Search

The objective: to determine the effectiveness of herbal medicine, which includes yarrow, lovage root and rosemary leaves, hepatoprotector with field artichoke and intestinal dialysis (a mixture of electrolytes, macrogol and activated carbon) to normalize kidney function in patients with active tuberculosis (TB). Materials and methods. During 6 years, 738 patients from 6 till 81 years old with active TB of various localizations, including kidneys, were examined and treated. We evaluated symptoms, anamnesis, clinical, biochemical tests of blood, urine, glomerular filtration rate, bacteriological analysis, polymerase chain reaction for DNA of Mycobacterium tuberculosis, immunological studies, methods of radiological diagnosis (sonography, radiography, multislice computed tomography, magnetic resonance imaging, radioisotope method), endoscopic research methods with targeted aspiration and biopsy to obtain biological material. The participants of the research were divided into two groups: main and control ones. Patients in the main group (n=73) were prescribed herbal medicine, which includes yarrow, lovage root and rosemary leaves, hepatoprotector with field artichoke and intestinal dialysis (a mixture of electrolytes, macrogol and activated carbon). The patients in the control group (n=70) used only herbal medicine, which includes yarrow, lovage root and rosemary leaves and hepatoprotector with artichoke. Variation statistics methods were used to process the obtained data. Results. According to the result of the study, 68 (93.1%) patients out of 73 persons in the main group with active TB, had symptoms of the improvement. In the control group, only 37 (52.8%) patients reported positive results. In 68 patients of the main group, normalization of renal function was achieved: normalization of blood creatinine levels, glomerular filtration rate, reduction of protein, leukocytes, erythrocyturia. Conclusions. The proposed method of treatment of patients with active tuberculosis of different localization, including kidneys, on the background of antimycobacterial therapy is one of the possible treatment options. It is proved that normalization of renal function was determined in 93.1% of patients, which is on 40% higher compared to the control group.

Introduction. Prostate cancer antigen-3 (PCA3) is a genetic biomarker, which got widespread and demonstrated high diagnostic potential. This gene expresses only in prostate gland tissue, furthermore, malignant prostate neoplastic transformation leads to 70 – 100 time overexpression of it. Polyadenylated matrix RNA (mRNA) is a functional product of this gene, which do not translating into protein. Gene contains of four introns and three exon. Product of PCA’s gene detecting in post massage urine using polymerase chain reaction (PCR) in combination with reverse transcription. It could use as prognostic biomarker in patients with first negative biopsy or before it performing. Moreover, index of PCA3 can be useful in detecting tumor aggressiveness and decisions about further treatment options. Taking into account these facts, patients with high initial PSA level can avoid unnecessary biopsies. Objective: to determine critical cut-off value of PCA3 index as prognostic biomarker of PCa development. Materials and methods. Research based on routine and special test’s data of 243 men in Institute of Urology, National Academy of Medical Sciences of Ukraine in period of 2015–2020 year. RNA extraction from postmassage urine samples performed using RNeasy (Qiagen) kit. Statistical analysis performed using SPSS Statistics 19.0 (IBM SPSS Statistics 19.0) та SAS 12.0 (IBM Statistical Analysis System 12.0). Critical cut-off values determined using three methods: calculating of average value and (Xave) and standard deviation (SD) of it, Heiner index, and Youden’s index. Evaluation of optimality of determined critical cut-off values performed by comparative analysis using index of positive prognosis (IPP), index of negative prognosis (INP), diagnostic accuracy of method (DAM), Sp and Se for each of used methods. Results and discussion. First method demonstrated than 97,5 % of all results, which means absent of disease, was below critical cut-off values, due to statistical deviations and accurate demonstrate than in case of asymmetry or multimodal distribution this method was unsatisfied. Wherein IPP was 95 %, INP – 72 %, DAM – 78 %, Sp – 97,5 % and Se – 52 %. Calculation of PCA3 index area under ROC-curve was 0,810 (0,771–0,849). Using Heiner’s method critical cut-off value of PCA3 index was 14,0 с. u., where in IPP was 75 %, INP – 82 %, DAM – 78 %, Sp – 78 % and Se – 78 %. Critical cut-off values of PCA3 index 33,4 c. u. which calculated by Youden’s index demonstrated IPP – 98 %, INP – 73 %, DAM – 80 %, Sp – 99 % and Se – 57 %. Conclusions. The most optimal critical cut-off value for PCA3 index was determined using Youden’s index and was 33,4 c. u. Keywords: prostate cancer, PCA , prostate cancer antigen-3, PCA3, prostate cancer antigen-3 index, PCA3 index, critical cut-off values of PCA3 index.

