Search

Despite advances in minimally invasive surgery, urolithiasis still recurs within the first five years after the first episode in more than 50% of patients. Researchers continue to search for new crystallisation inhibitors, metaphylaxis strategies and laser sources for stone destruction. Therefore, to achieve these goals, it is necessary to study kidney stones not only as the result of an isolated process of pathological biomineralisation in the human body, but also as a biogenic mineral or rock that obeys universal patterns and has certain properties. Consequently, kidney stones need to be studied using methods that are widely used in the geological sciences for the study of minerals, such as computed microtomography and petrological analysis. In this review, the properties of kidney stones studied using various research methods used in geosciences are discussed. These properties are also considered as new biomarkers of urolithiasis. This review discusses how new data from multimodal stone analysis can be used to develop personalised metaphylaxis and treatment strategies for all types of urolithiasis, including the most common idiopathic calcium-oxalate urolithiasis.

The aim of the work is to analyze the scientific literature data on the principles and state of rational antibiotic therapy use according to factors for the development of inflammatory changes in the urinary tract with the identification of the latter in the complex therapy for urolithiasis, taking into account the peculiarities of contact laser lithotripsy. The article presents the results of analytical processing of professional publications on current principles of rational antibiotic therapy in the surgical treatment for urolithiasis, taking into account factors that may influence the development of inflammatory changes in the urinary tract. It has been revealed that there is currently no clear understanding about chances of developing infectious processes during the treatment for urolithiasis of various localization, as well as the advisability and duration of using antibiotics in the comprehensive treatment of the disease. At the same time, antibiotic overuse has resulted in phenomena of resistance, side effects, and a number of other complicating factors needed to be addressed. Conclusions. An analysis of present approaches to antibacterial therapy, considering its rationality at different treatment stages, has been conducted concluding that clear criteria and indicators for the use of drugs have not been specified, but these data serve only as recommendations and have not been thoroughly examined. Data on searching for a solution to problematic aspects are also provided.

Introduction. According to the guidelines, the stone maximum diameter is one of the main criteria for choosing the method of nephrolithotripsy. When planning an operation, the surgeon focuses not only on the diameter, but also on the renal pelvis anatomy, stone density and number of it, the presence of hydronephrosis, a history of surgery, etc. The maximum diameter is not an exhaustive characteristic that allows you to choose the optimal treatment.Objective. To evaluate the effect of stone volume (compared to its maximum diameter) on the duration of minimally invasive endoscopic nephrolithotripsy.Materials & methods. The study was retrospective. The study included 55 patients (22 women, 33 men), the average age was 47.0 ± 1.9 years. All patients underwent minimally invasive thulium fiber laser nephrolithotripsy for stones up to 20 mm (mean maximum diameter — 13.3 ± 0.6 mm, mean density — 1041.0 ± 48.0 HU). Minimally invasive endoscopic interventions such as retrograde intrarenal surgery (RIRS, n = 30), minipercutaneous and micropercutaneous nephrolithotripsy (miniPNL, n = 16 and microPNL, n = 9, respectively) were performed. Patients with urinary system abnormalities, acute urinary tract infections and patients without stone-free status were excluded from the study. In addition to evaluating standard indicators, the stone volume was calculated in all patients using the formula of a scalene ellipsoid (median volume — 287 [144; 538] mm3). Spearman's rank correlation coefficient (r) with an assessment of the significance level was calculated for the stone maximum diameter and volume for the total sample of patients and for each surgical intervention method separately.Results. The analysis of the total sample of patients reliably revealed a weak correlation (r = 0.39) between the stone maximum diameter and surgery time. And a moderate correlation was found between the stone volume and surgery time (r = 0.53). A similar relationship with the linear distribution was also observed in the analysis in all groups.Conclusion. When choosing minimally invasive laser nephrolithotripsy, it is advisable to focus not only on the stone maximum diameter, density, and localisation, but also on the stone volume, which has a great correlation with the surgery time.

The choice of surgical treatment for nephrolithiasis remains a matter of debate. The article is a literature review dedicated to a comparative analysis of the efficacy and safety of extracorporeal shock-wave lithotripsy (ESWL) and endoscopic methods for the treatment of nephrolithiasis. The literature review was based on the analysis of articles published in the PubMed / MEDLINE, and eLibrary databases. Sixty publications on the topic of the review were analysed. As a result of data analysis, endoscopic therapies have a significant advantage over ESWL with comparable safety. The development and dissemination of less invasive techniques such as mini-percutaneous nephrolithotripsy and ultra-mini-percutaneous nephrolithotripsy in the future may change the approach to the surgical treatment of any form of nephrolithiasis.

Introduction: Kidney stones disease is a medical condition when hard deposites made of various minerals and substances form inside kidneys. It may lead to clinical symptoms as severe pain felt in the belly area or side of the back. Also it can radiate and reach testicles, groin area, labia. Other symptoms may include blood in the urine, abnormal color of urine, fever, nausea, vomiting. Because of growing incidence rate- adequate question is how can we protect ourselves from kidney stones development by changing habits. Aim of study: Fundamental aim of study is to demonstrate how daily, routine habits changes may have a huge impact on kidney stones development risk. State of knowledge: There are a lot of confirmed parameters and factors which can lead to kidney stones devolopment. Factors that increase risk of developing kidney stones include: dehydration, diet (meat intake, fruit/vegetables intake, sodium intake), family or personal history, obesity, digestive diseases and surgery, metabolic disorders, urinary track infections, anatomical abnormalities- obstruction of the kidney, calyceal diverticulum, horseshoe kidney, ureterocele. This group includes many modified factors, so lifetime risk of kidney stones depends also on our habits and way of life. Conclusion: There are many modified factors which may lead to this disease and because of that it is crucial to improve patients and whole society awareness about them. By appropriate daily habits changes we can significantly reduce risk of lifetime kidney stone disease development. It is important to know that concrete reports and analyses were made and they demonstrated scientifically proven correlations.

