A modern view on tubeless percutaneous nephrolithotomy

Vozianov, S.O.; Sahalevych, A. I.; Бойко, А. І.; Haiseniuk, F. Z.; Kohut, V. V.; Dzhuran, B. V.; Sosnin, Mykola

doi:10.14739/2310-1210.2021.4.226895

Cited by 4 publications

(5 citation statements)

References 52 publications

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“…Тривале перебування у стаціонарі, ступінь післяопераційного болю та розвиток більшості ускладнень при аУЛТ зазвичай спричинені розміром транспаренхіматозного каналу та необхідністю у встановленні нефростомічного дренажу [26]. Проте з технічним прогресом у плані мініатюризації інструментарію для ПНЛ, а також здобуття все більшого досвіду персоналу -час стаціонарного перебування після міні-ПНЛ значно скоротився [39,40].…”

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Modern Methods of Treatment for Proximal Ureterolithiasis

Ozhohin

2021

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Urolithiasis is a disease characterized by the formation of stones in the urinary tract. According to statistics, SCC causes about 30% of hospitalizations in the urology department. Treatment of SCC is divided into conservative and operative. The choice of method depends on age, clinical course of the disease, general condition of the patient, anatomical and functional condition of the kidneys and the size of the localization of the calculus. Methods of treatment of SC have changed significantly in recent years. Due to the technical achievements of the method of open ureterolithotomy, which was once the standard method of treatment of so-called «complicated» concretions of the ureter, evolved into a laparoscopic ureterolithotomy, and with the advent of ultrasonic and laser lithotriptors – began the newest era of minimally invasive urology– extracorporeal shock-wave lithotripsy and endourology: antegrade percutaneous ureterolithotripsy, retrograde ureteroscopic lithotripsy and flexible retrograde uretherolithotripsy (FURS). The purpose of the work – on the basis of scientific literature to assess the effectiveness, safety and profitability of modern methods of surgical treatment for proximal ureterolithiasis. During the scientific research, attention was paid to the following parameters: stone free rate (SFR), postoperative pain level, need for painkillers, number of postoperative bed-days, presence of postoperative fever, hemoglobin level, need for blood transfusion, and on the economic component during the implementation of a technique. The principles of treatment of patients with large proximal ureterolithiasis are described in the clinical guidelines of the European and American Associations of Urologists. However, for example, which of the 3 proposed methods of treatment of large proximal ureterolithiasis to choose – there is no consensus from the world urological community. Percutaneous antegrade ureterolithotripsy is the preferred method of choice in patients with large proximal ureteral stones that cannot be removed by contact or extracorporeal ureterolithotripsy, characterized by a high level of absence of stones and minimal complications, optimal post operative and high indicators of economic attractiveness of this technique.

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Section: рулт/ф-рулт проти аултunclassified

Modern Methods of Treatment for Proximal Ureterolithiasis

Ozhohin

2021

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“…Нефролітіаз в Україні посідає друге місце серед усіх урологічних захворювань після сечових інфекцій [5,6]. Загалом у світі каменеутворення виявляють у 1500-2000 випадках на 1 млн населення [7].…”

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“…Уратний нефролітіаз (УН) -урологічна патологія, причинами якої можуть бути екзогенні й ендогенні фактори, включаючи спадковий. Характеризується УН появою уратних каменів у нирках і сечових шляхах, схильністю до рецидивування, часто тяжким перебігом [5,8]. Майже 25 % каменів складаються з сечової кислоти (СК).…”

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“…На УН нині хворіють до 20-30 % пацієнтів (у 1950 роки -5-10 %), тобто спостерігають тенденцію до збільшення випадків виявлення цього захворювання. Провідну роль у патогенезі УН відіграють порушення пуринового обміну, що виявляють за розвитком гіперурикемії (ГУ) та гіперурикурії [5,10].…”

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Disorder of purine metabolism in the etiopathogenesis of urate nephrolithiasis

Vorotyntsev¹,

Bilai²,

Білай³

2023

АП

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Urinary stone disease (USD) is a polyetiological urological disease caused by both exogenous and endogenous factors, including hereditary ones. It is characterized by the appearance of stones in the kidneys and urinary tract, and a tendency to relapse, often with a severe course. Almost 25 % of stones consist of uric acid (UA). The leading role in the pathogenesis of urate nephrolithiasis (UN) is played by disorders of purine metabolism, which are characterized by the development of hyperuricemia (HU) and hyperuricuria. The aim of the work is to review modern literary sources on the role of purine metabolism disorders in the etiopathogenesis of UN. Results. The development of UN depends on the constancy of the acidic urine pH, as well as on a decrease in diuresis, HU and hyperuricuria. UA is the final metabolite of purine metabolism and the main stone-forming substance in patients with UN. HU develops both due to uncompensated disorders of purine metabolism with a decrease in renal secretion and intestinal uricolysis (excretion pathway) and excessive intake of purine bases in the body and their increased synthesis in vivo (metabolic pathway). Citric acid, as one of the main metabolites of the tricarboxylic acid (TCA) cycle, is connected through the corresponding substrates to the formation of purines and the metabolite of amino acid metabolism, glutamine. TCA is connected to the cycles of urea, glyoxylate and purine bases through α-ketaglutaric acid. It is a substrate of citric acid, and it affects the synthesis of glutamate, which combines with ammonia to form glutamine, used in the cycle of purine synthesis. Conclusions. The role and diagnostic value of purine metabolism upsets, disorders of the TCA (citric acid), amino acid metabolism (glutamine), the activity of xanthine oxidase is a key enzyme in purine synthesis which passes through TCA with the participation of its metabolite α-ketaglutarate, have been established. TCA is bound to glutamine, rich in nitrogen, which is necessary for the synthesis of purine bases.

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“…We believe that decreased trauma associated with smaller tract may in part account for the difference, though we did not measure analgesia requirement in the postoperative setting. Of course, the duration of postoperative hospital stay is affected not only by the quantitative and qualitative complications composition, but also the possibility of using tubeless techniques [28][29][30]. We successfully completed mPNL without nephrostomy drainage placement in 214 (41.1%) patients: 129 (24.8%) tubeless mPNL with antegrade ureteral stenting and 85 (16.3%) total tubeless mPNL.…”

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Mini-percutaneous nephrolithotomy in surgery of nephrolithiasis

Sahalevych

Sergiychuk

Ozhohin

et al. 2021

Ukr. J. Nephrol. and Dial.

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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.

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A modern view on tubeless percutaneous nephrolithotomy

Cited by 4 publications

References 52 publications

Modern Methods of Treatment for Proximal Ureterolithiasis

Modern Methods of Treatment for Proximal Ureterolithiasis

Disorder of purine metabolism in the etiopathogenesis of urate nephrolithiasis

Mini-percutaneous nephrolithotomy in surgery of nephrolithiasis

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