[Mini-PCNL, micro-PCNL or RIRS: comparative efficacy and safety in renal stones up to 2 cm].

INTRODUCTION: One of the main trends in the evolution of endoscopic treatment of urolithiasis is the miniaturization of instruments. This is obvious in the development of minimally invasive percutaneous nephro-lithotomy (PCNL) and retrograde intrarenal surgery (RIRS). However, there are few studies comparing the efficiency and safety of these methods. AIM: To evaluate and compare the efficiency and safety of mini-PCNL, micro-PCNL and RIRS in the treatment of kidney stones up to 2 cm in size. MATERIALS AND METHODS: Between October 2020 and December 2022, a total 72 patients underwent minimally invasive endoscopic procedures in two centers, including RIRS (n=30), mini-PCNL (n=26) and micro-PCNL (n=16) using thulium fiber laser FiberLase U2. The efficiency of procedure (stone free rate [SFR]) was assessed using non-contrast-enhanced CT. SFR was considered as the absence of residual fragments > 4 mm. Complications (safety) were evaluated based on the Clavien-Dindo classification. RESULTS: The mean age of all patients was 47.7 (22-84) years. There were no significant differences between three groups in stone characteristics according to CT (maximum diameter, density, volume and number of stones, the presence of pelvicalyceal dilation). SFR was significantly different between the groups (p=0.034). The overall SFR was 81.9% (n=59). After RIRS, mini-PCNL, and micro-PCNL the SFR was 93.3%, 80.8%, and 62.5%, respectively. A significant difference was found between the RIRS and micro-PNL groups, with 2 out of 30 and 6 out of 16 patients requiring repeat procedure, respectively (p=0.026). The overall rate of complication of grades I-II, IIIa and IIIb according to Clavien-Dindo was 6.9%, 9.7% and 6.9%, respectively. A significant difference was found between the RIRS and micro-PCNL (p=0.021) for grade I-II complications. A rate of grade III complications was not differed between the groups. The operation time was higher for mini-PNL (79.8 (30-145) min), and it was shorter for RIRS (55.7 (30-155) min). The length of stay was lower in RIRS group (4.5 (1-12) days). CONCLUSION: The highest SFR was achieved in the RIRS group. In terms of the number of complications of I-II grades according to Clavien-Dindo, the duration of the procedure and the length of stay, RIRS also showed the advantage. There were no significant differences in efficiency and safety between the micro-PNL and mini-PNL. There are not enough studies comparing minimally invasive methods for treating kidney stones. It is necessary to continue research in this area in order to develop an optimal algorithm for choosing the method of endoscopic treatment.

The Burden of Residual SymptOms That Complicate the Life of Patients Who Have Suffered a new Coronavirus Infection (THROW study).

Aim      To evaluate the prevalence of residual symptoms in patients hospitalized for novel coronavirus infection at 8 months after discharge and the severity of such symptoms depending on demographic characteristics, concurrent diseases, and specific features of the acute period of COVID-19.Material and methods  This study included the patients who were managed for novel coronavirus infection in a COVID-19 hospital and provided their consent to participate in the study (98 patients). At 8 months after discharge from the hospital, a structured telephone interview was performed.Results Only 40 % of patients treated for COVID-19 did not have any complaints at 8 months after discharge from the hospital. The most frequent complaints in the long term were fatigue (30.5 %), weakness (28.4 %), shortness of breath (23.2 %), arthralgia (22.1 %), myalgia (17.9 %), and anosmia (15.8 %). The background of chronic diseases and obesity, percentage of lung damage according to CT data, and the requirement for oxygen support during the acute period in our sample were not related with the presence of symptoms in the long term. The presence and severity of symptoms during the long term were not determined by the clinical condition, volume of lung damage, or requirement for oxygen support but were related with the gender and severity of inflammation upon admission.Conclusion      Independent predictors for persistence of symptoms in the patient sample with severe novel coronavirus infection during the long term included chest and joint pain during the stay in the hospital, female gender, and increased levels of C-reactive protein upon admission.

[Features of a new corOnavirUs infection course and optioNs therapy DEpending on the andRogenic status (FOUNDER): androgenic status in men with COVID-19 and its relationship with the disease severity].

OBJECTIVE: Analysis of androgen status in men hospitalized with a moderate COVID-19 and its relationship with the severity of the disease. MATERIALS AND METHODS: The study included 152 males with a confirmed diagnosis of COVID-19 based on the results of a positive PCR for the SARS-CoV-2 virus and/or computed tomography of the lungs hospitalized at the MSU University Clinic due to the moderate and severe COVID-19. Examination of the level of biochemical blood parameters (CRP, creatinine, urea, glucose, total testosterone (T)); CT of the lungs. To objectify the severity of the clinical symptoms, the NEWS2 distress syndrome severity scales and the original scale for assessing the clinical condition of patients with COVID 19 (SHOCS-COVID) were used. RESULTS: The median T level in 152 examined patients was 2.14 [1.21; 3.40] ng/ml. In patients with a T level below the median, the CRP level was more than two times higher, and the D-dimer value was almost two times higher than in patients with T level above median. The duration of treatment in the hospital was longer in men with COVID 19 and an initial T level below the median than in patients with T about the median (13 days vs 10.5 days, p=0.003). Low T level was correlated with lung damage by lung CT. After improving the clinical condition, there was a linear increase in the level of T independent of its initial level. CONCLUSION: Among men with moderate and severe COVID-19, a decreased testosterone level is detected in 46.7% of cases. Patients with low testosterone levels on admission have more severe COVID-19. A significant increase in testosterone level was observed after successful COVID-19 treatment without any special action regarding testosterone level.