МЕТОДИКА ФОРМИРОВАНИЯ СТРАТЕГИИ ЭКОСИСТЕМНОГО ЦИФРОВОГО МАРКЕТИНГА В ПРЕДПРИЯТИИ РИТЕЙЛА В УСЛОВИЯХ НЕОПРЕДЕЛЕННОСТИ БУДУЩЕГО / Д. Э. Возиянов //Сборник научных работ серии «Экономика». Вып. 27. – Донецк : ГОУ ВПО «ДОНАУИГС», 2022. – С. 107-123. В статье обоснована методика, направленная на разработку стратегии экосистемного цифрового маркетинга в ритейле, учитывающая особенности современного периода, характеризующегося его неопределенностью. METHODOLOGY FOR FORMING AN ECOSYSTEM DIGITAL MARKETING STRATEGY IN A RETAIL ENTERPRISE IN CONDITIONS OF UNCERTAINTY OF THE FUTURE / D. E.VOZIANOV //Collection of scientific works of the series "Economics". Issue 27. - Donetsk: SEE HPE "DAMPA", 2022. – Р. 107-123. The article justifies the methodology aimed at developing an ecosystem digital marketing strategy in retail, taking into account the features of the modern period characterized by its uncertainty.

МЕТОДИКА ФОРМИРОВАНИЯ СТРАТЕГИИ ЭКОСИСТЕМНОГО ЦИФРОВОГО МАРКЕТИНГА В ПРЕДПРИЯТИИ РИТЕЙЛА В УСЛОВИЯХ НЕОПРЕДЕЛЕННОСТИ БУДУЩЕГО / Д. Э. Возиянов // Сборник научных работ серии «Экономика». Вып. 27. – Донецк : ГОУ ВПО «ДОНАУИГС», 2022. – С. 107-123. В статье обоснована методика, направленная на разработку стратегии экосистемного цифрового маркетинга в ритейле, учитывающая особенности современного периода, характеризующегося его неопределенностью. METHODOLOGY FOR FORMING AN ECOSYSTEM DIGITAL MARKETING STRATEGY IN A RETAIL ENTERPRISE IN CONDITIONS OF UNCERTAINTY OF THE FUTURE / D. E. VOZIANOV // Collection of scientific works of the series "Economics". Issue 27. - Donetsk: SEE HPE "DAMPA", 2022. – Р. 107-123. The article justifies the methodology aimed at developing an ecosystem digital marketing strategy in retail, taking into account the features of the modern period characterized by its uncertainty.

