[Experience in the use of mineral water "Naftusya" of Zbruchansk field in the treatment of patients with uroliths].

The study has evaluated the effect of combined treatment including slightly mineralized hydrocarbonate-magnesium-calcium mineral water "Naftusya" of Zbruchansk field on the urinary system of 47 adult patients with urolithiasis and chronic pyelonephritis aged 24 to 76 years and 3 children of different age groups. 14 patients dropped out of the study group after 1-3 days after the start of treatment due to the negative reaction of the gastrointestinal tract to the reception of water; thus, study group consisted of 36 patients. At baseline, kidney or ureteral stones were diagnosed in all patients. For adult patients, water was administered at a dose 200 ml 3 times a day, for children--50-150 ml 3 times a day, 30-40 minutes before meals for 7-20 days. Examination of patients was performed using laboratory, ultrasound and radiographic methods. It was revealed that against the background of complex treatment, discharge of small stones, their fragments and urinary sand have occurred 1-3 days earlier than with standard treatment. There was no effect on calcium and inorganic phosphate metabolism. The trend to uric acid crystalluria and reducing the pH of urine was revealed. Statistically significant reduction of leukocyturia and erythrocyturia was identified. 60% of patients had a disappearance of bacteriuria or reduction of the titer of bacteria. The results led to the conclusion of advisability of use of mineral water "Naftusya" of Zbruchansk field in the complex treatment of inflammatory processes in the urinary system and for stimulation of discharge of ureteral stones with sizes enabaling to presume their independent discharge.

[Experience of use of prolit septo in the complex treatment of patients with urolithiasis].

The efficacy of phytogenic drug prolit septo in the complex treatment of patients with urolithiasis complicated by infectious-inflammatory process was evaluated. The effects of prolit septo were assessed by a comparative evaluation of the results of microbiological analysis of urine in 14 patients of main group and 12 patients of control group. Patients in both groups were matched by sex, age, and results of raiological, clinical, biochemical and microbiological methods of examination. For the treatment of 11 patients of the main group, prolit septo was applied in combination with standard anti-bacterial treatment, 3 patients received monotherapy with prolit septo within 3-6 weeks. The drug was administered at a dose of 1200 mg (2 capsules) 3 times a day. Twelve patients of the control group received only standard treatment. The duration of treatment in both groups was 1-2 weeks. It was found that combined therapy with prolit septo is more effective than standard antibacterial treatment. Against the background of combined therapy the disappearance of bacteriuria was noted in 54.5% of patients of main group compared with 8.3% of patients of control group.

[Prediction of changes in chemical form of urolithiasis].

The course of recurrent urolithiasis was studied in 131 patients (64 females, 67 males, age 27-69 years). Before the start of 1-15-year followup the patients' condition was: after spontaneous elimination of the concrements, after extracorporeal shock-wave lithotripsy and/or percutaneous nephrolitholapaxy, after open surgical interventions, after surgery and spontaneous elimination of the concriments, after litholysis (patients with hyperuricemic urolithiasis). At the start of the follow-up 127 patients had no uroliths, 4 patients had bilateral concrements. The group of patients free of uroliths consisted of 33 patients with hyperuricemic urolithiasis, 52--with calcium-oxalate, 42--with magnesium-ammonium-phosphate form of the disease. As shown by follow-up ultrasound and x-ray examinations, each of these patients had 1 to 7 recurrent concrements. Infrared spectrophotometry and x-ray diffraction determined chemical composition of both primary and 352 recurrent concrements. The patients were also examined with biochemical, microbiological methods, urine clinical examination was made. Possibility, metabolic and microbiological evidence for changes in urolithogenesis type in patients with different forms of the disease were found. In hyperuricemic urolithiasis recurrent concrements can be calcium-oxalate and phosphate, in calcium-oxalate urolithiasis--phosphate. Transformation of magnesium-ammonium-phosphate urolithiasis into hyperuricemic or calcium-oxalate urolithiasis was observed. Changes in the form of the disease more frequently occur in hyperuricemic and calcium-oxalate urolithiasis than in phosphate one. Phosphate concrements form less frequently in patients with hyperuricemic urolithiasis. One kidney can simultaneously contain hyperuricemic or calcium-oxalate concrement while the contralateral kidney--phosphate concrement associated with uric urease producing infection.

[Renal function after surgical treatment of stag-horned nephrolithiasis].

