Golovkevіch V. Diagnosis and rational choice of tactics in treatment of decompensated forms of non-refluxing megaurer in children.

The Dissertation is solving the actual problem of urology the essence of which is in the improvement of quality of diagnostics and the results of treatment in decompensated forms of non-refluxing megaureter in babies and infants by determination of echographic criteria for decompensation of urodynamics in the upper urinary tract, taking into account the genesis of disturbances of urodynamics at ureterovesical junction and the activity of microbe- inflammatory process of the urinary system.The work analyses the complex examination and differential treatment of 62 children (92 ureters) with decompensated forms of megaureter at the ages from 3 months to 6 years.There have been determined the prognostically significant criteria for risk assessment (high, low) of decompensation in ureteric urodynamics based on sonographic markers. The criteria for high risk decompensation of urodynamics are the reduction in the incidence of ureteral contractions lower than 4 per 1 min. The risk of decompensation is 12.778 (95% CI 4,575- 35.687; 84% of test sensitivity, specificity - 69%) and dilatation of the ureter is more than 2.0 cm in diameter - the risk of decompensation is 11.058 (95% CI 4.042 -30.252;. Sensitivity - 78% specificity - 76%).Determination of immunologic and enzymologic indicators in the urine of children with megaureter is non-invasive and informative method for assessment of renal functional state. The efficacy of staged treatment of patients with decompensated forms of megaureter is proved by restoration of the functional state of renal parenchyma proved by the enzymologic parameters in 71,8-56,2%, and by the decreased activity of tubulointerstitial fibrosis by the imunologic indicators in 25-37,5%.