The objective: to evaluate the effectiveness of portable pneumatic contact lithotripter LMA StoneBreaker in endoscopic contact ureterolithotripsy of ureteral stones of different localization depending on their density and search for opportunities to increase it. Materials and methods. Contact pneumatic ureterolithotripsy was performed in 89 patients (49 men, 40 women), 39 (43.8%) patients (I group) underwent standard contact pneumoureterolithotripsy, and 50 (56.2%) patients (11 group) – modified (with prior fixation of the stone in the ureter loop Dormia), which allowed urethrolithotripsy in situ and prevented the migration of stones and their fragments proximally. The number of strokes required to initiate fragmentation, complete fragmentation, and total ureterolithotripcy time for stones of different localization and density were determined. The integrity of the stones was determined by computed tomography in units of Haunsfield (HU). The mineral composition of stone fragments after their removal was diagnosed by X-ray diffraction analysis. The effectiveness of the applied methods was evaluated in groups of patients by complete (100%) removal of stone fragments from the ureter and by the number of cases of retrograde migration of stones into the renal cavity. Results. No intraoperative complications were observed. The number of strokes for the initial and complete disintegration of the stone, regardless of the method of ureterolithotripsy and their localization, depended on their density, ie its mineral composition. The minimum number of strokes for start and complete fragmentation of the stone was recorded in patients with a stone density of 480+54 HU and diagnosed as phosphates. Oxalate and uric acid stones, as well as their combinations (density 1310–1580 HU) required the maximum number of blows. Stone migration was noted in 8 (8.99%) patients. Thanks to intraoperative stone fixation was able to reduce the average time of lithotripsy (from 15,65±6.9 min to 12.3±6,15 min) and reduce the frequency of retrograde stone migration from 15.4% (in 6 patients of group 1) to 4% (2 patients of ІI group). The dependence of lithotripsy efficiency on stone localization is established. It was highest in patients with stones of the lower third of the ureter (95% in patients of group 1 and 100% of patients in group II) and with low density (480–840 HU). The lowest efficacy was observed in patients whose stones were localized in the upper third of the ureter (66.3% in group I and 90% in group II) and had a high density (more than 1200 HU). Due to the fixation of the stone with modified pneumoureterolithotripsy, the overall effectiveness of the method increased from 84.6% to 96%. Conclusions. Traneurethral contact pneumoureterolithotrysis using a portable pneumatic lithotripter LMA Stonebreaker – is effective, safe, minimally costly and easy to use. The effectiveness of contact pneumatic ureterolithotripsy depends on the location and density of the stone. The number of strokes required for the initial and complete fragmentation of the stone directly depends on the density of the stone and does not depend on its location and method of performing pneumoureterolithotripsy. The use of a modified technique with fixation of the stone in the ureter during the process of lithotripsy reduces the time of the operation and increases its effectiveness.

The objective: evaluation of the effectiveness and safety of percutaneous nephrolithotripsy in patients in the supine position. Materials and methods. For the period 2017–2021, 521 mini-PNL were performed according to the standard technique, where in 458 (87,9%) cases the operation was performed in the patient’s prone position, and in 63 (12,1%) cases on the supine position (group 1). The control group (2 group) consisted of 70 patients, sporadically selected among 458 patients to whom PML performed in a standard prone position. Mini-PNL was performed under combined regional (spinal-epidural) anesthesia in 98,7% (514) cases, in 1,3% (7) under endotrachial anesthesia. Results. The average time of surgery was 41,1±11,4 minutes in the 1st group and 57,4±10,3 minutes in the 2nd group (р0,05), stone-free conditions (96,4 vs. 98,2%; p>0,05) and average hospital stays (2,3 vs. 2,2 days; p>0,05). None of the patients in both groups had complications higher than Clavien IIIa. When performing PNL in the supine position, in contrast to performing PNL on the prone position, there is always the possibility of using combined endoscopic methods. Where 3 (4,8%) patients underwent combined retro- and antegrade approaches for combination of nephrolithiasis with «wedged» calculi of the pyelourethral segment and in distal ureter, and retrograde laser endoureterotomy was performed in one (1,6%) patient. The limitation of our study includes a small sample size and a lack of group randomization. Conclusions. The patient’s position on the supine position, during the implementation of PNL, is a safe technique and can be a particularly attractive option for the category of patients with high anesthesiological risk; in the case of planned simultane (transurethral and percutaneous) interventions on the UMP; in patients who are obese or with severe deformityof the spine.

