[Obstructive uropathia in pregnant women: results of treatment depending on the etiopatogenetic factor of development].

Actuality. The development of renal colic in pregnant women is one of the most common reasons for visiting a hospital that is not associated with obstetric pathology. Given the pharmacological and diagnostic limitations during gestation, the problem of expanding the renal cavitary system in pregnant women, as well as the choice of treatment tactics, remains a difficult clinical task. MATERIALS AND METHODS: The study group included 537 patients with obstructive uropathy with a gestation period of 5 to 36 weeks, who were hospitalized from January 2018 to January 2022 at the GBUZ GKB named after. S.S. Yudina DZM. Depending on the etiopathogenetic obstructive uropathy, the patients were divided into 3 groups: group I - 201 (37.4%) patients with gestational pyelonephritis (the presence of a systemic inflammatory response syndrome) and expansion of the renal cavitary system without confirming the diagnosis of urolithiasis; group II - 216 (40.2%) patients with renal colic (presence of pain without signs of a systemic inflammatory reaction) and enlargement of the renal cavitary system not associated with urolithiasis; group III - 120 (22.4%) pregnant women with an expansion of the cavitary system of the kidney caused by urolithiasis, both with and without signs of a systemic inflammatory reaction. Age, body mass index and previous number of pregnancies in all groups did not differ. The mean age of the patients in the three groups was 26.1 years, with a mean gestational age of 20.8 weeks. In 433 (80.6%) patients, pain was observed in the lumbar region on the right, in 83 (15.5%) - on the left, the bilateral nature of the process - in 21 (3.9%) patients. RESULTS: In group I, despite ongoing conservative therapy, 129 (64.2%) pregnant women received an internal ureteral stent. After 2-4 weeks of follow-up, the ureteral stent was removed in all patients. As a result, a short-term drainage method (up to 4 weeks) was effective in 90.1% of pregnant women, and in 13 (9.9%) patients, it was necessary to re-insert the stent, followed by a routine replacement of the drain every month. Considering the pain syndrome among patients of group II, drainage was performed in 80 (37%) pregnant women. Routine stent replacement was required in 2 (2.3%) patients. In group III, the location of the calculus in the pyelocaliceal system was in 28 (23.3%) patients, in the ureter - in 92 (76.7%) patients. Independent passage of the calculus was noted in 8 (6.7%) pregnant women, ureteroscopy without prior stenting was performed in 31 (25.8%) pregnant women with ureteral calculus. The remaining 81 (67.5%) pregnant women underwent stent placement at the first stage. When the stone was localized in the ureter, 32 (22.7%) patients underwent contact laser ureterolithotripsy and 21 (17.5%) patients underwent ureterolithoextraction. When a stone was located in the kidney, 28 (23.3%) pregnant women underwent pyelocalicolithotripsy. Achievement of the stone-free status was observed in 92.8%. CONCLUSION: Obstructive uropathy in pregnant women requires identification of the cause and a multidisciplinary approach. Long-term drainage of the urinary tract should be avoided and short-term drainage should be preferred. Surgical treatment of urolithiasis, regardless of gestational age, is an effective and safe method.

[Mean features of the nephron- sparing surgery in older patients with localized renal cell carcinoma].

BACKGROUND: Imaging diagnostics becomes more widespread, the incidence of incidental renal cell carcinoma (RCC) among older adults is increasing each year. Although nephron-sparing surgery are the standard of care for localized RCC, the potential risk of perioperative complications and readmission rates are higher among older patients. OBJECTIVE: To compare the main perioperative indicators, as well as oncological and functional results in the treatment of localized RCC in in older patients and middle-aged patients MATERIALS AND METHODS: From 2016 to August 2021 at the N.I. Pirogov Russian National Research Medical University on the basis of N.I. Pirogov City Clinical Hospital No. 1 we performed 134 laparoscopic PN. The 1st group included patients from 55 to 69 years old - 96 (71.6%) and 2nd group - 70 years and older - 38 (28.4%). The physical status was assessed according to the ASA (American Society of Anesthesiologists) classification and the Charlson comorbidity index (IC) was calculated. Glomerular filtration rate (GFR) was estimated using the MDRD (Modification of diet in renal disease) formula. RESULTS: Length of the operation in patients in 1st group was 133.1 minutes. (60-250), in 2nd group 139.3 (50-240), the median time of warm ischemia was 12.4 (7-33) and 12.7 (6-22) minutes, the median blood loss volume was 123.3 and 135.1 ml, respectively. Complications, according to the Clavien-Dindo classification, were in 21 (21.9%) cases in patients from 55 to 69 years old and in 9 (23.7%) in patients 70 years and older. The median GFR for MDRD in the postoperative period for groups I and II was 57.4 and 50.5 ml/min/1.73 m2. The median follow-up time was 26 (4-66) months. A positive surgical margin was observed in 2 (2.1%) cases in the 1st group and in 1 (2,6%) in 2nd group. The median follow-up time was 26 (4-66) months. CONCLUSION: Nephron-sparing surgery is safety in patients 70 years and older and the main intraoperative and oncological results are comparable to the group of middle-aged patients. Age itself is not a contraindication to surgical treatment.