[The efficiency of combined methods of lithotripsy for ureteral stones].

Extracorporeal shockwave lithotripsy (ESWL) is the first line treatment of uncomplicated upper ureteral stones. Ureterorenoscopy with contact lithotripsy (URS) are useful for middle and lower ureteral stones. However, the presence of residual calculi, the stone fragments migration and the formation of "steinstrasse", when using those methods separately, prompts employing combination of lithotripsy modalities. The aim of this article is to find out the optimal combination of stone disintegration methods. The study compared the use of lithotripsy as stand - alone methods with their combined application. All patients were divided into 3 groups: group 1 - 131 patients with lower ureteral stones, group 2 - 45 patients with middle ureteral stones, group 3 - 48 patients with upper ureteral stones. A secondary intervention was required in 9.2% of cases with lower ureteral stones, in 51.1% of cases with middle ureteral stones and 43.75% of cases with upper ureteral stones. In our cases such number of patients required repeated interventions are most likely associated with frequent stone migration in pyelocaliceal system and residual stones after ESWL. On the other hand, it is related to achieve of urinary tracts "stone free condition" within one hospitalization in accordance with recent guidelines. The effectiveness of extracorporeal shockwave lithotripsy is significantly affected by the composition of the stones. Usage flexible ureterorenoscopy and percutaneous nephrolithotripsy based upon laser lithotripsy enables to achieve clinical effectiveness regardless of the density and location of the stones.

[Prospects for using biological markers in various types of urinary stone lithotripsy].

AIM: To investigate the feasibility of using biological markers for determining the optimal timing to repeat lithotripsy of urinary stones. MATERIALS AND METHODS: This was a prospective, randomized, single-center cohort study of 100 patients randomized into 4 groups. Patients of group I (n=46), II (n=20), III (n=18) and IV (n=16) were used contact lithotripsy (URS), ESWL, PNL, combined lithotripsy. In all patients, before surgery and at 1, 7, 14, 20 days after lithotripsy, iron-induced urine chemiluminescence was measured to determine the level of reactive oxygen species (ROS) and concentration of medium-mass molecules (MMM) in urine. RESULTS: Analyzing the time of operation and the size of stones only in group I was detected the significant negative correlation (r=-0,479, p<0,05). In patients of all groups, the level of ROS have decreased after the surgery with further returning to baseline level. Dynamics of changes MMM in urine has not revealed a reliable change tendency. CONCLUSION: The definition of the quantity of ROS in urine is a promising criterion in measuring the degree of urinary system damage and the time for repeated lithotripsy. The level of ROS in the urine after URS, ESWL and the ESWL-URS combination returns to baseline on the 7th day and after PNL on the 14th day postoperatively, thus allowing to pathogenetically define the optimal timing of repeat lithotripsy.

[Results of therapy in different groups of risk for superficial bladder cancer].

Approximately 10.0% of tumors occurs in the lower urinary tract and morbidity and lethality are constantly on the rise. Over 90% of such tumors registered in Europe and the USA is transitional cell carcinoma. Primary bladder cancer morbidity in Russian males rose by 4.0-4.6% in 1990-1997 while the share of patients with superficial bladder cancer (SBC) went up by 1.5% for the same period. According to the National Bladder Cancer Group, the rising incidence of relapsing SBC is associated with urothelial dysplasia, positive test for urinary sediment after therapy and occurrence of four or more tumors larger than 5 cm. Prevention of muscular invasion is vital in management of SBC. Sometimes, such aggressive modalities as early cystectomy or radiotherapy are recommended in cases of high risk for this pathology. Conversely, certain palliative measures, short of transurethral resection of the bladder and adjuvant intravesical therapy, are regarded as sufficient.