Urolithiasis is one of the most common disease encountered in the daily practice of a urologist. Depending on the severity of the course, patients with urolithiasis and, in particular, kidney stones, are often required to have the surgical treatment. The greater problem is deemed to be staghorn nephrolithiasis and the choice of the optimal surgical technique for the elimination of kidney stones. The objective: to evaluate the efficacy and safety of the combined method of fragmentation of coral kidney stones in comparison with standard ultrasound lithotripsy. Materials and methods. A total of 352 percutaneous nephrolithotripsies (PCNL) were performed: 187 (53,1%) – patients who were diagnosed with staghorn calculi. The age of the patients ranged from 26 to 66 (mean age 42,5 years). There were 89 men and 98 women. 78 (41.7%) patients had previously undergone surgical treatment (open surgery or PCNL) of kidney stones, in which recurrent staghorn stones were subsequently identified. Nine (4,8%) patients had bilateral coral calculi. The size of the stone varied from 3,5 to 11,0 cm. Their density ranged from 300 to 1500 Hounsfield units. The most frequent complication of the underlying disease was chronic pyelonephritis – 145 (77,5%) patients. Hydronephrosis on the affected side was diagnosed in 98 (52,4%) patients. A combined pneumatic and ultrasonic lithotripter ShockPulse-SE from Olympus (Japan) was used for breaking kidney stones. We performed PCNL in a combined mode in 41 (21,9%) patients with staghorn nephrolithiasis. Results. In the group of patients using combined pneumatic and ultrasonic lithotripsy, complete removal of the staghorn calculus was achieved in 97,6% of cases (in 40 of 41 patients), whereas in the opposite group, using an ultrasonic lithotripter only in 84,9% (in 124 of 146 patients). The duration of the PCNL operation using the ShockPulse-SE device was from 35 to 130 minutes, on average – 48±5 minutes. The duration of the surgical intervention using an ultrasound lithotripter is from 90 to 180 minutes, an average –105±7 minutes. Blood loss during PCNL using an ultrasonic lithotripter was 200–400 ml, whereas with the ShockPulse-SE apparatus – 100–200 ml. An exacerbation of pyelonephritis was noted in 7 patients (in two patients after PCNL in a combined mode and in five after PCNL using an ultrasonic lithotripter). The mean length of patient hospitalization after surgery ranged from 4 to 10 days. At the same time, the average duration after PCNL using the combined ShockPulse-SE technique was 4±1 days, while after PCNL using an ultrasonic lithotripter it was 6±1 days. Conclusions. The combined technique of lithotripsy with a combined probe for simultaneous pneumatic and ultrasound lithotripsy has shown better results in terms of safety and efficacy compared to using only an ultrasound lithotripter. Used for decades, ultrasound lithotripsy for staghorn stone PCNL is both effective and safe moreover it’s a traditional technique. Thus, in comparison with ultrasound lithotripsy, the combined technique showed a shorter operation time, with less blood loss, a shorter length of patient hospitalization and less pyelonephritis in the postoperative period, as a result of maintaining a lower intrarenal pressure gradient during the operation. At the same time, the cost of the procedure using a combined probe was estimated, which turned out to be higher than traditional ultrasound lithotripsy. The use of combined lithotripsy with simultaneous aspiration of stone fragments is an indisputable advantage of this kind of PCNL in patients with staghorn nephrolithiasis, which brings the effectiveness of this technique closer to 100%.

РЕЗЮМЕ. Мета – підвищення ефективності лікування хворих із нейрогенними розладами сечовипускання. Матеріал і методи. Обстежено 56 хворих із нейрогенними порушеннями сечовипускання. Функціональний стан детрузора, внутрішнього сфінктера сечового міхура, зовнішнього сфінктера уретри визначали за допомогою електроміографічного дослідження. Електростимуляцію сечового міхура проводили за стимулювальною методикою з частотою 70 Гц, модуляцією 100 %, посилка-пауза 4–6 с, протягом 15 хв, курсом 2 тижні. Результати. Встановлено, що електроміографія відображає функціональний стан сечовивідних шляхів. Призначення електростимуляції дозволило досягти достовірної позитивної динаміки в клініко-функціональному стані пацієнтів. Висновки. Лікування пацієнтів із нейрогенними розладами сечовипускання за допомогою електростимуляції є ефективним.

The objective:to determine the effectiveness of herbal medicine, which includes yarrow, lovage root and rosemary leaves, hepatoprotector with field artichoke and intestinal dialysis (a mixture of electrolytes, macrogol and activated carbon) to normalize kidney function in patients with active tuberculosis (TB). Materials and methods.During 6 years, 738 patients from 6 till 81 years old with active TB of various localizations, including kidneys, were examined and treated. We evaluated symptoms, anamnesis, clinical, biochemical tests of blood, urine, glomerular filtration rate, bacteriological analysis, polymerase chain reaction for DNA of Mycobacterium tuberculosis, immunological studies, methods of radiological diagnosis (sonography, radiography, multislice computed tomography, magnetic resonance imaging, radioisotope method), endoscopic research methods with targeted aspiration and biopsy to obtain biological material. The participants of the research were divided into two groups: main and control ones. Patients in the main group (n=73) were prescribed herbal medicine, which includes yarrow, lovage root and rosemary leaves, hepatoprotector with field artichoke and intestinal dialysis (a mixture of electrolytes, macrogol and activated carbon). The patients in the control group (n=70) used only herbal medicine, which includes yarrow, lovage root and rosemary leaves and hepatoprotector with artichoke. Variation statistics methods were used to process the obtained data. Results.According to the result of the study, 68 (93.1%) patients out of 73 persons in the main group with active TB, had symptoms of the improvement. In the control group, only 37 (52.8%) patients reported positive results. In 68 patients of the main group, normalization of renal function was achieved: normalization of blood creatinine levels, glomerular filtration rate, reduction of protein, leukocytes, erythrocyturia. Conclusions.The proposed method of treatment of patients with active tuberculosis of different localization, including kidneys, on the background of antimycobacterial therapy is one of the possible treatment options. It is proved that normalization of renal function was determined in 93.1% of patients, which is on 40% higher compared to the control group.

