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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.

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%.

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.