[Renal function after surgical treatment of stag-horned nephrolithiasis].

Renal function in patients with stag-horn nephrolithiasis was assessed after two surgical treatments--percutaneous nephrolitholapaxy (PCN L) and pyelonephrolithotomy. The function of the operated and contralateral kidneys was studied early and late after operation by parameters of blood biochemistry, Doppler investigation of renal parenchyma, dynamic nephroscintigraphy. Stabilization or improvement of blood biochemical indices was observed in 58 (70%) patients. A secretory renal function late after surgery (from 6 months to 2 years) evidenced for improvement or stabilization of renal function (according to radionuclide test) in 71 (85.5%) patients. Integral parameters of renal blood flow were physiological or improved versus preoperative ones. PCNL was made in patients with deficient secretion less than 70%, 35 (87.5%) patients were diagnosed to have stabilization or functional improvement. After open intervention functional improvement took place in 11 (25.6%) patients, stabilization of renal function occurred in 25 (58.1%) patients. Tubular secretion deterioration was seen much more frequently in patients after open intervention. PCNL is less invasive surgical intervention than pyelonephrolithotomy as this technique produces milder surgical trauma and does not result in intraoperative renal ischemia. PCNL is the most effective surgical modality in stag-horn concrements of the kidneys and significantly expands potential of low-invasive treatment of such patients.

[Surgical treatment of coral nephrolithiasis: analysis of complications].

Coral nephrolithiasis (CN) patients treated surgically in Research Institute of Urology and hospital N 47 from 2005 to 2008 were divided into 5 groups by treatment: PCNL, PCNL+extracorporeal lithotripsy (EL), EL, open interventions, EL of the residual concrements after previous open operations. Most complications were observed after EL and they were caused by evacuation of many fragments. PCNL caused in some cases massive hemorrhage stopped by conservative methods. Open operations can effectively remove concrements in one stage but sometimes entail such severe complications as damage to adjacent organs, pleura or abdomen, hemorrhage, exacerbation or progression of chronic pyelonephritis. Results of combined surgical interventions (PCNL+EL) and EL of residual concrements after open surgery are comparable with those of EL as monotherapy if the schedule of repeat sessions is observed and saving regimens of fragmentation are used.