Contains fulltext : 237261.pdf (Publisher’s version ) (Closed access) Adherence to national and international clinical practice guidelines is suboptimal throughout Europe. The European Association of Urology Guidelines Office project "IMAGINE" (IMpact Assessment of Guidelines Implementation and Education) has been developed to measure baseline adherence to urological guideline recommendations across Europe and to identify issues that drive nonadherence.

Extracorporeal shock wave lithotripsy (ESWL) has been used in the treatment of urolithiasis since 1980s. The method has proven to be effective and minimally invasive, but in last years the effectiveness of the method has decreased significantly from 90 % to 60 %. Studying of the causes of this phenomenon and methods of improving treatment outcomes are important problems of modern minimally invasive urology. The objective: to evaluate the effectiveness of the application of ESWL on Siemens Modularis Uro in the treatment of patients with ureterolithiasis. Materials and methods. ESWL was performed in 662 patients with ureteral stones ranging in size from 5 mm to 19 mm on Siemens Modularis Uro. Results. In 95.01 % of cases, the urinary tract was free of stones by the method of ESWL, the removal of stones in 1 session occurred in 376 (56.8 %) patients, with repeated – in 253 (43.2 %) patients. In 33 (4.99 %) patients the result of ESWL was unsatisfactory, fragmentation or elimination of stone fragments did not occur and for these patients ureteroscopy (ureterolithotripsy) was performed as second stage of treatment. During endoscopic intervention in 78.8 % of patients the fragmentation was satisfactory (fragments were smaller than 4 mm), but the elimination of fragments did not occur due to changes of the wall of the ureter in the area of its primary location. The overall rate of stone fragmentation after ESWL sessions in the patients in the trial was 98.94 %. Conducting ESWL with the proposed parameters did not affect the effectiveness of the method (p>0.1), but allowed to significantly increase the life of medical equipment. No complications directly related to lithotripsy were detected. Conclusion. The obtained results make possible to consider ESWL as a priority method of treatment for patients with ureteral stones up to 15 mm, taking into account the risk factors of inefficiency.

Derivatives markets have long ago started to be an important part of the global market in general and international monetary relations in particular. They make the process of risk management more advanced. It helps bringing the global monetary relations to a higher development level. Global trade in derivatives performs the functions of integration of regional capital markets and helps the global economy participants reduce available risks and concentrate on the further development of international trade and monetary relations. Therefore, the derivatives market contributes to reducing the risk level and balancing the international capital flow. Modern world trends in the derivatives’ market development are studied. The structure of the world derivatives market is determined with the separation of its exchange and over-the-counter parts. The instrumental structure of the market is analyzed with the separation of the most popular underlying assets among the derivatives market participants. The author notes that the share of interest rate and foreign exchange derivatives is constantly growing, with an advantage on the side of interest rate derivatives. The paper determines that there is a gradual shift of trade from exchanges to the over-the-counter market in the market of interest derivatives due to the passage of transactions through central counterparties, as well as the growing share of electronic and automatic trading. Analysis of the dynamics of foreign exchange derivatives reveals that contracts increasingly include currencies that do not belong to the top four (USD, EUR, JPY, GBP). At the same time, the US dollar remains the leading currency in operations with interest rate and foreign exchange derivatives. The cross-border operations with derivatives are analyzed. The paper proves that the global nature of the modern derivatives market can be supported by the recognition and implementation of global standards and the cooperation of regulators around the world.

