Введение. Эмфизематозный пиелонефрит – редкая, но тяжелая форма некротизирующей инфекции, вызывающей образование газа в чашечно-лоханочной системе, почечной паренхиме, околопочечном пространстве. Общий уровень смертности достигает 20–40%. Цель. Оценить собственные результаты лечения пациентов с острым эмфизематозным пиелонефритом. Материалы и методы. Наблюдали 7 пациентов с эмфизематозным пиелонефритом. Все наши пациенты страдали сахарным диабетом, мочекаменной болезнью – 57,1%, гидронефроз выявлен у 71,4%. Результаты. Оперативному лечению подверглись 5 человек, и 2 пациента лечились консервативно с хорошим эффектом. После операции умер 1 пациент. Выводы. Всем пациентам с острым пиелонефритом на фоне сахарного диабета необходимо выполнение КТ почек; пациентам с эмфизематозным пиелонефритом I и II класса показано малоинвазивное лечение при сохраненном или восстановленном оттоке мочи из пораженной почки; антибактериальное лечение пациентов с эмфизематозным пиелонефритом должно проводиться по принципу деэскалационной эмпирической антибактериальной терапии. Показания к выполнению нефрэктомии: 1) III класс эмфизематозного пиелонефрита (газ в паранефральном пространстве с обширной (более 2/3 почки) гнойной деструкцией почки); 2) неэффективность малоинвазивных методов лечения острого эмфизематозного пиелонефрита. Introduction. Emphysematous pyelonephritis is a rare but severe form of necrotizing infection causing gas formation in the pelvicalyceal system, renal parenchyma, and perinephric space. The overall mortality rate reaches 20–40%. Purpose. To evaluate our own treatment results in patients with acute emphysematous pyelonephritis. Materials and methods. A total of 7 patients with emphysematous pyelonephritis were observed. All our patients suffered from diabetes mellitus and urolithiasis (57.1%); hydronephrosis was revealed in 71.4%. Results. 5 people underwent surgical treatment and 2 patients were treated conservatively with a good effect. After the operation 1 patient died. Conclusions. All patients with acute pyelonephritis against the background of diabetes mellitusneedtoundergorenal CT; patientswithclass Iand IIemphysematouspyelonephritis should be treated minimally invasively with preserved or restored urine outflow from the affected kidney; antibacterial treatment of patients with emphysematous pyelonephritis should be carried out according to the principle of de-escalating empirical antibacterial therapy. Indications for nephrectomy are: 1) class III emphysematous pyelonephritis (gas in the paranephral space with extensive (more than 2/3 of the kidney) purulent destruction of the kidney); 2) inefficiency of minimally invasive treatment methods of acute emphysematous pyelonephritis.

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Background. One of the life-threatening diseases among patients with a single kidney is acute purulent pyelonephritis (APP). The disease is accompanied by oliguria or anuria and in many cases comes with the development of multiple organ dysfunction. Objectives. To present the features of the clinical manifestations of APP of a solitary kidney, the results of clinical and laboratory examination, the role of kidney imaging methods (USG, MRI and contrast-enhanced CT) in identifying foci of purulent destruction in the parenchyma, and the immediate results of treatment of patients with APP of a solitary kidney. Material and methods. 10 patients with APP of a solitary kidney were observed. The role of imaging methods (USG, CT and MRI) of the kidney in the detection of purulent destruction in parenchyma is shown. Methods of treating patients are considered: open organ-preserving surgery, nephrectomy; installation of an internal ureteral stent followed by antibiotic therapy and puncture nephrostomy followed by antibiotic therapy. Results. The best immediate results were noted in the group of patients who underwent open organ-preserving surgery in the volume of decapsulation of the kidney, excision of carbuncles, opening of abscesses and drainage of the calices-pelvis system of the kidney with nephrostomy. 3 out of 10 patients needed hemodialysis. Conclusion. Open organ-preserving surgery remains a reliable adequate method of surgical treatment of APP of a solitary kidney. In case of a single focus of destruction in the kidney parenchyma up to 3 cm in diameter or with signs of apostematous pyelonephritis, an effective method of treatment is the installation of an internal ureteral stent followed by antibiotic therapy. 30% of patients with APP need hemodialysis treatment.

The article represents the authors’ own observation of the patient with xanthogranulomatous pyelonephritis (XPN). Xanthogranulomatous pyelonephritisis a rare form ofchronic bacterial calculous pyelonephritis. Factors predisposingto thedevelopmentof xanthogranulomatous pyelonephritis include the following: the impairment of theurinary flowalong theurinarytract, type II diabetes mellitus, and chronic inflammation of the kidney. XPN is an uncommon cause of chronic pyelonephritis resulting in non-functioning kidneys and poses a preoperative diagnostic dilemma which may mimic other malignant diseases of a kidney (renal cell carcinoma, leiomyosarcoma) and acute pyelonephritis as a bacterial infection causing inflammation of the kidneys (a renal carbuncle). The patient was examined at the urology clinic of .Grodno State Medical University: general clinical blood and urine tests, ultrasound examination, X-ray computed tomography - native and with contrast enhancement, magnetic resonance imaging were performed. The patient underwent nephrectomy due to the impossibility of organ-preserving surgery - removal of a volumetric formation located at the hilum of the kidney and adjacent to the vessels. Histopathologyof the specimen wasconcludedas xanthogranulomatouspyelonephritis. The patientsunderwentMR examinations, ultrasound examination and X-ray computed tomography with contrast enhancement, but adiagnosisofxanthogranulomatous pyelonephritiswas not confirmed unequivocally. The final diagnosis is usually established only after histologic examinationof biopsy specimens of removed kidney.

Introduction. Stress urinary incontinence is a problem not only for the female, but is also a social, medical and economic issue for the community. The main method of treating stress urinary incontinence in women is surgical intervention with the use of synthetic mesh tape. Possibilities of intra and post-surgical complications is a major setback of surgical treatment. Attempts to restore/improve urethral sphincter functions by implanting stem cells has become a perspective method. Methods and materials. Ten female patients from the Urological Clinic of the Grodno State Medical University were chosen for treatment using autologous mesenchymal stem cells. All of them were undergone tourological and gynecological examinations. All chosen patients filled in an Incontinence Quality of Life questionnaire, related to the continention of urine before and after the implant of stem cells. After the explantation of fatty tissue, autologous mesenchymal stem cells were extracted and cultivated, a mixture of stem cells with a gelatine-based substance. Stem cells were introduced para-urethrally and into the urethral wall. Results. After 12 months after the implant 9 women completely retained urine during physical activity. No imperative disorders noted. One patient continued losing urine during physical activity, and her condition remained without improvement. Conclusion. A positive result by criteria of urine retention, urination disorder, and a subjective evaluation of quality of life was achieved in 90% of patients. A lack of even a small positive effect on one patient gives evidence to pathological changes in the organs of the genitourinary, in which stem cell therapy has a low effectiveness. First results inspire a careful optimism, but a continuation of research is required due to a small number of observations.