ABSTRACT
Retro- and prospective analyses of 802 case histories of patients with nephrostomic drainage (n=272), ureteral catheter (n=27) and ureteral stent (n=503) treated for urolithiasis in the urological department of M.F. Vladimirsky Moscow Region Research Clinical Institute and Zhukovsky city hospital hospitalized in 1995 to 2009 made it possible to develop algorithms of choice of upper urinary tract drainage depending on clinical and laboratory indices. Nephrostomic drainage is preferable in a single functioning kidney, acute obstructive pyelonephritis, anuria, hyperthermia above 38 degrees C, marked supravesical urodynamic disorder, in renal failure, serum creatinine over 200 mcmol/l, urea over 10 mmol/l, blood potassium over 5 mmol/l, uric acid over 380 mcmol/l and leukocytosis over 8 x 10(9) l. Draining with ureteral stent was used primarily in elective surgery--extracorporeal shock-wave lithotripsy and transurethral operations. Stenting was better tolerated and entailed less frequent complications. In the rest cases choice of drain method should be made by the urologist. In active inflammation, before getting antibioticogram, the drain should be followed by antibiotic treatment with fluoroquinolones, cephalosporines of the third or forth generation, aminoglycosides, carbapenems in standard doses.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Drainage , Stents , Urolithiasis/therapy , Age Factors , Aged , Female , Humans , Middle Aged , Prospective Studies , Retrospective Studies , Russia , Urolithiasis/bloodABSTRACT
The analysis of the results of examination and treatment of 510 urolithiasis patients with organic infravesical obstruction (IVO) treated in the urological clinic of M. F. Vladimirsky Moscow Regional Research Clinical Institute and in the urological department of Zhukovsky city hospital from 1995 to 2009 made it possible to arrive at the following conclusions: the above patients have obstruction symptoms in 100% cases, irritative symptoms--in more than 2/3 of the patients; combined use of low invasive, endoscopic and open methods reestablishes urodynamics of the lower urinary tract in more than 90% patients; the decision on the treatment policy and techniques depends on severity of clinical symptoms caused by IVO and urolithiasis as well as disturbance of upper and lower urinary tract urodynamics. In adequate choice of the patients and correct indications combined use of low invasive, endoscopic and open methods provides good treatment effect in patients with IVO and urolithiasis.
Subject(s)
Urinary Bladder Neck Obstruction/diagnosis , Urinary Bladder Neck Obstruction/surgery , Urolithiasis/diagnosis , Urolithiasis/surgery , 5-alpha Reductase Inhibitors/administration & dosage , 5-alpha Reductase Inhibitors/therapeutic use , Adrenergic alpha-1 Receptor Antagonists/administration & dosage , Adrenergic alpha-1 Receptor Antagonists/therapeutic use , Aged , Combined Modality Therapy , Humans , Male , Minimally Invasive Surgical Procedures , Treatment Outcome , Urinary Bladder Neck Obstruction/complications , Urodynamics , Urolithiasis/complications , Urologic Surgical Procedures, MaleABSTRACT
The paper deals with a complex sociohygienic study of the basic indices of resource provision of the public health system in the Tver Region and with an analysis of the scope of inpatient care to the population of the Torzhok District, Tver Region. Based on an in-depth examination, the efficiency of the use of the bed fund of the central district hospital (CDH) was evaluated and economic losses from inadequate use of beds and economic effects of work of daily CDH-based hospitals were calculated.
