[Safety and efficacy of a new method of percutaneous nephrolithotripsy performed under ultrasound and endovisual control without the use of intraoperative x-ray examination].

PURPOSE OF THE STUDY: to study the safety and efficacy of using a new method of performing percutaneous nephrolithotripsy under ultrasound and endovisual control. MATERIALS AND METHODS: A comparative analysis of the results of percutaneous nephrolithotripsy performed under ultrasound and endovisual control in 515 (84.1%) patients (main group) and percutaneous nephrolithotripsy performed under fluoroscopic control in 97 (15.8%) patients (control group) was carried out. The groups did not differ in age, gender, body mass index, the number and location of stones, and the duration of the disease. In the main group, there were more patients with large, staghorn and X-ray negative stones, and there were also more patients with kidney block. To analyze and stratify the complications of percutaneous nephrolithotripsy, we used a modified classification of surgical complications according to the Clavien-Dindo system. Statistical analysis of the material was carried out using the licensed package IBM SPSS Statistics Version 14.0.1. RESULTS: The average duration and number of stages of operations in the main and control groups was the same. Almost all operations in groups (93,8% 91,8%) were performed in one step (=0,55). In the main group, in the vast majority of cases95,1%; <0,001), percutaneous nephrolithotripsy was performed through one puncture access, with the degree of complete elimination of stones statistically the same as in the control group (80.6% in the main group and 70.1% in the control group, p=0.158). The degree of decrease in hemoglobin in the postoperative period in the groups did not differ (=0,271). The frequency of postoperative complications in both groups did not differ statistically: in the control - 33.0%; in the main group - 29.3% (p=0.469). The severity of complications according to Clavien-Dindo did not differ in the groups either (p=0.17). CONCLUSION: Percutaneous nephrolithotripsy under ultrasound and endovisual control is a safe and effective operation. The results of the operation and the frequency of early complications are comparable with the traditional X-ray control technique.

[Unilateral combined lap partial nephrectomy and pyelolithotomy for ipsilateral tumor & kidney staghorn stone]

OBJECTIVE: To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone. MATERIALS AND METHODS: Retrospective multicentral comparative study. Group "Combo" was presented by patients with the mentioned combined pathology (n=15). Group "Standart" (n=69) formed from common patients who underwent standard lap partial nephrectomy for renal tumor in the absence of kidney stones. Perioperative factors and results were studied and compared. Video presentation of combined surgical technique is available at: https://youtu.be/fAfYJDvGzsU. RESULTS: Of all patients, no positive margins, no conversions to open surgery or nephrectomy & any complications Clavien >III were detected. There were no any significant differences between the two groups except for OR time (150 [120; 210] vs 130 [100; 180] min; p=0,001). Differences between indexes of WIT (16,27+/-3,8 vs 15,9+/-4,5 min; p=0,107), EBL (200 [150; 300] vs 200 [150; 300] cc; p=0,981), length of stay (7 [6;9] vs 8[6;9] days; p=0,611), intraop complications (0,00 vs 4,3%; p=0,411) and values of postop Clavien III rate (0,00 vs 4,3%; p=0,411) for "Combo" & "Standart" respectively were comparable as well as oncological outcomes. Stone-free rate for combined procedures reached 93,3%. CONCLUSION: conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone is safe and efficient alternative to 2-step treatment of this rare disease.

[LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR KIDNEY TUMORS R.E.N.A.L. SCORE 10 and HIGHER]

OBJECTIVE: To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy for patients with kidney tumors R.E.N.A.L. score 10 and higher. MATERIALS AND METHODS: Retrospective comparative study. Everyone who has been treated from I 2015 to I 2020 by one surgeon in our department by lap partial nephrectomy was included. Patients were randomized by criteria of R.E.N.A.L. score in two groups: 40 those who had this index 10 or more ("R10+"), and 69 - all the rest ("R less or equal 9"). Perioperative factors and results were studied and compared. Video presentation of the surgical technique is available at: https://youtu.be/1254WSFMxJ0. RESULTS: No conversions to open surgery or nephrectomy & any complications Clavien >III were detected. Of all patients, benign lesions were identified in 21(19,3%). Up stage from 1-2 to 3 occurred in 6 (6,82%) cases. Intraop complications: 4,3% vs 2,5% (p=0,6) and the same values of postop Clavien III rate for "R less or equal 9" & "R10+" groups respectively. There were no any significant differences between the two groups except for three parameters: OR time, estimated blood loss & warm ischemia time. In "R10+" cohort these values were 170 [130; 210] min, 250 [162; 337] ml & 20,1+/-5,7 min. And in "R less or equal 9" - 130 [100; 180] min, 200 [150; 300] ml & 15,9+/-4,5 min respectively (p<0.05 for all). Oncological results were comparable and nephrometric index had no effect on them. CONCLUSION: conventional lap partial nephrectomy is safe and efficient even in cases of complex tumors with R.E.N.A.L. score 10 and higher.

