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...

Abstract. The present study aimed to assess the effectiveness and safety of mini-percutaneous nephrolithotomy (mPNL) in comparison with standard percutaneous nephrolithotomy (sPNL) for the treatment of complex nephrolithiasis. Methods. During the period from 2012 to 2020, 1021 patients with solitary (10.0-30.0 mm), staghorn and multiple renal calculi were retrospectively divided into two groups: sPNL (500 patients) and mPNL (521 patients). The groups were compared by the stone-free rate (%, SFR), the duration of the surgery, complications and hospital stay. Results. SPNL and mPNL were highly effective procedures for the treatment of nephrolithiasis. The mPNL group had longer operative times (81.0±15.5 vs 69.1±13.9 min, p<0.001) and higher frequency tubeless/totally tubeless procedures (41.1 vs 6.8%, p<0.001). mPNL showed a higher SFR (96.4 vs 91.8%, р=0.002 in patients with complete staghorn (90.1 vs 77.3%, p<0.05) and multiple kidney stones (89.5 vs 70.8%, p=0.03). Postoperative decrease in hemoglobin was lower in mPNL group 1.1±0.34 vs 2.1±0.26 g/dl (p<0.001). The incidence rate of urinary tract infections and postoperative hospital stay was lower in the mPNL group: 7.3 vs 13.2%, p=0.03 and 1.9±0.6 vs 4.3±2.4 days, р<0.001. Conclusions. MPNL is a safe and effective treatment for patients with complex renal stones with an improved stone-free rate and lower complication rate and shorter hospital stay. Smaller diameter tract in mPNL procedures was associated with a longer duration of surgery.

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...

Mini percutaneous nephrolithotomy (mPNL) is a standard treatment for kidney stones larger than 1.5 cm, with the placement of a nephrostomy drainage at the end of it, which is considered the standard procedure, but tubeless/ totally tubeless mPNL techniques reduce postoperative discomfort in patients and shorten hospital stays. The aim of article was to compare the efficacy and safety of our proposed modified method of totally tubeless mPNL with control of the parenchymal canal, with existing methods of tubeless/totally tubeless mPNL. Novelty of the study presented by modified method of totally tubeless mPNL. During the period from 2018 to 2020 we performed 486 mPNL were performed in our clinic in total, among which 63 (12.9%) patients underwent tubeless PNL. Patients whose surgeries ended with using tubeless techniques were divided into three groups: Group I – 22 patients who had tubeless mPNL (with ureteral stent), Group II (20 patients) – totally tubeless mPNL with a safety thread (the proposed procedure), Group III (21 patients) – totally tubeless mPNL. In all three groups, the access point was most often made through the lower group of renal calyces: Group I – 12 (54.5%), Group II – 14 (70.0%), Group III – 13 (61.9%); then through the middle calyx: Group I – 8 (36.4%), Group II – 6 (30.0%), Group III – 7 (33.3%); and the upper calyx: Group І – 2 (9.1%), Group ІІ – 0%, Group ІІІ – 1 (4.8%), no differences in the distribution of access points between groups were found (p=0.67). There were no differences in the distribution of tract sizes between the groups (p=0.95) with tract dilatation to 16.5/17.5 Fr was performed most often: Group I – 12 (54.5%), in Group II – 11 (55.0%) and Group III – 11 (52.4%). The mean duration of surgery in Group I was 83.0±22.9 min, in Group II – 74.9±13.6 min, in Group III – 72.6±12.0 min (p=0.47). This study confirms the high effectiveness of totally tubeless mPNL. The proposed modification to perform totally tubeless mPNL allows you to have permanent postoperative control over the parenchymal channel and in case of postoperative bleeding it enables you to immediately insert nephrostomy drainage through the safety thread. Study contributes to practical methods as an intermediate step for surgeons who are considering transition to a totally tubeless PCNL technique.

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