[STANDARD TRANSCUTANEOUS AND ULTRA-MINI TRANSCUTANEOUS NEPHROLITHOTRIPSY IN TREATMENT OF NEPHROLITHIASIS].

Comparative analysis of two variants of transcutaneous nephrolithotripsy (TCNLT) in 45 patients, suffering nephrolithiasis, was performed. In 17 patients (the first group) the ultra-mini (UM) TCNLT, using tubus 11Сh, was done, and in 28 patients (the second group) ­ TCNLT, using a standard tubus 24Сh. The operation duration in the first group have had constituted (86.2 ± 16.3) min at average, and in the second group ­ (51 ± 13.6) min. The method of UМ TCNLT is a secure, miniinvasive, owing low rate of morbidity, comparing with a standard procedure, but with equal efficacy, concerning the «stone free¼ status (accordingly, 95.3 and 96.5%) in patients when calculi's diameter up to 2 sm. Тubus 11Ch guarantees lesser risk of hemorrhagic complications occurrence, permits to conduct UM TCNLT without nephrostomic draining of the renal calyx and pelvis system more confidently.

[ОPTIMIZATION OF EXAMINATION ALGORITHM FOR PATIENTS BEFORE AND AFTER OPERATIVE INTERVENTION FOR HYDRONEPHROSIS].

Algorithm of the patients examination, suffering hydronephrosis, caused by obstruction of different etiology, was optimized, what permitted, using qualification of rational volume and sequence of diagnostic methods, owing high sensitivity and specificity, as well as morphological diagnostic coefficients (parenchymal­stromal, dysbalance of collagens) and the risk criterion for recurrence occurrence, to estimate renal structure­ functional state, to determine the disease stage, its course severity and to substantiate a volume and duration of preoperative preparation needed, the operative intervention kind and postoperative management of the patients.

[COMPLICATIONS OF SURGICAL TREATMENT OF A RENAL­CELL CANCER WITH INTRAVENOUS SPREADING].

Retrospective investigation, conducted for estimation of perioperative complications, while performing surgical treatment of a renal­cell cancer with tumoral thrombi, was presented. In 132 patients the tumoral thrombi spreading is restricted by renal vein and by vena cava inferior (VCI) as well. The patients were operated on, using the "chevron" access in the absence of artificial blood circulation. Perioperative complications rate in the patients in presence of macroscopic tumoral thrombi constitute 56.8%, while tumoral spreading into VCI ­ is trustworthy bigger (р<0.05). Presence of cardiac insufficiency, tumoral invasion of the VCI wall, retrograde spreading of thrombus with the VCI concurrent blood thrombosis, аs well as presence of the indices in accordance to the ECOG scale more than 1 point have constituted unfavorable factors.

[Morphogenesis of connective tissue in patients with hydronephrosis caused by stricture of ureteric-pelvic segment of various etiology].

In patients, suffering hydronephrosis stages II-III, caused by the ureteric-pelvic segment (UPS) obstruction due to inborn failures of urinary system, the collagen types I and III ratio reduction, and in acquired obstruction--its enhancement, are noted in interstitium, renal parenchyma vessels and the UPS walls. While obstruction in patients due to inborn failures in vascular basal membranes a deficiency of collagen type IV and appearance of nontypical for vascular basal membranes intersticial collagen type Il are observed. In the acquired UPS, obstruction the, enhancement of content of collagen type IV is revealed only. These disorders are mostly pronounced in patients with the disease recurrence. There was proposed diagnostic coefficient of ratio between collagens types I and III in patients, suffering hydronephrosis, caused by obstruction of various etiology. In hydronephrosis, caused by the UPS stricture, the cytokines disbalance occurs, impacting processes of collagen formation.

[Optimization of education for laparoendoscopic technologies in Ukraine].

International experience of training of surgeons, including urologists, in laparoendoscopic technologies, was analyzed. Practical course "The Fundamentals of aparoscopic Surgery" (FLS) and the European program of education for basic laparoscopic urologic skills (E-BLUS), which are used in specialized centers, constitute a standard programs of development of basic endosurgical skills. Such centers in Ukraine are absent. The project of complex system of a simulating education, testing and certification of surgeons, who are trained in endovideosurgical technologies, is proposed. While performing surveying of Ukrainian surgeons there were revealed the problems in a process of their education and introduction of highly technological methods: insufficient equipment with modern apparatuses, absence of a standardized pro- gram of education. The staged program of education was elaborated, taking into account progressive international experience and adopted to our environment and con ditions.

[Microtranscutaneous nephrolithotripsy--new possibilities in treatment of patients, suffering urolithic disease].

The results of a new method of laser microtranscutaneous puncture nephrolithotripsy application in patients, suffering nephrolithiasis, including it, occuring on background of the ureteropelvic segment stricture and formation of hydronephrosis, were analyzed. The method application permits to lower significantly or eliminate the roentgen burden on patient and surgeon. The laser microtranscutaneous puncture nephrolithotripsy is less traumatic, than a standard transcutaneous puncture nephrolithotripsy and retroperitoneal endovideoscopic pyelolithotomy.

[Changes of the cytokines profile in patients with hydronephrosis and indicated operative treatment].

The pronounced dysbalance of the cytokines profiles in the blood of patients, suffering recurrent hydronephrosis, caused by pelvio-ureteric segment stenosis of various etiology and in different clinical course, in the inborn obstruction especially, was revealed on a 21th postoperative day, witnessing the existence of various ways of the stricture recurrence occurrence. As a prognostic criterion of risk of the recurrence occurrence there were proposed: a ratio of level of a tumor necrosis factor-alpha (TNF-alpha) to interleukin-10 (IL-10) level, and as an additional diagnostic criterion--the IL-17 level, as well as revealing of the inherited genesis of the disorder in a system of fibrillogenesis regulation--the IL-4 level.

[Peculiarities of the connective tissue metabolism in patients with hydronephrosis].

The connective tissue metabolism was investigated in patients, suffering hydronephrosis, caused by obstruction of various etiology of pelvio-ureteric segment (PUS) and ureter, which has a recurrent course. On the 21th day postoperatively the blood indices enhancement was revealed, what characterizes the disorder of collagen synthesis and degradation, including, free (FOP), proteinbinded (PRBOP) and peptidebinded (PEBOP) oxyproline. The changes noted are more pronounced in patients with the inborn obstruction of PUS and recurrent course of the disease. A new marker--the PRBOP to FOP levels ratio--was proposed for prognostication of stricture recurrence.