The article dedicate to the problem of failure of extracorporeal shockwave lithotripsy in patients with ureterolithiasis and reveal the changes which appear in the ureter in the location of the stone.The aim. Analysis of the results of treatment in patients, suffering ureteric stones, using the ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy. Materials and methods. In 137 patients with ureteric stones, whom ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy was conducted, the symptoms of the disease, the diagnostic methods value, efficacy of surgical treatment and reasons of the failure of previous method of treatment were analyzed. Results. In 135 patients endoscopic removal of stones has been succeeded, in 2 patients because of total obliteration of the ureter, uretero-ureteral anastomosis has been performed. If the symptoms, with are characteristic of ureterolithiasis, persists up to one week stones don’t cause significant macroscopic changes to the ureter wall. If the stone persists in the ureter longer than a week we identified local appearing of oedema. Long–term (more than two months) ureteric stone persistence increase the risk of intramucosal “ingrowth” of the calculi greatly. Conclusion. The URS and ESWL are high effective and minimal invasive methods of surgical intervention for patients with ureterolithiasis, guaranteeing high level of postoperative “stone free rate”. Prolongation of the stone insertion time in the ureter causes the ureteric wall changes, complicating performance of minimal invasive interventions (ureterolithotripsy and extracorporeal shock–wave lithotripsy) and reduce its efficacy.

The objective:evaluation of the effectiveness and safety of percutaneous nephrolithotripsy in patients in the supine position. Materials and methods.For the period 2017–2021, 521 mini-PNL were performed according to the standard technique, where in 458 (87,9%) cases the operation was performed in the patient’s prone position, and in 63 (12,1%) cases on the supine position (group 1). The control group (2 group) consisted of 70 patients, sporadically selected among 458 patients to whom PML performed in a standard prone position. Mini-PNL was performed under combined regional (spinal-epidural) anesthesia in 98,7% (514) cases, in 1,3% (7) under endotrachial anesthesia. Results.The average time of surgery was 41,1±11,4 minutes in the 1st group and 57,4±10,3 minutes in the 2nd group (р0,05), stone-free conditions (96,4 vs. 98,2%; p>0,05) and average hospital stays (2,3 vs. 2,2 days; p>0,05). None of the patients in both groups had complications higher than Clavien IIIa. When performing PNL in the supine position, in contrast to performing PNL on the prone position, there is always the possibility of using combined endoscopic methods. Where 3 (4,8%) patients underwent combined retro- and antegrade approaches for combination of nephrolithiasis with «wedged» calculi of the pyelourethral segment and in distal ureter, and retrograde laser endoureterotomy was performed in one (1,6%) patient. The limitation of our study includes a small sample size and a lack of group randomization. Conclusions.The patient’s position on the supine position, during the implementation of PNL, is a safe technique and can be a particularly attractive option for the category of patients with high anesthesiological risk; in the case of planned simultane (transurethral and percutaneous) interventions on the UMP; in patients who are obese or with severe deformityof the spine.

