<b><i>Background:</i></b> In patients with autosomal dominant polycystic kidney disease (ADPKD) and end-stage kidney disease, bilateral nephrectomy (BN) is currently performed predominantly via the laparoscopic approach. We analysed the results of BN depending on the approach and preoperative and perioperative factors. <b><i>Patients and Methods:</i></b> This was a single-centre retrospective study carried out from April 2010 to March 2020, including a total of 142 patients presenting with ADPKD who were treated by BN. Of these, 108 patients meeting the inclusion criteria were selected to analyse the results. We compared therapeutic outcomes depending on the surgical approach (laparotomy or laparoscopy) and the type of the operation (emergent or elective). <b><i>Results:</i></b> Of the 108 eligible patients, 36 (group I) underwent laparoscopic BN and the remaining 72 patients (group II) were subjected to midline laparotomy. Sixty-nine patients underwent elective surgery and 39 endured emergent operations. The most frequent indications (87 patients, 80.6%) for surgical treatment were urinary tract infection and infected cysts. The median length of hospital stay for group I and group II patients amounted to 8 days (IQR: 7.5–9) and 12.5 days (IQR: 9–16.5), respectively (<i>p</i> &#x3c; 0.001). However, comparing the patients operated on electively, the actual difference in the length of hospital stay was inconsiderable: median 8 days (IQR: 7–9) in group I and 9 days (IQR: 9–11.5) in group II. The median duration of the operation was significantly (<i>p</i> &#x3c; 0.001) longer in group I amounting to 217.5 min (IQR: 197.5–305) than in group II equalling 115 min (IQR: 107.5–145). The frequency of postoperative complications, lethal outcomes, and blood loss volume did not statistically significantly differ depending on the surgical approach. Only patients operated on emergency underwent releparotomy due to intraoperative large bowel injury. Lethal outcomes (<i>n</i> = 18, 16.7%) after surgery were observed only in emergent patients. Sepsis prior to surgery, systemic inflammation response syndrome (SIRS) with the CRP level above 173 mg/mL, prolonged preoperative antibacterial therapy, and undiagnosed large bowel injury were associated with a lethal outcome after BN. <b><i>Conclusion:</i></b> The results of open and laparoscopic BN in elective surgery were comparable. Emergency operations for infected renal cysts and SIRS were associated with increased incidence of large bowel injury and lethal outcomes.

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Introduction. In recent years, the number of patients with autosomal dominant polycystic kidney disease (ADPKD) who undergo kidney transplantation without nephrectomy has increased. The most frequent and adverse complication from your own kidneys is infection of cysts (IC). This dictates the need to predict the probability of IC and determine diagnostic and therapeutic approaches in this category of patients. Materials and methods. The results of observation and treatment of 55 patients with ADPKD who underwent kidney transplantation from 2000 to 2019 without prior nephrectomy were evaluated. Results. Bilateral nephrectomy in connection with IC was performed in 10 (18.1%) patients, and one patient died from sepsis progression. Burdened urological history (kidney operations for suppuration of cysts and recurrent urinary tract infection (UTI)) significantly increased the chances of nephrectomy for IC by 6.8 times (AOR 6.83; 95% CI 1.34-34.8; p=0.021). The median time from kidney transplantation to nephrectomy was 7 months (Q1-Q3: 2-8). Acute graf pyelonephritis was associated with IR (p=0.045) in single-factor analysis. Forty-five patients are under observation, with a median follow-up of 41 months (Q1-Q3: 19-76). Seventeen patients underwent magnetic resonance imaging using diffusely weighted image protocols (MRI-DWI). MR-signs of infection were detected in 5 patients. Given the absence of clinical and laboratory manifestations of inflammation, nephrectomy was not performed. Further followup did not indicate the development of clinical and laboratory signs of UTI in any case. Discussion. As our study and a number of other studies have shown, in patients with ADPKD after kidney transplantation, the most frequent indication for nephrectomy is inflammatory changes in their own kidneys. Patients with a history of severe pyelonephritis or IC who previously had pyelonephritis or IC before kidney transplantation are at risk for developing inflammatory changes after kidney transplantation, and it does not matter how long ago they had a history of pyelonephritis attacks or kidney surgery. This fact should be taken into account before kidney transplantation and offer patients a nephrectomy before kidney transplantation. Our work is consistent with a number of non-numerous publications that have shown that in the diagnosis of IC, the most informative non-invasive, imaging method is MRI of the kidneys, but this method has low specificity, which can lead to an increase in the number of false positive conclusions and an increase in the number of unjustified nephrectomies. Conclusion. The predictor of infection of own kidney cysts after transplantation is a burdened urological history. MRI DWI has high sensitivity and low specificity in the diagnosis of IR in ADPKD. When identifying single cysts with MR-signs of infection in the absence of clinical, laboratory manifestations of UTI, nephrectomy is not indicated.

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Introduction. Patients in the outcome of urological diseases after the beginning of treatment with hemodialysis in the presence of permanent drainage in the kidneys, or with recurrent pyelonephritis have high risks of urosepsis and death. In order to improve the results of diagnosis and treatment of this category of patients, we analyzed our own results. Materials and methods. The study included 58 patients with end-stage chronic renal failure (ESRD) who were treated with hemodialysis and had a nephrectomy for active pyelonephritis in the period from 2013 to 2020. Results. The most informative method in the diagnosis of pyelonephritis was magnetic resonance imaging using diffuse-weighted image protocols (MRI-DWI), the diagnostic efficiency was 94%. There were no differences in the frequency of intraoperative complications in laparoscopic and open nephrectomy. The mortality rate after nephrectomy was 25.9% (n=15). With a preoperative C-reactive protein (CRP) level of more than 95 mg/l (p=0.011) and a Charlson comorbidity index of more than 5 (p=0.003), a high probability of death was predicted. Long-term (more than 14 days) antibacterial preoperative therapy was significantly associated with sepsis before surgery, postoperative antibiotic-associated colitis, and infectious-inflammatory complications from the postoperative wound. Discussion. Our work, as well as many other publications, demonstrates a high incidence of septic complications in patients with ESRD. Patients with permanent drainage in the upper urinary tract are most at risk. this study convincingly showed that the results of nephrectomy are significantly worse in the presence of a systemic inflammatory reaction (SIRS), and therefore it is advisable to perform a nephrectomy before the development of SIRS. Our opinion on the possibility and safety of laparoscopic nephrectomy in chronic pyelonephritis in patients with ESRD who have undergone repeated renal interventions is consistent with a number of other studies in recent years. Conclusion. Diagnosis of pyelonephritis in patients with ESRD is advisable to start with MRI-DWI. The results of nephrectomy are better in the absence of a systemic inflammatory response. It is necessary to minimize antibacterial therapy before surgery. Laparoscopic nephrectomy is a safe procedure for inflammatory kidney diseases.