Urinary tract stones are a common condition that significantly reduces quality of life. A proper diet is an important factor in the prevention and treatment of lithiasis and, for this reason, dietary interventions have become an essential part of treatment. In our review of the literature, we analysed the individual components of diet in terms of the risk of developing urinary tract stones. A number of dietary guidelines have been developed to reduce lithogenic factors in the urine, such as calcium oxalate, calcium phosphate and uric acid. Current guidelines recommend increasing the intake of fluids, increasing the intake of fruit and vegetables, using a balanced calcium supplementation and limiting the supply of sodium and especially animal protein. Based on these recommendations, a vegetarian diet containing dairy products combined with calcium supplementation appears to have the lowest risk of developing urinary stones. However, there are still many uncertainties in this area, and research needs to continue and be expanded to include the influence of diet type on the risk of lithiasis. This will allow us to gain a better understanding of the factors influencing the disease process and to create clear guidelines in the field of urolithiasis in the future.

Objective: To determine the surgical possibilities of the one-stage laparoscopic repair in the obstructed ureteropelvic junction (UPJ) complicated with nephrolithiasis in combination with the retrograde intrarenal surgery.Case report: The patient A., a 36-year-old male complaining about dragging pains in the right lumbar region was admitted to Urology Unit No. 1 of Krasnodar Regional Clinical Hospital No. 2. The patient underwent ultrasound examination, CT, and dynamic renal scintigraphy. The findings were as follows: the enlargement of pelvicalyceal system in the right kidney (calyx up to 22 mm, pelvis up to 50 mm), 5 calyx concrements and 2 pelvic concrements 6 to 8 mm in size, obstruction at the level of the right UPJ up to 10 mm in length, III grade hydronephrosis on the right according to Lopatkin classification.Conclusions: The combination of laparoscopic surgery and retrograde intrarenal surgery with the flexible ureteroscope and holmium laser is an effective and safe method for the treatment of UPJ obstruction complicated with nephrolithiasis.

Introduction. Long-term results of renal transplantation from living donors are much better than the results of cadaveric transplantations. Recently, because of the shortage of living donors, some centers have started using kidneys from living donors with asymptomatic stones as a potential solution for the problem. However, the optimal surgical solution for such situations has not yet been developed.Aim. To evaluate our obtained transplantation results of using the kidneys from living donors with nephrolithiasis and compare them with the literature data.Material and methods. In the period from 2012-2021, renal transplantations in our clinic were done in three patients from related donors with stones in the kidney. One donor underwent mini-percutaneous lithotripsy one month prior to nephrectomy. The other two underwent simultaneous retrograde lithotripsy and laparoscopic donor nephrectomy. In these cases a holmium or thulium laser was used for the destruction of calculi. All donors underwent laparoscopic retroperitoneal nephrectomy.Results. All stones were successfully removed. There were no surgical complications in donors during and after procedures. Warm ischemia time did not exceed 3.5 minutes. The general length of hospital stay was 10 days in case of predonation stone removal surgery and 6 and 4 days in the cases of simultaneous procedures, respectively. All grafts were transplanted to related recipients. One of the recipients was treated with hemodialysis before transplantation, the other one with peritoneal dialysis. The third recipient underwent preemptive transplantation (before the start of dialysis). The graft function in all cases was immediate. During the follow-up period (9-57 months), no signs of nephrolithiasis were seen in either donors, or recipients.Conclusions. Consideration of potential donors with stones in one kidney might increase the number of living donor renal transplantation. Simultaneous RIRS and laparoscopic donor nephrectomy can be considered as an alternative to sequential operations or ex vivo stone extraction. The presented technique is reproducible, safe and was not associated with an increased length of hospital stay.

Objective: to identify the main causative agents of chronic calculous pyelonephritis and determine their antibiotic resistance in patients with nephrolithiasis combined with coronary heart disease (CHD).Material and methods. A retrospective case-control study included 181 patients aged 57 to 82 years old who were treated at the urological center of branch no. 1 of Burdenko Main Military Clinical Hospital in 2014–2019. All patients long-term suffered from urolithiasis complicated by chronic calculus pyelonephritis in combination with CHD. Clinically significant results of bacteriological urine examinations (CFU≥103) were analyzed. The midstream urine specimen cultivation was performed sectorally on Endo agar. The minimum suppressive concentration of the test antibacterial preparations for each of the detected microorganisms was determined by dilution on a dense Müller–Hinton agar culture medium (BBL, USA). The results were processed using the Shapiro–Wilk, Kolmogorov–Smirnov, and χ2 Pirson criteria. The values of p≤0,05 were considered as statistically significant.Results. Specimen culturing revealed Escherichia coli – 24.8%, Klebsiella pneumoniae – 18.3%, Pseudomanas aeruginosa – 11%. Staphylococcus spp., and Enterococcus spp. were most important among gram-positive pathogens (total 26.6% of cases). The sensitivity of the detected infectious agents to basic antibacterial drugs turned out to be sharply reduced. It is noteworthy that 65% of P. aeruginosa strains were sensitive to meropenem.Conclusion. In patients with recurrent urolithiasis combined with CHD, the proportion of gram-positive coccas was increased on the background of calculous pyelonephritis with a simultaneous decrease in the proportion of poly-resistant gram-negative infectious agents (nosocomial strains of E. coli and K. pneumoniae).