Urolithiasis is one of the most common disease encountered in the daily practice of a urologist. Depending on the severity of the course, patients with urolithiasis and, in particular, kidney stones, are often required to have the surgical treatment. The greater problem is deemed to be staghorn nephrolithiasis and the choice of the optimal surgical technique for the elimination of kidney stones. The objective:to evaluate the efficacy and safety of the combined method of fragmentation of coral kidney stones in comparison with standard ultrasound lithotripsy. Materials and methods.A total of 352 percutaneous nephrolithotripsies (PCNL) were performed: 187 (53,1%) – patients who were diagnosed with staghorn calculi. The age of the patients ranged from 26 to 66 (mean age 42,5 years). There were 89 men and 98 women. 78 (41.7%) patients had previously undergone surgical treatment (open surgery or PCNL) of kidney stones, in which recurrent staghorn stones were subsequently identified. Nine (4,8%) patients had bilateral coral calculi. The size of the stone varied from 3,5 to 11,0 cm. Their density ranged from 300 to 1500 Hounsfield units. The most frequent complication of the underlying disease was chronic pyelonephritis – 145 (77,5%) patients. Hydronephrosis on the affected side was diagnosed in 98 (52,4%) patients. A combined pneumatic and ultrasonic lithotripter ShockPulse-SE from Olympus (Japan) was used for breaking kidney stones. We performed PCNL in a combined mode in 41 (21,9%) patients with staghorn nephrolithiasis. Results.In the group of patients using combined pneumatic and ultrasonic lithotripsy, complete removal of the staghorn calculus was achieved in 97,6% of cases (in 40 of 41 patients), whereas in the opposite group, using an ultrasonic lithotripter only in 84,9% (in 124 of 146 patients). The duration of the PCNL operation using the ShockPulse-SE device was from 35 to 130 minutes, on average – 48±5 minutes. The duration of the surgical intervention using an ultrasound lithotripter is from 90 to 180 minutes, an average –105±7 minutes. Blood loss during PCNL using an ultrasonic lithotripter was 200–400 ml, whereas with the ShockPulse-SE apparatus – 100–200 ml. An exacerbation of pyelonephritis was noted in 7 patients (in two patients after PCNL in a combined mode and in five after PCNL using an ultrasonic lithotripter). The mean length of patient hospitalization after surgery ranged from 4 to 10 days. At the same time, the average duration after PCNL using the combined ShockPulse-SE technique was 4±1 days, while after PCNL using an ultrasonic lithotripter it was 6±1 days. Conclusions.The combined technique of lithotripsy with a combined probe for simultaneous pneumatic and ultrasound lithotripsy has shown better results in terms of safety and efficacy compared to using only an ultrasound lithotripter. Used for decades, ultrasound lithotripsy for staghorn stone PCNL is both effective and safe moreover it’s a traditional technique. Thus, in comparison with ultrasound lithotripsy, the combined technique showed a shorter operation time, with less blood loss, a shorter length of patient hospitalization and less pyelonephritis in the postoperative period, as a result of maintaining a lower intrarenal pressure gradient during the operation. At the same time, the cost of the procedure using a combined probe was estimated, which turned out to be higher than traditional ultrasound lithotripsy. The use of combined lithotripsy with simultaneous aspiration of stone fragments is an indisputable advantage of this kind of PCNL in patients with staghorn nephrolithiasis, which brings the effectiveness of this technique closer to 100%.

The objective:to evaluate the effectiveness of portable pneumatic contact lithotripter LMA StoneBreaker in endoscopic contact ureterolithotripsy of ureteral stones of different localization depending on their density and search for opportunities to increase it. Materials and methods.Contact pneumatic ureterolithotripsy was performed in 89 patients (49 men, 40 women), 39 (43.8%) patients (I group) underwent standard contact pneumoureterolithotripsy, and 50 (56.2%) patients (11 group) – modified (with prior fixation of the stone in the ureter loop Dormia), which allowed urethrolithotripsy in situ and prevented the migration of stones and their fragments proximally. The number of strokes required to initiate fragmentation, complete fragmentation, and total ureterolithotripcy time for stones of different localization and density were determined. The integrity of the stones was determined by computed tomography in units of Haunsfield (HU). The mineral composition of stone fragments after their removal was diagnosed by X-ray diffraction analysis. The effectiveness of the applied methods was evaluated in groups of patients by complete (100%) removal of stone fragments from the ureter and by the number of cases of retrograde migration of stones into the renal cavity. Results.No intraoperative complications were observed. The number of strokes for the initial and complete disintegration of the stone, regardless of the method of ureterolithotripsy and their localization, depended on their density, ie its mineral composition. The minimum number of strokes for start and complete fragmentation of the stone was recorded in patients with a stone density of 480+54 HU and diagnosed as phosphates. Oxalate and uric acid stones, as well as their combinations (density 1310–1580 HU) required the maximum number of blows. Stone migration was noted in 8 (8.99%) patients. Thanks to intraoperative stone fixation was able to reduce the average time of lithotripsy (from 15,65±6.9 min to 12.3±6,15 min) and reduce the frequency of retrograde stone migration from 15.4% (in 6 patients of group 1) to 4% (2 patients of ІI group). The dependence of lithotripsy efficiency on stone localization is established. It was highest in patients with stones of the lower third of the ureter (95% in patients of group 1 and 100% of patients in group II) and with low density (480–840 HU). The lowest efficacy was observed in patients whose stones were localized in the upper third of the ureter (66.3% in group I and 90% in group II) and had a high density (more than 1200 HU). Due to the fixation of the stone with modified pneumoureterolithotripsy, the overall effectiveness of the method increased from 84.6% to 96%. Conclusions.Traneurethral contact pneumoureterolithotrysis using a portable pneumatic lithotripter LMA Stonebreaker – is effective, safe, minimally costly and easy to use. The effectiveness of contact pneumatic ureterolithotripsy depends on the location and density of the stone. The number of strokes required for the initial and complete fragmentation of the stone directly depends on the density of the stone and does not depend on its location and method of performing pneumoureterolithotripsy. The use of a modified technique with fixation of the stone in the ureter during the process of lithotripsy reduces the time of the operation and increases its effectiveness.

