Postgraduate Education named after P. L. Shupyk, Kyiv, Ukraine Study purpose -to assess the possibility of percutaneous antegrade ureterolithotripsy as an alternative treatment for patients with large calculi of the proximal part of ureter. Patients and methods.Results of 75 mini percutaneous antegrade ureterolithotripsy with contact lithotripsy were studied. The mean size of the ureteral calculi was 1.8 ± 0.7 cm. The operations were performed with epidural anesthesia with intravenous sedation, in the patient's position "on the abdomen" in 62 (82.7 %) cases and in the patient's position "on the back" in 13 (17.3 %) cases. Puncture of the renal cavity system was performed with combined ultrasound and fluoroscopic guidance. Accesses were performed through the lower calices group in 14 (18.7 %) cases, through the middle calices group in 39 (52.0 %), and through the upper calices group in 22 (29.3 %) cases.Results. The mean time of mini percutaneous antegrade ureterolithotripsy was 58.5 ± 15.4 min, while the stone free rate was achieved in all 100% of patients. The mean level of hemoglobin drop was not more than 15.5 ± 5.4 GM/DL In the postoperative period, aggravation of pyelonephritis was noted in 8 (10.6 %) patients. Nephrostomy drainage followed percutaneous antegrade ureterolithotripsy in 24 (32.0 %) cases, nephrostomy drainage and internal ureteral JJ stent in 33 (44.0 %), and the operation was ended with a tubeless method with only ureteral JJ stent placement in 14 (18.7%) cases. Nephrostomy drainage, as well as ureteral stants (with tubeless method), were removed in 1-2 days. The mean period of postoperative stay of patients in the hospital was 2.3 ± 0.8 days. It was noted that antegrade fiberureteropyeloscopy is an extremely time-consuming and cost-demanding method, as an alternative to which may be percutaneous antegrade ureterolithotripsy with use of mini-nephroscope tubes.Conclusions. Analysis of urolithiasis treatment with the method of mini percutaneous antegrade ureterolithotripsy indicates that this method is an attractive direction in the treatment of patients with large calculi of the proximal parts of ureter that allows achievement of the full stone free rate state, time of surgical treatment and hospital stay for patients with this pathology reduction.Перкутанна антеградна уретеролітотрипсія в лікуванні уретеролітіазуМета роботи -оцінити можливість антеградної перкутанної уретеролітотрипсії як альтернативного варіанта лікування пацієнтів із великими конкрементами проксимального відділу сечоводу.Матеріали та методи. Вивчили результати 75 мініперкутанних антеградних уретеролітотрипсій із контактною літотрипсією. Середній розмір каменю сечоводу становив 1,8 ± 0,7 см. Операції виконали під епідуральною анестезією з внутрішньовенною седацією в положенні хворого на животі в 62 (82,7 %) випадках, в 13 (17,3 %) випадках -у положенні хворого на спині. Пункцію порожнинної системи нирки виконали під комбінованим ультразвуковим і флюороскопічним наведенням. Через нижню групу чашечок доступи виконали в 14 (18...

Study purpose -to improve the solitary nephrolithiasis treatment effectiveness by determining the optimal conditions for ESWL or mini PNL application in the treatment of kidney calculi 1.0 to 2.5 cm in size. Patients and methods.A comparative analysis of the results of minimally invasive methods application for nephrolithiasis treatment was performed in 210 patients treated with mini PNL (the group I) and 190 patients treated with ESWL (the group II). Patients with calculi more than 1.5 cm predominated in the group of mini PNL and with calculi less than 1.5 cm -in the ESWL group. The number of patients with calculi 1.5-2.0 cm in both groups was the same: 24.3 % and 24.2 % (P > 0.05).Results. It was noted that the calculi destruction effectiveness after 1-4 or more sessions of ESWL took place in 182 patients (95.8 %). At the same time, an increase in the mean density of calculi above 600 HU caused reduction (P < 0.001) of the primary ESWL session efficiency almost twofold. When performing the 221 mPNL, 97.1 % of the patients required one surgical treatment. The number of complications (bleeding, attack of pyelonephritis) in the group II was insignificantly higher in contrast to the group I -26 (12.3 %) and 45 (14.1 %), respectively (P < 0.05). The stone-free status (up to one month) was noted in 62.6 % of patients after the completion of ESWL sessions that increases the risk of nephrolithiasis recurrence from 37.4 %. In treatment with mPNL, the stone-free status reached 97.1 % (P < 0.001), and in repeated mPNL applying in 2.8 % of cases -100 %. The mean clinic postoperative treatment periods in the group I were lower in contrast to patients of the group II -3.0 ± 1.5 and 12.5 ± 3.6, respectively (P < 0.001).Conclusions. This comparative analysis of features and results of uncomplicated nephrolithiasis with mPNL and ESWL treatment indicates that mPNL is the most preferred method for kidney calculi 1.0 to 2.5 cm and more in size treatment.Раціональний вибір малоінвазивного методу лікування при неускладненому нефролітіазі з конкрементами нирки від 1,0 до 2,5 см Матеріали та методи. Здійснили порівняльний аналіз результатів застосування малоінвазивних методів лікування нефролітіазу у 210 пацієнтів, які лікувалися методом міні-ПНЛ (I група), та 190 хворих, які лікувалися за допомогою ЕУХЛ (II група). У групі міні-ПНЛ переважали пацієнти з конкрементами понад 1,5 см, а у групі ЕУХЛ -із конкремен-тами розмірами менше ніж 1,5 см. Кількість хворих із конкрементами розмірами 1,5-2,0 см в обох групах однакова: відповідно 24,3 % і 24,2 % (p > 0,05).Результати. Відзначено, що ефективність руйнування конкрементів після 1-4 і більше сеансів ЕУХЛ була у 182 па-цієнтів (95,8 %). При цьому збільшення середньої щільності каменів понад 600 од. НU призвело до зниження (p < 0,001) ефективності первинного сеансу ЕУХЛ практично вдвічі. При виконанні 221 мПНЛ, 97,1 % хворим потрібно було одне хірургічне втручання. Кількість ускладнень (кровотеча, атака пієлонефриту) у II групі хворих була суттєво більшою, ніж у I групі -відповідно 26 (12...