Renal function in patients with stag-horn nephrolithiasis was assessed after two surgical treatments--percutaneous nephrolitholapaxy (PCN L) and pyelonephrolithotomy. The function of the operated and contralateral kidneys was studied early and late after operation by parameters of blood biochemistry, Doppler investigation of renal parenchyma, dynamic nephroscintigraphy. Stabilization or improvement of blood biochemical indices was observed in 58 (70%) patients. A secretory renal function late after surgery (from 6 months to 2 years) evidenced for improvement or stabilization of renal function (according to radionuclide test) in 71 (85.5%) patients. Integral parameters of renal blood flow were physiological or improved versus preoperative ones. PCNL was made in patients with deficient secretion less than 70%, 35 (87.5%) patients were diagnosed to have stabilization or functional improvement. After open intervention functional improvement took place in 11 (25.6%) patients, stabilization of renal function occurred in 25 (58.1%) patients. Tubular secretion deterioration was seen much more frequently in patients after open intervention. PCNL is less invasive surgical intervention than pyelonephrolithotomy as this technique produces milder surgical trauma and does not result in intraoperative renal ischemia. PCNL is the most effective surgical modality in stag-horn concrements of the kidneys and significantly expands potential of low-invasive treatment of such patients.

[Surgical treatment of coral nephrolithiasis: analysis of complications].

Coral nephrolithiasis (CN) patients treated surgically in Research Institute of Urology and hospital N 47 from 2005 to 2008 were divided into 5 groups by treatment: PCNL, PCNL+extracorporeal lithotripsy (EL), EL, open interventions, EL of the residual concrements after previous open operations. Most complications were observed after EL and they were caused by evacuation of many fragments. PCNL caused in some cases massive hemorrhage stopped by conservative methods. Open operations can effectively remove concrements in one stage but sometimes entail such severe complications as damage to adjacent organs, pleura or abdomen, hemorrhage, exacerbation or progression of chronic pyelonephritis. Results of combined surgical interventions (PCNL+EL) and EL of residual concrements after open surgery are comparable with those of EL as monotherapy if the schedule of repeat sessions is observed and saving regimens of fragmentation are used.

[Results of surgical treatment of coral nephrolithiasis].

A total of 98 patients (39 males and 59 females) with coral nephrolithiasis (CN) were divided into 3 groups depending on the variant of surgical treatment. The results were followed up for 5 years. Group 1 and 2 patients have undergone combined low-traumatic open surgery or low-invasive interventions (extracorporeal lithotripsy--ECL or percutaneous nephrometolapaxy--PN), group 3 patients--open surgery (pyelonephrolithotomy or section nephrolithotomy. It was found that the treatment was longest in group 1 and shortest in group 3, complications occurred most frequently in group 3 on section nephrolithotomy, least frequently in group 2. A significant decline of operated on kidney late after the treatment was observed in patients subjected to section nephrolithotomy. Thus, ECL and PN produce positive results in patients with CN (elimination of the stone with a minimal risk of residual concrements) in good long-term function of the operated on kidney.

[Role of the level of obstruction and urodynamics of the upper urinary tract in infectious-toxic complications in urolithiasis. (Clinical and experimental study). ]. / Rol' urovnia obstuktsii v narushenii urodinamiki verkhnikh mochevykh putei pri oslozhneniiakh mochekamennoi bolezni (Kliniko-éksperimenal'noe issledovanie)

Clinical studies have revealed that location of the occlusion in the kidney and upper third of the ureter raises the risk of severe infectious-toxic complications of urolithiasis. It is shown experimentally that mechanisms of compensation of impaired urinary transport along the upper urinary tracts differ in obstruction of the upper and lower third of the ureter.

[Operative treatment of kidney calculi]. / Operativnoe lechenie korallovidnogo nefrolitiaza.