Urolithiasis is one of the most common urological conditions (30–45 %), peaking in the 4th–6th decades of life. About 50 % of patients have one recurrent episode of nephrolithiasis during their lifetime, and among the operated patients, more than 10–15 % of individuals report recurrences with the need for repeated surgical treatment. Increasing the incidence of nephrolithiasis in the world requires the development of new and improvement of existing methods of surgical treatment, which would be characterized by a high level of efficiency and low invasiveness with minimal complications and postoperative rehabilitation. The use of a combination of percutaneous nephrolithotripsy and flexible ureteronephrolithotripsy, especially in complex cases of urolithiasis, can increase the safety and improve the treatment of nephrolithiasis by combining the positive qualities of both methods. Aim. To summarize the data of the world scientific literature on the treatment of nephrolithiasis by studying a combination of percutaneous nephrolithotripsy and retrograde or antegrade flexible intrarenal surgery based on the evaluation of their effectiveness and safety. Materials and methods. The literature review was conducted using the databases PubMed, Google Scholar, Web of Science and Scopus for the period 2015–2022. The following keywords were used for the search: surgical treatment of nephrolithiasis, endoscopic combined intrarenal surgery (ECIRS), percutaneous nephrolithotomy, retrograde intrarenal surgery, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotomy, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotripsy. Conclusions. The use of ECIRS increases the effectiveness of one-stage treatment of nephrolithiasis with minimal complications and reduces the number of re-operations required. Treatment of complex forms of nephrolithiasis may be a priority for ECIRS. The main disadvantages of ECIRS are the need for simultaneous operation of two operating surgeons and the availability of two sets of endoscopic equipment, which make this procedure expensive.

Urolithiasis ranks second among urological diseases, after inflammatory processes, and first among surgical interventions in urological hospitals. The problem of this disease treatment is a long-term rehabilitation and disablement, which entails a significant increase in costs and requires changes in the tactics of treatment of patients. Since its introduction until today, percutaneous nephrolithotomy (PCNL) is the standard treatment for nephrolithiasis with a stone size of more than 1.5–2.0 cm. In its standard version, PCNL ends with the placement of nephrostomy catheter through the formed parenchymal channel, but there are techniques of the surgery completion either without nephrostomy catheter with a JJ stent – tubeless PCNL, or without nephrostomy and JJ stent at all – totally tubeless PCNL. However, nowadays, the use of tubeless and totally tubeless techniques is one of the most controversial topics in percutaneous nephrolithotomy in terms of safety and efficacy in their application. Aim. To analyze the results and safety of percutaneous nephrolithotomy by means of tubeless and totally tubeless techniques based on scientific evidence. Analysis of the scientific literature shows that tubeless and totally tubeless PCNL techniques are a safe method of percutaneous surgery and their application reduces pain and analgesic requirements in the postoperative period, shortens the length of postoperative hospital stay, and enhances recovery after surgery in patients, therefore resulting in cost-saving treatment. Conclusions. Tubeless and totally tubeless PCNLs are recommended for widespread use in urological practice, but it is worth to mention that these techniques should be performed in selected patients and by an operating surgeon with significant experience in percutaneous surgery.

Although urolithiasis is a common disease in the European population, bilateral staghorn stones are a relatively rare variant of nephrolithiasis. It is often associated with a chronic urinary tract infection or a metabolic disorder. The aim of this paper is to show an example of the treatment of bilateral staghorn stones in a patient chronically infected with a resistant strain of Proteus mirabilis. Percutaneous nephrolithotripsy (PCNL) is currently the gold standard of treatment. And this is the way the patient was managed. In the following section, the authors sought to describe new reports on this treatment method and how it could be improved. Conservative treatment does not appear to be a safe alternative. And of the other surgical treatments, PCNL has the greatest benefits. Nearly 68% of patients with bilateral staghorn stones have some underlying metabolic disorder in a small sample of patients. It seems reasonable, therefore, to introduce genetic and metabolic diagnosis in younger patients with the aim of prevention through diet or pharmacotherapy.

Urolithiasis is not a rare disorder in children. Its etiology, incidence and localization vary by geographic region. It is an increasing problem, especially in developing countries. Metabolic abnormalities have been claimed to play a significant role in the kidney stone disease. Most of the studies confirmed that hypercalciuria, hypocitraturia are the most commonly identified metabolic disorder in children with urolithiasis. It is important to evaluate them to modify and prevent the stone recurrence.

Objective: to compare the forms and clinical course of primary hypeparathyroidism in hospitalized patients over a ten-year period, with patients identified by a routine analysis of blood calcium in Arkhangelsk region.Material and methods: At the first stage, a retrospective analysis of 48 case histories of patients who received inpatient treatment for PHPT in two multidisciplinary hospitals in Arkhangelsk from 2005 to 2015 was carried out. At the second stage, a screening of blood calcium was performed in patients of large outpatient clinic in Arkhangelsk from March 1 to March 31, 2015, as a result of which 21 cases of the first established PHPT were detected. A comparative analysis of the clinical course was carried out in two groups of patients with PHPT compared with the control group.Results: patients with PHPT detected during screening showed a higher incidence of mild forms of the disease (38 %), a higher level of bone mineral density in all parts of the skeleton according to dual-energy X-ray absorptiometry, and a lower incidence of nephrolithiasis (24 % vs. 69 %) compared with hospitalized patients, among which the manifest forms of the disease prevailed (88 %), fibrocystic osteitis was detected in 44 % of cases, and coral nephrolithiasis - in 10% of cases.Conclusion: a routine study of blood calcium levels helps to identify primary hyperparathyroidism at earlier stages to prevent the development of severe complications and invalidisation of patients.