The objective: evaluation of the effectiveness and safety of percutaneous nephrolithotripsy in patients in the supine position. Materials and methods. For the period 2017–2021, 521 mini-PNL were performed according to the standard technique, where in 458 (87,9%) cases the operation was performed in the patient’s prone position, and in 63 (12,1%) cases on the supine position (group 1). The control group (2 group) consisted of 70 patients, sporadically selected among 458 patients to whom PML performed in a standard prone position. Mini-PNL was performed under combined regional (spinal-epidural) anesthesia in 98,7% (514) cases, in 1,3% (7) under endotrachial anesthesia. Results. The average time of surgery was 41,1±11,4 minutes in the 1st group and 57,4±10,3 minutes in the 2nd group (р<0,05), due to the lack of need to revolutionize the patient on the abdomen. Statistically greater (p<0,05) of the ability to perform/ additional percutaneous access in patients in the supaine position. Infectious complications (9,5 vs. 7,1%; p>0,05), stone-free conditions (96,4 vs. 98,2%; p>0,05) and average hospital stays (2,3 vs. 2,2 days; p>0,05). None of the patients in both groups had complications higher than Clavien IIIa. When performing PNL in the supine position, in contrast to performing PNL on the prone position, there is always the possibility of using combined endoscopic methods. Where 3 (4,8%) patients underwent combined retro- and antegrade approaches for combination of nephrolithiasis with «wedged» calculi of the pyelourethral segment and in distal ureter, and retrograde laser endoureterotomy was performed in one (1,6%) patient. The limitation of our study includes a small sample size and a lack of group randomization. Conclusions. The patient’s position on the supine position, during the implementation of PNL, is a safe technique and can be a particularly attractive option for the category of patients with high anesthesiological risk; in the case of planned simultane (transurethral and percutaneous) interventions on the UMP; in patients who are obese or with severe deformityof the spine.

Urolithiasis is one of the most common disease encountered in the daily practice of a urologist. Depending on the severity of the course, patients with urolithiasis and, in particular, kidney stones, are often required to have the surgical treatment. The greater problem is deemed to be staghorn nephrolithiasis and the choice of the optimal surgical technique for the elimination of kidney stones. The objective: to evaluate the efficacy and safety of the combined method of fragmentation of coral kidney stones in comparison with standard ultrasound lithotripsy. Materials and methods. A total of 352 percutaneous nephrolithotripsies (PCNL) were performed: 187 (53,1%) – patients who were diagnosed with staghorn calculi. The age of the patients ranged from 26 to 66 (mean age 42,5 years). There were 89 men and 98 women. 78 (41.7%) patients had previously undergone surgical treatment (open surgery or PCNL) of kidney stones, in which recurrent staghorn stones were subsequently identified. Nine (4,8%) patients had bilateral coral calculi. The size of the stone varied from 3,5 to 11,0 cm. Their density ranged from 300 to 1500 Hounsfield units. The most frequent complication of the underlying disease was chronic pyelonephritis – 145 (77,5%) patients. Hydronephrosis on the affected side was diagnosed in 98 (52,4%) patients. A combined pneumatic and ultrasonic lithotripter ShockPulse-SE from Olympus (Japan) was used for breaking kidney stones. We performed PCNL in a combined mode in 41 (21,9%) patients with staghorn nephrolithiasis. Results. In the group of patients using combined pneumatic and ultrasonic lithotripsy, complete removal of the staghorn calculus was achieved in 97,6% of cases (in 40 of 41 patients), whereas in the opposite group, using an ultrasonic lithotripter only in 84,9% (in 124 of 146 patients). The duration of the PCNL operation using the ShockPulse-SE device was from 35 to 130 minutes, on average – 48±5 minutes. The duration of the surgical intervention using an ultrasound lithotripter is from 90 to 180 minutes, an average –105±7 minutes. Blood loss during PCNL using an ultrasonic lithotripter was 200–400 ml, whereas with the ShockPulse-SE apparatus – 100–200 ml. An exacerbation of pyelonephritis was noted in 7 patients (in two patients after PCNL in a combined mode and in five after PCNL using an ultrasonic lithotripter). The mean length of patient hospitalization after surgery ranged from 4 to 10 days. At the same time, the average duration after PCNL using the combined ShockPulse-SE technique was 4±1 days, while after PCNL using an ultrasonic lithotripter it was 6±1 days. Conclusions. The combined technique of lithotripsy with a combined probe for simultaneous pneumatic and ultrasound lithotripsy has shown better results in terms of safety and efficacy compared to using only an ultrasound lithotripter. Used for decades, ultrasound lithotripsy for staghorn stone PCNL is both effective and safe moreover it’s a traditional technique. Thus, in comparison with ultrasound lithotripsy, the combined technique showed a shorter operation time, with less blood loss, a shorter length of patient hospitalization and less pyelonephritis in the postoperative period, as a result of maintaining a lower intrarenal pressure gradient during the operation. At the same time, the cost of the procedure using a combined probe was estimated, which turned out to be higher than traditional ultrasound lithotripsy. The use of combined lithotripsy with simultaneous aspiration of stone fragments is an indisputable advantage of this kind of PCNL in patients with staghorn nephrolithiasis, which brings the effectiveness of this technique closer to 100%.