262 cases of coral nephrolithiasis (CN) treated for the last 5 years (mean age 51.6 years) have been analysed. Of them, 46 (17.9%) patients have undergone 2 to 4 operations, 14 (5.4%) patients had bilateral nephrolithiasis. Open surgical interventions (section nephrolithotomy, pyelonephrolithotomy) were performed in 31 and 106 patients, respectively. All of them had a severe form K-3 or K-4. Extracorporeal shock-wave lithotrophy (ESWL) was conducted in 72 (27.5%) patients with coral concrements K-1, K-2. 'Mean number of the procedures per a stone was 4.2. Transcutaneous puncture nephrolithotripsy (TPNT) was made in 53 (20.2%) patients (K-2, K-3). The results of the treatment were assessed at discharge and 12 months after it. The efficacy of the treatment was judged by completeness of the stone elimination, postoperative complications and interventions to correct these complications. Open operations eliminated the stones completely in 71.2% patients, in combination with ESWL--in 91.6%, TPNT--in 78%, in combination with ESWL--in 94.5%. Efficacy of ESWL as monotherapy + stent reached 68.1%. Open operations entailed complications in 41.6% (of them 68.5% in section nephrolithotomy), TPNT--in 18.2%, ESWL--in 16.3%. Coral nephrolithiasis should be treated by skilled specialists in clinics furnished with modern facilities, combination of which minimizes traumatic complications and raises treatment efficacy.

[Urinary tract occlusion: a principal cause of some complications of urolithiasis]. / Okkliuziia mochevyvodiashchikh putei -- osnovnaia prichina razvitiia riada oslozhnenii mochekamennoi bolezni.

Urinary tract occlusion in urolithiasis is a serious complication which provokes an attack of acute obstructive pyelonephritis. The infected urine aggravates this infectious-inflammatory process and endangers bacterial shock. Etiopathogenesis of this shock is outlined and modern approaches to its management are described.

[Ways of improving preparing research and teaching personnel and clinicians in urology in the Russian Federation]. / Puti sovershentstovaniia podgotovki nauchnykh, nauchno-pedagogicheskikh i prakticheskikh kadrov urolov v Rossiiskoi Federatsii.

The article covers basic principles of urologists' and researchers' training for state healthcare system. The role of a student research group in proper students selection for further special education in urology is pointed out. The article contains a plan of training in clinical residency including theoretical basis of urology and allied fields, diagnostic tools and practical skills, especially in urgent cases. The principles of postgraduate research personnel training in the field of urology are highlighted also. Special attention is paid to regional specialists training. The residents in surgery are preferred for further training in urology.

[Risks and complications of surgical treatment of urinary lithiasis of single kidney]. / Opasnosti i oslozhneniia operativnogo lecheniia bol'nykh mochekamennoi bolezn'iu edinstvennoi pochki.

163 patients with urolithiasis of the solitary kidney were treated surgically. Analysis of causes of postoperative complications (n = 70) and lethal outcomes (n = 11) demonstrate that lethal outcomes were in many cases related to exacerbation of renal failure, acute calculous pyelonephritis which had provoked sepsis and bacteriotoxic shock, acute hemorrhage with hemorrhagic shock followed by development of DIC-syndrome.

[Occlusive factor in development of urolithiasis complications]. / Okkliuziruiushchii faktor v razvitii oslozhnenii mochekamennoi bolezni.

Causes and mechanisms of complications in urolithiasis are analysed with a focus on the role of occlusion of the urinary tracts in the onset of pyoseptic complications. Most severe of them is bacteriotoxic shock which is hard to treat and dangerous for essential body functions. The priority of the treatment must be reestablishment of urine passage. Additional tools of the treatment include wide-spectrum antibiotics, efferent detoxication, electrochemical blood oxidation, hyperbaric oxygenation, UV blood radiation.

[Recurrence-free and recurrent urolithiasis: metabolic differences]. / Metabolicheskie razlichiia neretsidivnogo i retsidivnogo urolitiaza.

Biochemical tests by 12 metabolic blood and urine indices reflecting the condition of renal function and metabolism of urolithogenic substances were made in the course of 1-6 year follow-up of 35 and 79 patients (46 females and 68 males aged 18-65 years) with recurrence-free and recurrent urolithiasis, respectively. The risk of recurrence for uric acid urolithiasis in serum concentration of urea 5.67 +/- 0.14 mmol/l and creatinine 0.090 +/- 0.008 mmol/l, in hyperuricemia and hyperuricuria was associated with elevation of renal excretion of total calcium to 5.88 +/- 0.49 mmol/day and ratio of daily renal excretion of sodium to renal daily excretion of potassium to 3.28 +/- 0.08; for calcium-oxalate lithiasis--with a rise in serum concentration of uric acid to 0.310 +/- 0.042 mmol/l and sodium to 114 +/- 0.8 mmol/l in hypercalciuria and hyperuricuria.