[Successful treatment of an infant with a rare anomaly: iliosacral dystopia of the right kidney and obliteration of the left distal ureter].

In the article a rare case of structural anomaly of ureter, namely obliteration, in 1-year-old infant is reviewed. The obliteration was located in the distal part of the left ureter. There was urine leakage through dilated and inflamed wall of the ureter towards right gluteal region with a formation of retroperitoneal abscess. A diagnosis was established based on preoperative MRI and intraoperative antegrade pyeloureterography. Extravesical Lich-Gregoir ureterocystoneostomy was successfully performed.

[Results of laparoscopic ureterolithotomy depending on the type of laparoscopic approach and location of the stone].

AIM: To investigate the results of laparoscopic management of patients with ureterolithiasis, depending on the type of laparoscopic approach and location of the stone. MATERIALS AND METHODS: This study is a retrospective analysis of 30 ureterolithiasis patients who underwent laparoscopic ureterolithotomy from 2010 to 2015. Patients were divided into four subgroups depending on the type of laparoscopic approach - transperitoneal (n=17) and retroperitoneal (n=13) and on location of stones - upper ureteral stone (n=20) and mid ureteral stone (n=10). The patients comprised 23 (76.7%) men and 7 (23.3%) women aged from 18 to 68 years (mean age 46.2+/-2.3 years). 15 patients had stones in the right and 15 in left ureters. The groups were comparable by sex, age, the severity of hydronephrosis, body mass index, duration of urolithiasis, comorbidities and previous surgeries (p>0.05). RESULTS: There were no deaths, conversion to open surgery or intraoperative complications. The only statistically significant difference between transperitoneal and retroperitoneal approaches was the absence of postoperative complications (p<0.05). The duration of drainage and hospital stay was significantly shorter in patients with mid ureteral stone than in patients with upper ureteral stone (p<0.05). CONCLUSION: Surgical management of patients with ureterolithiasis of various locations using laparoscopic ureterolithotomy by different approaches showed positive results of in all cases thus indicating high clinical effectiveness of this method.

[The choice of surgical modality to treat patients with staghorn nephrolithiasis].

AIM: Improvement in the results of the treatment of patients suffering from staghorn and multiple nephrolithiasis, using open method of surgery and a retrospective analysis of the surgical data. MATERIAL AND METHODS: There was executed asurgical treatment of the 730 patients with staghorn and multiple nephrolithiasis in the period from 1998 to 2012. 480 of the patients had one-sided staghorn stones and 250 of them had double-sided staghorn stones. Age of the patients varied from 4 to 76 years old (average - 49). There were 351 men (48,0%) and 379 women (51,9 %). 290 (39,8%) patients had only staghorn stones, but 440 (60,2%) patients suffered from staghorn stones combining with multiple ones. RESULTS: There were executed 1065 surgical operations at the 730 patients. There was used pyelotomy and nephrolithotomyfor the purpose of the ablation of stones. Nephrostomy was placed on the right of the 116patients (15,8%), on the left - 93patients (12,7%), pyelostomy on the right - 46 patients (6,3%), on the left - 31patients (4,2%), intrarenalstent on the right - 181 patients (24,7%), on the left - 167patients (22,8%), stent and nephrostomy on the right - 29 patients (3,9%), on the left - 6 patients (0,8%). Surgical operations of 184 patients (25,2%)fulfilled throughcross-clamping of the nephritic artery.Cross-clamping time of the nephritic artery in average was 16.5 minutes (5-50), average duration of the surgical operation - 2,6 hours (1,5-6), intraoperative hemorrhage - 110 ml (50-300). During the re-examination there was found that 175 patients (23,9%) had recurrent stones.During first ten years after operation there were found recurrent stones at 238 patients (32,6%), 100 (13,6%) of them had the second operation. CONCLUSION: Taking into account that minimally invasive methods of the staghorn and multiple nephrolithiasistreatment is ineffective and demand a few courses of medical treatment, open surgical operations still have a leading positions as they create extensive possibilities for the favorable and safe revision of the kidney during ablation of stones.

[Laparoscopic radical nephrectomy].

OBJECTIVE: Evaluation of retrospective results of treatment of patients with kidney cancer, who have undergone a laparoscopic or a retroperitoneoscopic radical nephrectomy. MATERIALS AND METHODS: We have conducted a retrospective analysis of 185 patients with kidney tumour, who have undergone a laparoscopic or a retroperitoneoscopic radical nephrectomy during 2010-2015. Amongst the participants there were 116 men (62.7%) and 69 women (37.3%) aged 29-86 (average age of 58.1 years). 150 patients (81.1%) have performed radical nephrectomy by transperitoneal access, while 30 patients (16.2%) experienced identical process through retroperitoneal access. 5 cases (2.7%) hybrid technique was utilized. 97 patients performed nephrectomy on the right side, 88 patients on the left side. 178 patients (96.2%) had a single kidney tumours, while 7 (3.8%) had multiple tumours ranging between 2-8. 15 patients, who experienced a laparoscopic radical nephrectomy, had a thrombus in kidney vein (level 1 under Mayo classification). 1 patient had a thrombus in vena cava (level 2). RESULTS: Only one of the patients suffered a fatal outcome. 12 patients (6.5%) had a conversion. The duration of operation ranged between 50-215 minutes (average of 104.3 minutes), time of insufflation ranged between 36-205 minutes (average of 96.2 minutes). Average intraoperative blood loss constituted 147.8 ml. Patients spent 2-18 days (average 4.1 days) in the hospital after the surgery. CONCLUSION: There is an obvious advantage to utilizing a laparoscopic or a retroperitoneoscopic intervention in order to treat kidney cancer. The process constitutes minimal invasiveness, low death rates, minimal intraoperative blood loss and fast rehabilitation of the patients. 72% of patients who have who have experienced surgical intervention, such as radical nephrectomy, spent only 3-4 days in the hospital.