Nephrolithiasis, known for centuries, remains an unresolved medical problem, moreover, in countries with a high standard, there has been an increase in incidence over the past 30 years. There are many diagnostic, therapeutic and prophylactic possibilities on the one hand, as well as the variety of different types of stones requiring knowledge of the specific opportunities. The purpose of this review is to present current scientific trends in nephrolithiasis. [ABSTRACT FROM AUTHOR]

Urolithiasis is one of the leading places in the field of uropathology. The relevance of this topic is determined by the fact that every year the number of patients with urolithiasis is steadily increasing, both in the Russian Federation and in developed countries. According to most authors, that due to the increasing life expectancy, changes at the chemical composition of water, lifestyle and peculiarities of human nutrition, as well as global climate changes. Medico-economic and social significance of urolithiasis is that roughly 2 / 3 of patients who get sick are 30 to 60 years old. The disease is characterized by frequent relapses, high prevalence of complicated forms, in some cases leading to disability of the patient, which makes it difficult to treat. In spite of this, mortality from urolithiasis in the last few years has noticeably decreased, due to the active study of the etiopathogenesis of the disease, improvement of diagnostic methods, development and implementation of minimally invasive technologies in the treatment of urolithiasis. This literature review provides information on the prevalence of urolithiasis, the etiology and pathogenesis of stone formation in the urinary system, as well as main information of the most effective methods of diagnosis and treatment of urolithiasis at this time.

Introduction. Nephrolithiasis consists of the production and retention of calculi in the urinary tract. It is being diagnosed in an increasing number of people of any age, and is one of the most common ailments in the world. Depending on a number of factors, it can be found in 5–20% of the population. Traditional surgeries are being replaced by less invasive methods of treatment. The relation between the endourological removal of calculi from the urinary tract and the assessment of the quality of life of patients who have undergone such procedures is an interesting topic worth analysing. In the 21st century, quality of life became the indicator of the efficacy of many therapies and procedures. It is associated with the quality of treatment, reflecting a better and longer life with the disease. Objective. The objective of this study is to demonstrate the quality of life of the surveyed patients with nephrolithiasis after the endourological removal of calculi from the urinary tract. Materials and methods. The group of surveyed individuals qualified for statistical analysis included 120 people diagnosed with nephrolithiasis. The patients underwent the procedure of the endourological removal of calculi from the urinary tract in 2015 in three hospitals in eastern Poland. Among the respondents, 48% of them underwent extracorporeal shock wave lithotripsy (ESWL), 31% had percutaneous nephrolithotripsy (PCNL), and 21% had uretherorenoscopic lithotripsy (URS). To evaluate the quality of life, a research tool was devised based on an abbreviated version of the Polish adaptation of the WHOQOL – BREF questionnaire. Also, a personal questionnaire prepared by the author was used. Results and conclusions. The analysis of the collected materials demonstrated the impact of the endourological removal of calculi from the urinary tract on the quality of life of the hospitalised patients. Differences were identified in individuals’ general rating of quality of life (57% of respondents were satisfied) and patients’ general satisfaction with their health (47.5% of respondents were satisfied) after the procedure. Significant differences were identified in each of the studied fields: physical, psychological, social and environmental. A statistically significant correlation of p

Studies of inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn's disease, is highly relevant due to their growing incidence and prevalence, and a wide range of extraintestinal manifestations. The paper deals with the discussion of renal damage types in IBD. Renal damage in IBD refers to rare cases of extra-intestinal manifestations and could both originate by the immunological mechanism common with IBD and directly related to inflammatory activity in the intestine, as well as be unrelated to the immunological activity of the bowel disease and be associated with metabolic disorders that develop in IBD. Finally, kidney damage in IBD can be caused by side effects of treatments. As an example, we present a case of mesangioproliferative glomerulonephritis as an extra-intestinal manifestation of ulcerative colitis and discuss the challenges of therapy and the effectiveness of genetically engineered biological agent golimumab. An algorithm for the differential diagnosis of the renal damage in patients with ulcerative colitis and Crohn's disease is proposed to be used in real clinical practice, with recommendations for monitoring of patients with IBD as those at risk for the development of chronic kidney disease.

Aim. To study the effects of oral hypoglycemic agents that can affect the probability of recurrence of nephrolithiasis. Materials and methods. The article is based on the results of examination and treatment of 315 patients suffering from recurrent nephrolithiasis and medically compensated type 2 diabetes mellitus treated at the N.A. Lopatkin Institute of Urology and Interventional Radiology - the branch of the SMRC of Radiology, Ministry of Health of Russia and D.D. Pletnev City Hospital Moscow Healthcare Department in 2012-2017. The patients were divided into three groups according to the applied tool antidiabetic: metformin, glibenclamide, canagliflozin. The control group consisted of patients receiving insulin therapy. Results and discussion. The propensity of Metformin to reduce the pH of urine, which has a negative impact in the conditions of urate nephrolithiasis, which is most common in the population of patients with type 2 diabetes mellitus. Glibenclamide, on the contrary, somewhat latches urine. But changes in the reaction of urine under the influence of the drug do not go beyond normal values and are not clinically significant. Canagliflozin increases diuresis due to medication induced glycosuria and stimulates renal excretion of uric acid and its salts. However canagliflozin does not cause significant shifts in the pH of urine that may somewhat negates the increased risk of recurrence of urate stone formation in the background of the uricosuric effect of the drug. Conclusion. Drug therapy of type 2 diabetes mellitus significantly affects the properties of urine from patients with nephrolithiasis.

Kidney stone disease is one of the most common disorders and can be considered a disease systmetic. It occurs in about 5-20 % of all population. Due to the chemical composition of deposits there are several types of kidney stones including calcium oxalate, calcium phosphate, uric acid, magnesium-amonium, phosphate, cysteine. Nephrolithiasis is more common in men than in women. Kidney stones are formed as a result of the crystallization of minerals and their salts. The cause of stone formation in the kidneys also contributes some drugs (such as corticosteroids), hyperparathyroidism, osteoporosis, long-term treatment of peptic ulcer with alkalizing preparations, overdose of vitamin D and improper diet. The most important in treatment of renal colic is relieving pain. Sometimes it is enough to administer analgesics, but sometimes it is necessary to administer strong opioid drugs. Effective medical treatments including thiazide, potassium citrate, acetohydroxamic acid can prevent new stone formation in most patients.