[Laparoscopic ureteral substitution: ileocalicostomy combined with psoas hitch].

A 50-year-old female presented to our department of urology with nephrostomy drain in the right kidney been placed because of an acute obstructive pyelonephritis. Nephrostogram revealed an intra-renal pelvis with no passage of contrast into the ureter. Retrograde pyelography identified the extended ureteric stricture and need for a substitution. Laparoscopic ileocalicostomy was performed to achieve a communication between the lower calyx and bladder. Video describing surgical technique is available on https://youtu.be/bIW_m3lwXWY. Due to thick and full-blooded renal parenchyma, a partial nephrectomy of the lower pole had to perform to get an access to the renal calyx. It took 25 min of warm ischemia. At that, sutures of renorrhaphy should have provided reliable hemostasis on the one hand, and free outflow of urine via an isolated calyx on the other. To reduce the length of ileoureter a bladder psoas hitch maneuver was used. A 25-cm-long segment of ileum was isolated and rotated in isoperistaltic manner. Double J stent was held through it. Ileocalicostomy by interrupted and ileovesicostomy by continuous sutures were performed one after another. There were no intraop complications. OR time - 300min. EBL - 200ml. Postoperative course was uneventful. Ten days after surgery, nephrostogram and cystography confirmed the patency of the neoureter and the tightness of both anastomoses. Nephrostomy drain was removed first, ureteral - one day after. "JJ" stood for 3 weeks. The patient is doing well at more than 12 months of follow-up with a stable renal and ileoureteral function. In comparison with open procedure our surgery is significantly less invasive, per contra robotic - not so expensive. As far as we known, this is the first case report of conventional laparoscopic intracorporeal ileocalicostomy with long-term good functional results demonstration.

[Horseshoe kidney tumor laparoscopic surgery. First 19 cases].

INTRODUCTION: Although horseshoe kidney (HSK) is the most common congenital anomaly of the upper urinary tract, renal cell cancer (RCC) in HSK develops extremely rarely. Until 2012 y. there were less than 200 cases of RCC in HSK published in PubMed. Only five cases of laparoscopic partial nephrectomies and some cases of heminephrectomies have been described in PubMed. AIM: To conduct a multicenter retrospective analysis of laparoscopic surgery for tumors in HSK. MATERIAL AND METHODS: From January 2013 to December 2018 a total of 19 conventional laparoscopic interventions were performed in patients with RCC in HSK, including 1 isthmusectomy, 5 partial nephrectomies and 13 heminefrectomies. In addition, 16 divisions of isthmus were done in 15 patients. The video describing our operation technique is available on: http://youtu.be/nk-WlbjNtIs . RESULTS: There were no conversions to open surgery and mortality as well as intra- and postoperative complications of Clavien grade 3 or higher. Warm ischemia time during partial nephrectomy didnt exceed 19 minutes. Operative time ranged from 110 to 270 min, while max estimated blood loss was 400 ml. All patients were followed for 6 month and no case of disease recurrence or progression was noted. CONCLUSIONS: The small number of laparoscopic interventions in patients with RCC in HSK doesnt allow to carry out a proper statistical analysis and draw certain conclusions. We presented the largest experience available in the literature and our results demonstrate the efficacy and safety of conventional laparoscopic technologies in the treatment of RCC in HSK.

[A case of successful plasma transurethral enucleationof benign prostatic hyperplasia the size of 530 cm3].

The article presents a description of the clinical case. Surgical treatment by plasma transurethral enucleation of the prostate was performed in patients with benign prostatic hyperplasia of giant size - 530 cm3. Observation in the short term showed the absence of functional and organic complications. Comparison with the results of surgical treatment of giant prostate adenoma by classical transurethral enucleation of the prostate, obtained in our urological clinic in 2015, showed a reduction in operating time by 1 hour without a significant increase in blood loss during surgery and without operational complications. The results demonstrate the prospects of the widespread introduction of plasma methods of transurethral operations in urological practice.

[Economic aspects of treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia].

A review of the literature dedicated to the economic aspects of drug and surgical treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is presented in the article. Currently, symptomatic therapy, which usually leads to an increase in the financial costs associated with the complications and surgical treatment, is most commonly used. The pathogenetic treatment of BPH (5-alpha reductase inhibitors), including combination therapy, requires an increase in costs, but it is also considered the most cost-effective approach. Despite the continuous growing of therapeutic armamentarium, the surgical treatment is still relevant and holds an important place. A lot of studies have shown that open procedures are inferior to endoscopic and minimally invasive interventions by both clinical and cost-effective results. At the same time, transurethral interventions on the prostate does not exclude economic losses due to the necessity of expensive laser technologies and the development of complications in the early postoperative period. Thus, currently, the best treatment option should be chosen not only on individual basis, but also depending on economic aspects based on a balanced medical and economic analysis of each treatment method.

