[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.

[Microbiological analysis as effective tool for optimization of empirical antibiotic therapy in the urological clinic].

AIM: to study the features of microbiota in patients of urological departments and to optimize the schemes of antibiotic therapy. MATERIALS AND METHODS: Data of microbiological studies in patients of urological departments in 2017 years were analyzed. Isolation of pathogens was carried out using standard techniques. A disk diffusion test using Mueller-Hinton agar with BioRad disks was used to determine the sensitivity. The statistical analysis was performed using the WHONET 5.4 program. In addition, a comparison with the results of the PCR study was done. RESULTS: A total of 672 etiological pathogens were isolated in whole clinic in 2017 year. From those, 173 pathogens were found in the urological clinic, which accounted for 25.7% of the total number. Gram-negative bacteria predominated and its proportion was 59.23%. Gram-positive bacteria were isolated in 24.4%, and fungi were found in 16.37% of cases. The structure of pathogens isolated from stoma or obtained by catheterization was not significantly different. Most frequently isolated pathogens included @K. pneumonia (22.8%), @E. coli (21.2%), @C. albicans (17%), @P. aeruginosa (11%), @E. aerogenes (6%) and @S. aureus (3 %). @K. pneumonia usually had an unfavorable resistance pattern. E. coli isolated from urine samples had more favorable resistance pattern in comparison to pathogens obtained from stoma. The bacteria which were found in intensive care unit had the increased level of resistance. CONCLUSION: Gram-negative bacteria predominate in the urological clinic with a relatively high proportion of extended-spectrum beta-lactamase-producing organisms. Risk factors for the emergence of multi-resistant pathogens are the treatment in the intensive care unit and the presence of stomas or catheters. The PCR method, carried out in parallel with routine microbiological studies and regular analysis of the overall bacterial spectrum, allows to optimize the starting antibiotic therapy from the first day of the disease. The use of cephalosporins is not justified in the most cases. Aminoglycosides and fluoroquinolones remain effective. The use of either -Lactamase-protected penicillins or fosfomycin is possible only after obtaining the results of bacteriological study. When prescribing carbapenems, the risk of inefficiency is especially high in patients with stomas/catheters and transferred from the intensive care unit.

[Immediate and long-term results of nephrectomy with inferior vena cava thrombectomy in renal cell carcinoma].

Results of treatment of 32 patients after nephrectomy with thrombectomy for renal cell carci-noma complicated by tumor thrombosis of the inferior vena cava were analyzed. The study in-cluded patients only with II - IV clot levels: 26 patients with T3b - the length of the thrombus 5.1 +/- 1.75 cm, 6 patients with T3c - the length of a thrombus - 14.8 +/- 0.98 cm. One patient (3.1%) died due to pulmonary artery thromboembolia in immediate postoperative period. 1-2 degrees Clavier Complications were observed in 11 patients, 3-4 degree - in two (6.2%) patients. 90.4% of patients had metastases in distant organs and (or) in the regional lymph nodes, which nega-tively affected the survival rates of patients - 5-year survival rate was 36%. The presence of lymphogenous metastases, MSKCC criteria were factors affecting survival rate. Survival rates of patients with T3b and T3C levels were not statistically different. The results of postoperative systemic targeted therapy were significantly statistically better than the results of immunotherapy.

[Ultrasound study of the liver and kidneys after different types of resection].

The ultrasound pattern of hepatic and renal changes after different types of resection is depicted. Ultrasound studies were performed in 335 patients operated on for focal hepatic masses and in 72 patients operated on for focal renal masses. The authors identified 3 patient groups after hepatic resection (segment-oriented liver resection (99 patients), portal hemihepatectomy (n=163), and extended hemihepatectomy (n=73)) and 3 patient groups after renal resection (planar (n = 83), wedge (n = 104), and frontal (n = 66)). It has been established that the number and location of hepatic veins in the liver stump, which the authors have designated as a hepatic vein rule, are of basic value in defining the type of hepatic resection. To determine the type of renal resection, it is essential to assess the shape of the organ and the area of its resection. The found echosemiotic patterns allow the type of performed resection of parenchymatous organs to be correctly determined in the majority of cases.

[Morpho-functional compensatory changes of colonic mucosa after long-term exposure to urine in the experiment].

Using 60 outbred albino male rats, the changes of colonic mucosa were studied after rectal infusion of urine for 1, 3 and 5 months. In response to prolonged exposure to urine, the mucosa was found to undergo gradual atrophic changes, including the reduction of its thickness and crypt depth. Moreover, the number of goblet cells was significantly decreased. Oral correction by weak solution of sodium hydrocarbonate could slow down the progression of atrophic processes in colonic mucosa.

Ultrastructural changes in colorectal mucosa after chronic contact with urine.

Ultrastructural changes in the colorectal mucosa in response to chronic contact with the urine were demonstrated in outbred albino rat experiments. Oral correction with slightly alkaline sodium hydrocarbonate solution reduced the destructive effect of the urine on rat colorectal mucosa.

[Organ-salvaging operations in tumors of renal parenchyma]. / Organosokhranoiushchie operatsii pri opukholiakh parenkhimy pochki.

An original method of kidney resection with the use of ultrasonic surgical destructor-aspirator is proposed. The method was applied in the treatment of 19 patients (20 renal resections and 1 tumor enucleation). No complications occurred. The use of ultrasonic destructoraspirator in renal resection enabled isolation of all the intraparenchymatous tubal structures of the kidney, each of them could be ligated and cut if visualization is adequate. This provided a complete hemostasis on the wound surface of the kidney and hemostatic suturing of the kidney wound became unnecessary. This method of renal resection reduced hospital stay of the patients because they had no hemorrhages, purulent complications and urinary fistulas.