implantation of diamond-shaped grafts using the GTIP or TIP graft technique.

Introduction. The small size of the bladder plate is a poor prognostic sign for successful treatment of exstrophy. Primary closure in newborns and infants with microcystisis often accompanied by complications and relapses; there for, the approach to the treatment of this group of patients requires a more detailed analysis. The aim of the study. Identify advantages and disadvantages of delayed primary closure surgery in patients with bladder exstrophy and microcystis. Materials and methods. During the period from 1994 to 2020, 265 children with bladder exstrophy were subjected to surgery, 123 patients were newborns. There were 37 children with microcystis (bladders plate

Introduction. Bladder exstrophy is one of the most complex malformations in pediatric urology. Material and methods. In 1996-2019, 112 children with bladder exstrophy, aged 2 -32 days, had a “primary bladder repair” in St Vladimir Children’s Municipal Clinical Hospital. All children (112) were divided into groups depending on dimensions of the cystic area: large bladder size (over 5 cm) - 39 (34.8%) patients; average size (35-50 mm) - 43 (38.9%); small size (less than 35mm) - 31 children (27.6%). Subgroup “A” - 77 patients (68.7%) were treated in 1996 - 2012, and the primary bladder closure was performed at their neonatal period regardless of the area size. Subgroup “B” - 35 children (31.2%), operated on in 2013-2019, had various volume surgeries depending on clinical manifestations. These groups are homogeneous and comparable in age and manifestations. Results. Complications after surgery were seen in 20 children (25%) from Subgroup “A”: exstrophy relapse - 14 (18%), divergence of bladder neck - 6 (7%). The outcome analysis has shown that the highest rate of exstrophy relapses and cervical divergence was observed in children with microcystis - 15 (57.4%) out of 21. In Subgroup “B”, exstrophy relapse was observed in 1 (2.8%) child with an average bladder size; cervical divergence - in 2 (5.6%) children with an average size and in 2 (5.6%) with microcystis. The number of complications in children with microcystis was reduced from 15 out of 21 children (71%) in Subgroup “A” to 2 out of 10 patients (20%) in Subgroup “B”. Conclusion. A differentiated approach to the choice of surgery volume and proposed additional measures lead to better bladder growth and better urine retention after the first surgery.