[Rentgenoendoscopic surgery of the complicated forms of urolithiasis with accompanying diabetes mellitus].

The successful application of endoscopic contact lithotripsy and nephrolithoextraction allows saving the patients from staghorn stones without having recourse to traumatic open surgical modalities. Percutaneous removal of staghorn stones with the use of rigid-lens nephroscopes presents as an effective and less-invasive treatment option with minimal amount of intra- and postoperative complications, which is particularly important in case of presence of accompanying diabetes mellitus.

[Characteristic of cytopathological changes in urine after extracorporeal shock wave lithotripsy].

The aim of the study is to assess the damage to the urothelium caused by shock waves through cytological examination of the urinary sediment in patients who had ESWL. Study included 100 otherwise healthy first-time stone-formers aged 20 to 50, who underwent ESWL on Modulit SLK machine. Urinary samples were taken before and immediately after ESWL, in two days and on the fourth day after ESWL. Control group included 20 healthy individuals. The urine was centrifuged, smears fixed by conventional MGG method and stained by azure-eosine using Pappenheim's method. Cytogram data analysis was performed using morphometric methods, allowing for qualitative and quantitative cell characteristics be translated into digital form. Student t-criteria was used for statistical evaluation of the difference of derived figure parameters. The authors put the stress on destructives processes. In order to rule out biased assessment of the cytograms, morphometric examination of urinary sediment was performed. Averaged value of the total cell index was calculated with one of the forms of cytopathology and deduced heterogeneity of cytological indices within a particular group X(cell)/ Σep (X(cell) where is the average value of the total cell index with one of the forms of cytopathology within the whole sampling, Sep is the total number epithelial cells). The sum of absolute indices of cytological changes is considered as "destruction index" (DI), which reflects accumulated pathological changes in epithelial cells: DI=X(1)/Σep + X(2)/Σep Immediately after ESWL a statistically valid (p<0.01) significant increase in DI is registered. In two hours after the session DI is decreased, but remains rather high, and almost normalizes by the fourth day. We also explored the specificity particular for each term of examination, expressed by cytological changes. Examination of indices of heterogeneity within a group with moderately expressed destructive changes (X(1)/Σep) revealed that these digital values even in healthy men are slightly above zero (0.15 ± 0.03). Just after ESWL values rise to 0.6 ± 0.1, then slowly decrease to 0.4 ± 0.1 (2 hours after) and 0.25 ± 0.07 (four days after). As to parameters specific to deep cellular changes (X(2)/Σep), it is equal to zero healthy men, rises after ESWL, then decreases in two hours and almost normalizes by fourth day. Digital values for this parameter are several orders lower than for parameters of cells with moderate changes. Study results indicate that epithelial lining of the upper urinary tract undergoes cytopatho-logical changes of different degrees, still they are of transitory and reversible nature, which is proven by urinary sediment cytogram performed on the fourth postprocedure day.

[The role of intraoperative pyelocaliceoscopy in the treatment of patients with staghorn and multiple kidney stones].

The surgical treatment of 36 patients with coral-like and multiple nephrolithiasis have been analyzed. The obtained data demonstrate that intraoperative pyelocaliceoscopy in addition to the "open" pyelolithotomy significantly facilitates the revealing and the removal of the stones; shortens the time of the operation; allows to avoid very traumatic nephrotomic sections during complete stone removal (94.4%), and may be recommended in routine urologic practice.

[The dynamics of pyelonephritic process activity indices after extracorporeal shock wave lithotripsy in patients with coral-like nephrolithiasis].

The parameters of pyelonephritic activity before and after extracorporeal shock wave lithotripsy (ESWL) have been analyzed in 68 patients with coral-like nephrolithiasis. The obtained data allow recommending ESWL treatment without preliminary draining of upper urinary tract only in patients with stable clinical and laboratory remission of inflammatory process. In all other cases, ESWL is recommended after upper urinary tract draining for the prophylaxis of the pyo-septic complications.