[Laparoscopic ileal ureteral substitution. Results of the first 40 operations].

INTRODUCTION: Despite the twenty-year history of laparoscopic ileal ureteral substitution, the literature is lacking studies reporting its outcomes, and those few are mainly case reports. Besides, they usually describe surgery from combined access, when the ileal segment resection and ileo-ileal anastomosis are performed from mini-laparotomy, and the remaining stages are done endoscopically. AIM: To conduct a multicenter retrospective analysis of our series of patients undergoing laparoscopic ileal ureteral substitution using only endoscopic access. MATERIAL AND METHODS: From 2010 to 2017, 48 ureters were replaced completely laparoscopically in 40 patients. Of them, 33 patients underwent total ureteric replacement, and the others had a subtotal ileal ureteral substitution. Video describing the operation technique is available on https://youtu.be/IeA60pSiUBE. RESULTS: The mean operating time was 335 minutes, and the estimated blood loss was 221 ml. Intraoperative complications (7.5%) were resolved during surgery. No patients required conversion to open surgery. There was no mortality. Postoperative Clavien III complications were observed in 7.5% of patients. The mean length of hospital day was 13.5 days. Functional results were followed from 6 months to 7 years. CONCLUSIONS: The presented material is the largest available in the literature, and the results, including long-term functional outcomes, demonstrate the efficacy and safety of laparoscopic technologies in the treatment of extensive strictures and obliterations of the ureter.

[Laparoscopic segmental ureteral resection with ileal-ureter substitution for ureteral urothelial carcinoma].

Ureteral resection for the mid-ureter urothelial carcinoma is the operation of choice in patients with low-grade tumors. However, extensive excision within normal tissues may lead to difficulty in appropriate apposition of the ends of the ureter, while incomplete resection increases the risk of oncological progression. This article describes the first experience with laparoscopic segmental ureteral resection with the ileal - ureter substitution for mid-ureter urothelial carcinoma. In this case, a short non-reconfigurated segment of the ileum was interposed between the distal and proximal ends of the resected ureter. Operative time was 230 min, and blood loss was less than 100 ml. No complications were observed. The patients postoperative hospital stay was seven days. Follow-up examination 12 months after surgery showed no evidence of the disease progression and preserved normal renal function. The proposed method may be considered as an alternative treatment for carefully selected patients.

[Laparoscopic pyelolithotomy for staghorn kidney stones. multi-center study].

AIM: To analyze the effectiveness and safety of laparoscopic pyelolithotomy (LP) in treating staghorn stones. MATERIALS AND METHODS: A multicentre retrospective analysis of the results of LP performed from January 2004 to December 2016 was conducted. INCLUSION CRITERIA: patients with staghorn calculi K3-K4, who underwent LP as an alternative to percutaneous nephrolithotripsy. The analysis included the incidence and structure of intra- and postoperative complications, the causes of access conversion, operating time, duration of postoperative hospital stay and stone clearance. RESULTS: A total of 137 patients met the inclusion criteria, including 78 (56.93%) men. There was no mortality and access conversion. Intraoperative complications occurred in 2 (1.46%) patients. Operating time was 130 [100; 150] min, blood loss was 150 [100; 200] ml. No need for blood transfusion was observed. The cumulative rate of postoperative complications was 5.11%, stone clearance was achieved in 86.13% of observations, the duration of postoperative hospital stay was 7 [7; 11] days. CONCLUSION: In cases of dense staghorn calculi located in a large "extra-renal" pelvis and have calyceal branches equal to the diameter of their necks, laparoscopic pyelolithotomy is an alternative not only to open, but also to percutaneous surgery.

[Initial experience with laparoscopic anatrophic nephrolithotomy].

Percutaneous nephrolithotomy is a recognized standard for minimally invasive treatment of large kidney stones. Percutaneous interventions for complete staghorn stones are associated with a higher risk of complications that precludes abandoning the traditional open operations, one of which is an anatrophic nephrolithotomy. This paper presents the first personal experience in laparoscopic transmesenteric anatrophic nephrolithotomy. The intervention was conducted in 3 patients (2 males and 1 female) aged 43 to 58 years, having a primary symptomatic complete left kidney staghorn stones sized from 7.2 to 9.1 cm along the longitudinal axis. Operation time ranged from 130 to 170 minutes, kidney warm ischemia time - from 21 to 24 minutes, blood loss - from 180 to 250 ml. The staghorn stone was completely extracted in 2 patients. In one patient, a 0.8 cm residual stone was left in the completely excluded calix, since it caused none clinical symptoms and did not impair urinary flow. At this stage, the number of laparoscopic procedures for complete staghorn nephrolithiasis is too small to carry out an adequate statistical analysis and draw any definite conclusions. Nevertheless, the first experience demonstrated not only plausibility but also the effectiveness of such operations.