Study purpose – to improve the solitary nephrolithiasis treatment effectiveness by determining the optimal conditions for ESWL or mini PNL application in the treatment of kidney calculi 1.0 to2.5 cm in size. Patients and methods. A comparative analysis of the results of minimally invasive methods application for nephrolithiasis treatment was performed in 210 patients treated with mini PNL (the group I) and 190 patients treated with ESWL (the group II). Patients with calculi more than 1.5 cm predominated in the group of mini PNL and with calculi less than 1.5 cm – in the ESWL group. The number of patients with calculi 1.5–2.0 cm in both groups was the same: 24.3 % and 24.2 % (P > 0.05). Results. It was noted that the calculi destruction effectiveness after 1–4 or more sessions of ESWL took place in 182 patients (95.8 %). At the same time, an increase in the mean density of calculi above 600 HU caused reduction (P < 0.001) of the primary ESWL session efficiency almost twofold. When performing the 221 mPNL, 97.1 % of the patients required one surgical treatment. The number of complications (bleeding, attack of pyelonephritis) in the group II was insignificantly higher in contrast to the group I – 26 (12.3 %) and 45 (14.1 %), respectively (P < 0.05). The stone-free status (up to one month) was noted in 62.6 % of patients after the completion of ESWL sessions that increases the risk of nephrolithiasis recurrence from 37.4 %. In treatment with mPNL, the stone-free status reached 97.1 % (P < 0.001), and in repeated mPNL applying in 2.8 % of cases – 100 %. The mean clinic postoperative treatment periods in the group I were lower in contrast to patients of the group II – 3.0 ± 1.5 and 12.5 ± 3.6, respectively (P < 0.001). Conclusions. This comparative analysis of features and results of uncomplicated nephrolithiasis with mPNL and ESWL treatment indicates that mPNL is the most preferred method for kidney calculi 1.0 to2.5 cm and more in size treatment.

Introduction. Large (>2 cm) and Staghorn kidney stones are severe forms of: nephrolithiasis. Percutaneous nephrolithotomy is first line in treatment of large kidney stones, according to the recommendations of the American and European associations of urology. In the modern literature is the high frequency of complications after percutaneous nephrolithotripsy, renal bleeding is the most serious of which. Many different methods of treatment with application of nephroscope small diameters in order to achieve acceptable high performance, but with fewer complications.Objective. We used a mini-percutaneous nephrolithotomy in patients with large and Staghorn kidney stones.Materials and methods. From February 2014 to January 2015, one surgeon of our center made 32 mini-percutaneous nephrolithotripsy in patients with large and Staghorn kidney stones. Criteria of effective treatment was the complete removal of stones or the presence of residual calculus size

The pathogenesis of urolithiasis in the modern view lies disregulating the pathological process of primary surplus mobilization reactions of protection, which leads to their further transformation in the reaction of damage that is the underlying basis for the formation of vicious circles. 299 patients with nephrolithiasis were examined, 10 patients were in the control group. Found that systemic and renal dysregulation pathological processes of stone the size of stones of 0.6 – 1.0 cm, top, middle cup the upper third of the ureter led to the formation of large and small “vicious circles”. Renal and extrarenal dysregulation pathological processes contributed to the increase in damage to the proximal tubule, since the primary damage to the said nephron. Department is not able to mobilize protective adaptive reactions aimed at increasing the excretion of acids and protein reabsorption, since they require additional energy costs. The use of the drug blemaren in nephrolithiasis reveals protective properties to reduce the manifestations of systemic and renal dysregulation pathological processes and promotes the rupture of formed large and small “vicious circles" with a decrease in proteinuria, the level of tumor necrosis factor-α, improving the transport of sodium ions, fibrinolytic activity of urine and it is advisable to develop guidelines for further use in the clinic of the drug blemaren as a promising method of treatment of urolithiasis.

Introduction: The main stages of flexible ureteroscopy in patients with renal stones are usually performed under X-ray guidance. Long-term exposure of ionizing radiation can have negative effects on the patients with nephrolithiasis and the operating team., Aim: To study the results of retrograde intrarenal surgery (RIRS) without fluoroscopic guidance., Materials and Methods: The results of flexible ureteroscopy (fURS) without X-ray-guidance in 76 patients were analyzed. There were 46 (53.3%) men and 30 (46.7%) women. The average age was 50.4+/-14.6 years. All patients underwent laboratory tests and non-contrast-enhanced computed tomography to determine the size and density of the stone. In all cases, preoperative ureteral stenting was performed. The average stone size was 10.5+/-4.2 mm. First, ureteroscopy with a rigid endoscope was done to assess the ureter and determine the depth of the introducing ureteral access sheath. After removing the ureteroscope along the guidewire, a ureteral access sheath was put at this distance. An inspection of the collecting system and laser fragmentation of kidney stones were performed using a flexible ureteroscope. In 64 (84.2%) patients, a 4.7 Ch stent was put at the end of the procedure, while in the remaining 12 (15.8%) patients, a ureteral catheter was left for 1-2 days. The operation time, stone-free rate, and the number of intra- and postoperative complications were studied., Results: All fURS were successful and performed without X-ray guidance. The average operation time was 42.5+/-8.0 minutes. After the first session, stone-free rate was 92.1% (70/76). In 6 (7.9%) cases, residual stones were found, which were completely removed after the second session. Intraoperative complications, namely perforation of the upper calyx by the distal end of the ureteral access sheath, were observed in 2 (2.6%) patients, which did not require any additional interventions. Postoperative complications occurred in 10 (13.2%) patients, including fever in 6 (7.9%) and hematuria in 4 (5.3%) cases. There were no serious complications, such as ureteral perforation or sepsis, and no blood transfusion was performed., Conclusion: Flexible ureteroscopy with laser lithotripsy can be performed safely and effectively without X-ray guidance.

