[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.

[Determining factors of effectiveness of extracorporeal shock wave lithotripsy in ureteral stones: results of own investigation].

The purpose of the present study is to investigate main determining factors of effectiveness of extracorporeal shock wave lithotripsy (ESWL) in urethral stones and the influence of these factors on the number of necessary sessions of ESWL procedure. The problem presents a special interest for insurance medicine, as the number of sessions has a direct impact on the cost and length of treatment. The present investigation included 162 patients with urolithiasis having stones in urethra. To find out determining factors of effectiveness of ESWL in urethral stones the following factors were considered: size, localization, radioopacity of stone, its duration of stay in urethra, the degree of dilation of upper urinary tract. The influence of mentioned factors on the number of necessary ESWL sessions was investigated. On the basis of the present study a conclusion can be made that the principal factors determining the clinical efficacy of ESWL in urethral stones are the stone size, condition of upper urinary tract and radioopacity of stone. The level of localization of the stone in urethra has no influence on ESWL efficacy. Therefore in case of large size stones, their long stay in urethra and significant disorders of urodynamics in upper urinary tract, in marked radioopacity of stones more than one session of ESWL is required. In such cases, we recommend to consider other less invasive methods of treatment of urethral stones (ureterorenoscopy or percutaneous urethra lithotripsy).

[Probability of development of "steinstrasse" depending on the number of extracorporeal shock wave lithotripsy in ureteral stones].

One of the complications of extracorporeal shock wave lithotripsy (ESWL) is the urethral obstruction by large stone fragments and formation of "steinstrasse". The present study aims at the investigation of the probability of development of "steinstrasse" depending on the number of ESWL sessions in urethral stone treatment. 162 patients with urinary tract stone disease having urethral stones were included in the present study. Based on the results of the present study it is stated, that the probability of formation of "steinstrasse" increases along with the number of ESWL sessions. Therefore, in such cases more intensive follow-up is necessary after ESWL for prompt detection of "steinstrasse" formation and prevention of possible complications.