[Complications of retrograde intrarenal sugery in patients with low pole kidney stones].

A lot of patients with nephrolithiasis have calculi at low pole calyces. One of the best and safety operative options of such category is retrograde intrarenal surgery (RIRS). RIRS is wide spread in current clinical practice. But not rarely it corresponded with different grade complications. Current literature review is dedicated to predictors of complications due to RIRS in patients with low pole calculi.

[Current approach to management of staghorn nephrolithiasis. Literature review. Part 2].

Data on predictors and methods for resolving the complications of surgical treatment of staghorn nephrolithiasis are presented. New information on the features of the morphological and functional state and individual platelet reactivity in patients undergoing surgical treatment is described. Thrombotic and hemorrhagic complications, intra- and postoperative bleeding, as well as prediction of PNL results in patients with staghorn stones are also discussed.

[An adaptation of the CLAVIENDINDO classification of complications for contact ureterolithot- ripsy].

AIM: to study an adaptability of the Clavien-Dindo classification of complications for contact ureterolithotripsy. MATERIALS AND METHODS: A total of 506 patients with ureteric stones who were undergone 545 endoscopic interventions in the Urologic Department of "MONIKI" named after M.F. Vladimirsky were included in retrospective analysis. RESULTS: Complications of grade 1, II, IIIa and IIIb were noted in 39 (7.1%), 24 (4.3%), 15 (2.8%) and 14 cases (2,6%), respectively. Among the complications of grade IVa, an acute pyelonephritis was complicated by the septic shock. The complication of grade IVb developed in 1 case (0.2%). There were no complications of Grade V. The Clavien-Dindo classification allows to grade only postoperative complications and attempts to adapt it for the assessment of intraoperative complications can lead to the distortion of study results. CONCLUSION: The uncontrolled use of the Clavien-Dindo classification in all areas of surgery can lead to a decrease in its accuracy, thereby reducing its value as fairly universal tool. In our opinion, a further work aimed to the development of strict criteria for the different grades of complications of the Clavien-Dindo classifications is needed. We believe it is possible and necessary to develop a single tool for the assessment of complications of typical interventions within a single surgical area.

[The changes in urine microflora in patients with urinary stone disease].

INTRODUCTION: Since the results of treatment of chronic pyelonephritis (CP) depend on timely and rationally selected targeted antibiotic therapy, when choosing a treatment regimen, it is necessary to rely on the local data obtained by monitoring the state of microflora in a particular hospital. AIM: to monitor the changes in urine microflora in patients with urinary stone disease. MATERIALS AND METHODS: A total of 598 isolated bacteria and yeast-like fungi from patients with urinary stone disease who were treated in the Department of Urology during different time periods (1997-1999, 2010-2014 and 2015-2017 yy) were analyzed. A comparison of the urine microbiota in patients with single kidney stone (n=154) and staghorn stone (n=147) for the period 2015-2017 yy. was carried out. RESULTS: The significant changes of gram-positive and gram-negative bacteria were found with a tendency to decrease in the proportion of the latter (from 80.6% to 50.6%, p<0.05) due to a decrease in the proportion of P. mirabilis and complete absence of Enterobacter spp, Serraciae spp and Citrobacter spp. as well as an increase in the number of gram-positive bacteria (from 18 to 48.7%, p<0.05) owing to increase in the proportion of E. faecium + E. faecalis. During observation period, E. Coli has remained the leading pathogen (26.4+/-0.32%). During observation period, a permanent fourfold prevalence of gram-negative bacteria in clinically significant concentrations (>104 CFU/ml) was found: E. coli (36.8+/-4.1%). The proportion of K. Pneumonia increased from 8.5% to 17.4%, and proportion of P. mirabilis decreased from 20.3 to 10.4%. Despite a significant increase in the proportion of Enterococcus spp. (from 4.6 to 26.6%) in the general population, the incidence of microorganisms in clinically significant concentrations during analyzed period remained unchanged and did not exceed 8.46+/-4.76%. In patients with single stones and patients with staghorn stones there was no significant difference in the proportion of analyses with clinically significant concentrations of bacteria fer (p>0.05). The percentage of analyses with clinically significant concentration was 70.06%, while in all patients with urolithiasis it was 59.7%. In patients under and over 60 years old, the largest number of bacterial pathogens were represented by E. coli. (29.7% and 32.1%, respectively). CONCLUSION: E. Coli remains the leading bacterial causative agent of calculous pyelonephritis, both in the general population and in analyses with clinically significant concentrations of bacteria. There were no significant differences in urine microflora in patients with staghorn and single stones.