Objective: to describe a case of normocalcemic hyperparathyroidism.Materials and methods. A female patient aged 51 years sought medical advice for complaints of spinal column and bone pains, periodic dizziness, and hand numbness. The patient underwent clinical and biochemical blood tests, determination of the blood levels of calcium, phosphorus, parathyroid hormone, concentrations of total vitamin D, calciuria, electrocardiography, thyroid ultrasonography, and neck computed tomography.Results. Based on her complaints, examination evidence, evaluation of the clinical presentations of the disease, and objective and instrumental examination findings, the patient was diagnosed with left parathyroid adenoma and primary hyperparathyroidism; stage II hypertensive disease, grade I, a moderate risk; retinal angiopathy of both eyes; stage I dyscirculatory encephalopathy with liquor and venous dyscirculation and moderate vestibular ataxia; urolithiasis; kidney stones; and spondylosis mainly involving the lumbar spine. The diagnostic determinants for verifying the diagnosis were the results of neck computed tomography, namely: the signs of space-occupying lesion in the projection of the left parathyroid gland; the blood level of parathyroid hormone 118.6 pg/ml (normal value (N) 9.5–75.0 pg/ml); total vitamin D 21.64 nmol/l (N 75–250 nmol/l); and calcium 2.48 mmol/l (N 2.15–2.50 mmol/l). The history of urolithiasis, repeated lithotripsy, as well as spondylosis with lumboischalgia was an absolute indication for surgical treatment.Conclusion. The practical interest in this case is due to the complexity of diagnosing normocalcemic hyperparathyroidism after vitamin D deficiency. The early stages of primary hyperparathyroidism are asymptomatic and frequently give rise to irreversible renal complications, causing renal failure and, as a consequence, disability. This clinical case demonstrates the importance of routinely determining vitamin D concentrations, which in turn triggers parathyroid adenomas.

Analysis of 185 patients operated on from 2000 to 2010 was carried out. Nephrolithiasis was diagnosed in 108 (58,3%). In 45 (24,3%), it was a guiding symptom which caused symptom survey for PHPT. Renal PHPT form accounted for 25%. Staghorn kidney stones were found in 17 (9,1%). Two-sided nephrolithiasis was observed in 15 (8,1%); in 4 patients, it was due to staghorn stones. The analysis revealed a high prevalence of nephrolithiasis in patients with PHPT.

Nephrolithiasis as the most common urological disorder characterized by frequent early relapses, acquires a social character, because these patients are 30 to 45% of all urological patients, while in Europe the disease is diagnosed in 2% of the population. The study included 40 patients with nephrolithiasis, 10 patients constituted the control group. Set the “hidden” damage to the proximal nephron in the presence of renal stones with a size of 0.6-1.0 cm in the upper third of the ureter, the upper and middle sections of the calyx, which is confirmed by the inhibition of enzymatic fibrinolytic activity of urine, the presence of tubular proteinuria in the absence of inhibition of proximal reabsorption of sodium ions. The link “hidden” damage to the proximal tubule of the degree of overload of the proximal nephron is a protein graphics multicorrelation dependence between the protein concentration of urine, standardized excretion protein and excretion, which are becoming more significant disharmony form towards control in the following sequence: the upper third of the ureter, medium cup, top cup.

The study includes the results of treatment of 167 patients with nephrolithiasis: first group included 80 patients with 1 session of extracorporeal shock wave lithotripsy (ESWL), the second group consisted of 87 patients who underwent 2-4 session ESWL. All patients underwent duplex scanning in renal blood flow, was determined by the concentration of serum creatinine and estimate the glomerular filtration rate. ELISA also investigated the dynamics of the content of lipocalin-2 (NGAL) and β2-microglobulin. All studies were performed at 5-7, 10-14, and 1-3 months after treatment. It is shown that in case of ESWL occurs renal parenchymal damage of varying degree, aggravated by increasing the number of sessions. By the early markers of acute kidney injury in patients with nephrolithiasis should include an increase urinary excretion of β2-MG and NGAL. Results of dynamic duplex scanning can reveal the underlying mechanisms of progression of renal dysfunction in patients after ESWL.

The aim of this study was to evaluate changes in tubulointerstitial renal parenchyma in patients with nephrolithiasis at various stages of surgical treatment using mediators nephrofibrosis and angiogenesis and the results of intraoperative biopsy of kidney. Results of surgical treatment of 65 patients with nephrolithiasis were studied. In serum and urine of patients content determined molecular mediators that characterize nephrosclerosis. It is shown that the most informative markers of tubulointerstitial fibrosis are IL12, VEGF in serum and excreted in the urine β2 MG, MCP 1 and NO. High level markers nephrosclerosis, conserved in the postoperative period in patients with bilateral nephrolithiasison the background existing tubulointerstitial damage indicates irreversibility nephrosclerosis and further progression of chronic kidney disease.

Research objective: The study investigates the antifibrotic nephroprotective effects of aliskiren on the condition of renal hemodynamics, changes of profibrotic cytokines level and markers of renal damage in patients with nephrolithiasis undergone various types of surgery. Materials and methods: Patients have been divided into 2 groups. The investigations have been performed before the surgery and in a month period. Concentrations of TGF-p, markers of acute renal tubulointerstitial damage — NGAL and p2-microglobulin in urine, levels of ET-1 in serum and indicator of endothelial dysfunction have been determined. Assessment of renal blood flow state by Doppler ultrasonography has been carried out in the same terms. Results: As a result of aliskiren treatment the decrease of mediators of tubulointerstitial damage and nephrofibrosis, significant improvement in renal blood flow in a month period after the surgery have been marked in comparison with the group which had not received nephroprotective therapy. Conclusion: Direct renin inhibitor aliskiren may be used as a means of renal protection therapy in treatment of patients with nephrolithiasis.