Urolithiasis (URL) is a common urological disease that often appears in the population, has a high recurrent rate and a significant impact on the social status of the population. Almost half of patients with URL disease are people with ureteric stones, 95% of which have secondary genesis. The main methods of treatment of such patients are extracorporeal shock-wave lithotripsy (ESWL) and ureterolithotripsy (URS). It is important in these cases to determine morphological changes (inflammation, edema, sclerosis, necrosis, etc.) that appear in the ureter in the placement of the stone and may reduce the effectiveness of minimally invasive treatment or/and removal of fragments during URS. The objective:studying morphological changes of the ureter wall in patients with ureterolithiasis in the zone of the calculus in dependence of the duration of clinical manifestations. Materials and methods.We have studied histological changes of the ureter wall in the location of the stone in patients with ureterolithiasis. We explored the ureter wall in patients depending on duration of typical manifestations of ureterolithiasis, which were 7-en days long, 30 days, and more than 2 months. Results.If the stone in the ureter is up to 7 days, it does not cause significant microscopic changes of the ureter wall. If the stone been in the ureter during 1 month, more significant morphological changes are determined with desquamation of the urothelium, edema and inflammatory changes in the submucosal membrane. In case of the duration of the calculi in the ureter is more than 2 months, we noted the exfoliation of the urothelium with the denudation of the basement membrane. In the submucosal layer there is an edema, diffuse disorganization of connective tissue fibers, fragments of growth of granulation tissue and dense connective tissue in the form of separate layers. Conclusion.With increasing duration of the disease in the wall of the ureter increases the manifestations of inflammatory, sclerotic and necrotic changes. Such changes have a direct impact on the quality of visualization of the calculus during endoscopic interventions, the rate of fragmentation and extraction (elimination) of fragments, as a consequence, increase the overall duration of the operation and the risk of intra- and postoperative complications.

Extracorporeal shock wave lithotripsy (ESWL) has been used in the treatment of urolithiasis since 1980s. The method has proven to be effective and minimally invasive, but in last years the effectiveness of the method has decreased significantly from 90 % to 60 %. Studying of the causes of this phenomenon and methods of improving treatment outcomes are important problems of modern minimally invasive urology. The objective: to evaluate the effectiveness of the application of ESWL on Siemens Modularis Uro in the treatment of patients with ureterolithiasis. Materials and methods. ESWL was performed in 662 patients with ureteral stones ranging in size from 5 mm to 19 mm on Siemens Modularis Uro. Results. In 95.01 % of cases, the urinary tract was free of stones by the method of ESWL, the removal of stones in 1 session occurred in 376 (56.8 %) patients, with repeated – in 253 (43.2 %) patients. In 33 (4.99 %) patients the result of ESWL was unsatisfactory, fragmentation or elimination of stone fragments did not occur and for these patients ureteroscopy (ureterolithotripsy) was performed as second stage of treatment. During endoscopic intervention in 78.8 % of patients the fragmentation was satisfactory (fragments were smaller than 4 mm), but the elimination of fragments did not occur due to changes of the wall of the ureter in the area of its primary location. The overall rate of stone fragmentation after ESWL sessions in the patients in the trial was 98.94 %. Conducting ESWL with the proposed parameters did not affect the effectiveness of the method (p>0.1), but allowed to significantly increase the life of medical equipment. No complications directly related to lithotripsy were detected. Conclusion. The obtained results make possible to consider ESWL as a priority method of treatment for patients with ureteral stones up to 15 mm, taking into account the risk factors of inefficiency.

Introduction: Placement of a nephrostomy tube at the conclusion of percutaneous nephrolithotomy (PCNL) has been traditionally considered a standard practice. However, in the past decade, t...