Background: There is limited published evidence regarding the incidence of intraoperative and postoperative events and the effect of percutaneous nephrolithotomy (PCNL) in supine and prone positions and laparoscopic pyelolithotomy on kidney function in patients with large and complex calculi. Materials and methods: We evaluated the surgical outcomes of 97 patients with large and complex kidney stones. The patients were divided into 3 groups: those who underwent PCNL in the prone position, PCNL in the supine position, and pyelolithotomy by laparoscopy and retroperitoneoscopy. General surgical outcomes, size of residual stones, stone-free rate, glomerular filtration rate (GFR), and split GFR obtained from Tc-99m renal dynamic scintigrams were analyzed. Results: Percutaneous nephrolithotomy in the prone position was correlated with improved function of the affected kidney. In the supine PCNL group, none of the analyzed indicators demonstrated a significant difference. Dynamic nephroscintigrams revealed negative changes in terms of accumulation and secretion of the affected kidney. A slight decrease in creatinine clearance was noted. However, positive dynamics in split GFR and secretory index were seen in this group. The laparoscopic group showed positive results in all analyzed parameters. However, full assessment of the function of the affected kidney in this group was limited due to restricted use of laparoscopic pyelolithotomy for complex stones. Conclusions: Percutaneous nephrolithotomy in the prone position resulted in the most favorable renal functional outcomes for patients with high-grade renal calculi, whereas a laparoscopic approach may be preferred for patients with stones of lower grades. The most significant factors that adversely affected renal function were intraoperative bleeding volume, kidney stone size and density, and body mass index.

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The work is based on the analysis of literature data devoted to the problem of preserving the functional state of the kidneys with various video endoscopic methods of surgical treatment of large and complex kidney stones. The purpose of the review is to highlight the likelihood of deterioration in the functional state of the kidneys in the postoperative period. A detailed analysis of postoperative outcomes in various minimally invasive methods of treatment of patients with large and complex kidney stones was carried out, with an overview of the possibility of using dynamic nephroscintigraphy as a method of objectively assessing the functional state of the kidneys.

Introduction. This work analyzes efficacy, convenience, and safety of a high-energy laser light technique for destructing large kidney stones in patients with nephrolithiasis in comparison to other contact methods of nephrolithotripsy.Material and methods. The effectiveness of contact laser nephrolithotripsy is compared to that of hydropneumatic and ultrasonic lithotripsy. Holmium green laser light was used in this laser procedure. For other techniques, Swiss LithoClast Master devices were used. The authors have analyzed outcomes obtained after operating on 73 patients with large and complex kidney stones.Results. To evaluate the effectiveness, basic parameters were taken (degree of kidney cleaning of stones and their fragments, probability of migration of stone fragments, blood loss, duration of surgery, complications, etc.). In addition, the correlation between basic parameters was obtained and analyzed.Conclusion. The present trial has shown that laser contact lithotripsy is the most optimal technique for destructing large and complex kidney stones in comparison to traditional modalities such as contact hydropneumatic and ultrasonic lithotripsy. It takes more time but provides more effective cleaning from calculi.