The paper gives the results of an open-label trial of the Uralyt-U citrate used in 30 patients with gout and nephrolithiasis. In addition to rapid urine pH optimization, the use of the drug is shown to cause a reduction in the serum level of uric acid, correlating with its enhanced excretion. The use of the agent features good compliance and fails to affect renal functional parameters.

output The paper describes current ideas on the pathogenesis and treatment of nephrolithiasis, virtually a constant attendant of gout. The prevalence of nephrolithiasis is reported to be increasing worldwide. Among all cases of nephrolithiasis, the frequency of uric acid nephrolithiasis ranges from 5 to 40%; that of nephrolithiasis in gout is, according to the data by different authors, 7 to 10%. Hyperuricosuria, low urine volume, and low urine pH are considered to be classical risk factors for uric acid nephrolithiasis. Uric acid nephrolithiasis, including that in gout, even if asymptomatic, is noted to require active therapy. The paper presents the basic principles of treatment for uric acid nephrolithiasis: to normalize urine pH; to eliminate or neutralize the sequels of hyperuricosuria, to correct comorbidities, and to increase urine.

The aim of this study was the estimation of clinical importance markers of renal damage at surgical treatment of nephrolithiasis. We studied results of operations in 110 patients with nephrolithiasis. The study presents new candidates for biochemical markers of acute kidney injury and renal interstitial fibrosis, with potentially high sensitivity and specificity. In this study were measured the concentrations of these biomarkers in urine. We suggested, that increased concentrations molecular mediators of renal damage (L2, IL-18) and interstitial fibrosis (MCP-1, TGFp, IGF1) in the patients with nephrophibrosis and strongetubulointerstitial injury, saved long-time period after operation, has been shown of progression chronic kidney disease

The aim of the study is to evaluate the influence of angiotensin converting enzyme (ACE) inhibitors of quinapril on the condition of renal hemodynamics, changes of profibrotic cytokines level and transforming growth factor at patients with nephrolithiasis undergone various kinds of surgery. Patients were divided into 2 groups initially and in 1 month after surgery. Concentrations of IL-6, TGFp and МСР-1 were determined in blood serum. Assessment of renal blood flow state by Doppler ultrasonography was performed in the same terms. As a result of quinapril treatment the decrease of МСР-1, TGFp and IL-6 was marked in comparison with the group which did not receive nephroprotective therapy. The analysis of Doppler ultrasonography data showed authentic improvement of renal blood flow in 1 month after surgery. The most informative parameter proved to be the resistance index that indicated the decrease of vascular resistance after surgical treatment in condition of quinapril therapy

Introduction: Stent encrustation is one of the most difficult problems that can lead to difficulties in stent removal, while ureteral obstruction can lead to renal failure. Despite the search for various preventive measures, it still remains unresolved., Aim: To study the effect of Blemaren on stent encrustation in patients with calcium-containing and uric acid stones after ureteroscopy with lithotripsy., Materials and Methods: A total of 60 patients with ureteral stones who underwent ureteroscopy with lithotripsy in A.V. Vishnevsky National Medical Research Center of Surgery from January to August 2022, were included in the study. In all cases ureteral stents 6 Ch were placed at the end of the procedure. Patients with uric acid and calcium oxalate stones (n=48) were randomized into two groups: in the main group (n=20), they were prescribed Blemaren up to the stent removal. In the control group (n=28), patients did not receive additional therapy. To determine the severity of incrustation, we used our own classification, where the percentage of lithogenic deposits relative to the lumen of the stent was calculated. Visual assessment and microscopic examination of the removed stents were performed on days 30+/-4.1 and 60+/-7.3., Results: In patients of both groups, the severity of encrustation on the 30th day after stent placement was low (up to 30%). There were no significant differences between the groups (p=0.421). The main changes were detected 60 days after stent placement. Microscopic study revealed significant differences between two groups. In patients who did not receive Blemaren, microscopic signs of encrustation of the proximal curl of the stent occurred 2.5 times more often than in the main group (p=0.001)., Conclusions: 1. The number of encrusted stents in patients with calcium oxalate and uric acid stones who did not receive Blemaren significantly increases after two months. 2. Upper urinary tract drainage with a stent for a period of more than 2 months is possible if clinically necessary, however, preventive measures to reduce the risk of encrustation should be applied.

Introduction: Uric acid stones (UA), consisting of uric acid/uric acid dihydrate, occur in 6.1-15.1% of all cases of urolithiasis in industrialized countries. At the same time, the frequency of these stones is directly dependent on age. Thus, the incidence of UA reaches 40% in men over 80 years of age and 27.3% in women over 90 years of age. UA are the only stones that are amenable to dissolution therapy with the use of citrate salts that alkalinize urine pH. A number of authors and European Association of Urology guidelines consider stone dissolution as a first-line therapy in the treatment of patients with UA, both as monotherapy and in combination with surgical procedures., Materials and Methods: The results of conservative treatment of 86 patients aged 28 to 78 years with radiolucent ureteral stones ranging in size from 3 to 25 mm and a density of 133 to 728 HU, who underwent 89 courses of stone dissolution therapy from 2011 to 2018, are presented in the article. They had no obstruction or were prestented. There were 52 men (n=55 courses) and 34 women (n=34 courses)., Results: In 78 out of 89 clinical cases (87.6%), stone-free status was obtained within 14 to 181 days. Most often the duration of therapy was 30 days. In 11 (12.4%) cases the treatment was considered ineffective. However, only in 4 (4.5%) patients the stone size did not change, while in 7 (7.9%) cases it decreased. The results of the study suggest the high efficiency of citrate therapy in patients with ureteral stones in case of unobstructed urine outflow (including those with stents), which is comparable to surgical treatment.

