PLACE OF TRANSURETHRAL CONTACT NEPHROLITHOTRIPSY IN THE TREATMENT OF PATIENTS WITH KIDNEY STONES


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Abstract

Currently, the question of choosing the optimal treatment for patients with large (>20 mm) concretions is still open. Extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolitholapaxy (PNL) are the main methods for removing of such concretions, with efficiency of 45-63, and 86-100%, respectively. Development of semirigid and flexible endoscopes, the creation of new types of contact lithotriptors have expanded the possibilities for use of transurethral treatment of urolithiasis. Results of treatment of 63 patients who underwent transurethral nephrolithotripsy (TUNL) for the large concretions in pelvicalyceal system (PCS) were analyzed. Selection of energy type for contact lithotripsy depended on the location, size, density of stone and type of uretherorenoscope. According to ultrasound and urography data after 30 days, stones and their fragments in the urinary tract were not found in 36 (57.1%) patients, clusters of small residual fragments were identified in 21 (33.3%) patients. In these cases, the stent was removed. During re-examination at 3 months, the full discharge of the fragments was observed in 19 (90.5%) of 21 patients. A separate group consisted of 6 (9.52%) patients, in whom residual concrements in PCS of operated kidneys were found after 30 days. In this group, two patients underwent one session of ESWL; repeated endoscopic interventions were performed in other patients, culminating in the complete removal of stone from PCS. According to the ultrasound and x-ray examinations, 55 (87.3%) patients achieved full exemption from concretions in PCS and urinary tract after 60 days. Thus, TUNL in the treatment of large and multiple kidney stones is comparable with ESWL and PNL on clinical efficacy, and in some clinical situations can be considered as a method of choice for surgical treatment of nephrolithiasis.

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