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.

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.

Introduction: Urolithiasis is a clinically and socially significant disease that requires long-term follow-up in order to prevent stone recurrence. Currently, telemedicine consultations in the "patient-doctor" format are actively used in urology, however, the methodology, technological base and assessment of the efficiency of remote monitoring of the patient's health status are virtually not developed., Aim: To provide basics for the methodology of remote monitoring of patients with urolithiasis for detailed comprehensive examination and comprehensive metaphylaxis of recurrent stone formation., Materials and Methods: A comprehensive clinical examination was carried out on the basis of the Institute of Urology and Human Reproductive Health, the National Medical Research Center on Urology and the Institute of Digital Medicine of FGAOU VO I.M. Sechenov First Moscow State Medical University during the period from 1st February to 1st December 2020. A total of 30 patients with urolithiasis were included in the study. Remote monitoring of health status was carried out using a portable analyzer "ETTA AMP-01" on dipstick. Data transmission was performed through a mobile application, which is part of the "NetHealth" information system (www.nethealth.ru). The values and frequency of urine tests performed by the patient independently, as well as patient satisfaction and adherence to the monitoring technology were evaluated. Analytical, clinical, sociological and statistical research methods were used., Results: By systematizing published data and our own clinical experience, we have developed a model for remote monitoring of the health status of patients with urinary stone disease, which included a system of indications and contraindications, a program and an order of the monitoring, as well as a basic technological solution (medical devices and a hardware-software complex). In this study, median duration of remote monitoring was 168 days. According to the questionnaire, general positive assessment and desire to continue telemonitoring was seen in 100.0% of cases, while 86.7% of patients positively evaluated the technical accessibility and reliability of the system and 93.3% considered the quality and availability of medical care as high., Conclusion: A methodology for remote monitoring of patients with urolithiasis has been developed with the aim of preventing recurrent stone formation. There was a high adherence of patients to remote monitoring with a tendency to decrease in values after 4 and 6 months. During these periods, it is necessary to carry out routine consultations by the physician who appointed remote monitoring in order to continue the follow-up program. There was a high satisfaction of patients with remote monitoring, and they pointed out the quality and availability of urological care owing to telemedicine technologies.

THE AIM OF THE RESEARCH: to reveal the relationship of various markers of calcium metabolism (osteopontin (OPN), parathyroid hormone-related protein (PTHrP), vitamin D, parathyroid hormone (PTH)) on the course of urolithiasis (Urolithiasis) in patients with calcium oxalate nephrolithiasis., Materials and Methods: 100 people were examined, the following groups were included: group 1 - patients with calcium oxalate primary nephrolithiasis (n=41), group 2 - with calcium oxalate recurrent nephrolithiasis (n=39). Group 3 included conditionally healthy volunteers (n=20). The studies were carried out by the immunoenzymometric ELIZA and biochemical methods using appropriate test systems., Results: in patients with recurrent nephrolithiasis, the serum PTHrP level is 54.6 (25.4-78.2) pg / ml, which is 3.7 times higher than in conventionally healthy individuals; the level of osteopontin is more than 1.5 times higher and amounts to 1.820 (0.991-2.212) pg / ml. In the group of primary nephrolithiasis, the level of PTHrP is 2-2.5 times higher than in conventionally healthy people. In patients with primary nephrolithiasis, the blood calcium level does not correlate with the level of PTHrP in the blood (r=- 0.0173, p> 0.05), as in the group with recurrent nephrolithiasis (r=0.0223, p>0.05)., Discussion: in patients with recurrent nephrolithiasis in the preoperative period, the serum levels of osteopontin and PTHrP in the blood serum were higher than in patients who were first diagnosed with urolithiasis, the data obtained can be used as a criterion for predicting the risk of recurrence of urolithiasis in the postoperative period. The blood calcium level does not have a statistically significant relationship with PTHrP, which allows us to assume that PTHrP has other mechanisms of influence on the development of urolithiasis, given the data obtained that the PTHrP level in patients with primary and recurrent nephrolithiasis is higher than in conditionally healthy people., Conclusion: Determination of the level of PTHrP and osteopontin in patients with urolithiasis allows predicting the risk of recurrence of urolithiasis at the stage of primary calcium oxalate nephrolithiasis. Determination of the level of PTHrP makes it possible to predict the risks of developing urolithiasis in conventionally healthy individuals, which can be used for targeted prevention of an unfavorable course of urolithiasis by prescribing timely adequate rational therapy and correcting the patients diet. At the same time, no correlation was found between the level of PTHrP and the level of blood calcium in patients with calcium oxalate nephrolithiasis; therefore, further studies of the role of this protein in the pathogenesis of urolithiasis are needed.

Aim: to study the calcium level in the urine, serum and hairs and to assess the diagnostic value of the calcium level in various biosubstrates in patients with calcium and non-calcium stones., Materials and Methods: a total of 99 patients with urinary stone disease were included in the study. A diagnostic value of calcium level in biosubstrates according to the chemical analysis of stone composition performed using qualitative chemical reactions and microcrystalloscopy was evaluated., Results: Urinary level of calcium and oxalate is proved to have high diagnostic value in patients with calcium nephrolithiasis (specificity 93.9% and 96.9%, and positive predictive value 88.2% and 97.2%, respectively). The specificity and positive predictive value of the calcium level in the hairs was 81.2% and 87.2%, respectively., Conclusion: A comprehensive study of the elemental spectrum in urine, hair, and serum increases the diagnostic value of the evaluation of calcium, determined by the type of studied biosubstrate and stone type in patients with nephrolithiasis.