[Psycho-emotional, vegetative-vascular and nephrological determinants of maladaptive stress in persons undergoing nephrectomy for renal cell carcinoma].

Operational stress is a combination of syndromes that can affect renal function in patients undergoing nephrectomy and affect the course of both the early and late postoperative periods. OBJECTIVE: to assess the relationship of psycho-emotional and autonomic stress with changes in the functional state of the kidney in patients undergoing nephrectomy for kidney cancer. MATERIALS AND METHODS: The clinical study involved 75 patients (mean age 64+/-3 years, stage 1 CKD) who underwent nephrectomy for localized kidney cancer. In patients of the study group (n=45) before surgery and in the early postoperative period on the 1st, 7th and 14th day, somatic and psychoemotional statuses were studied using the Zung scale, Kerdo index, and glomerular reaction rate estimates. Group control (n=30) of patients who underwent nephrectomy 12 months ago, with the results of clinical studies, as a result of which there were no clinical, laboratory and radiological diseases of a single kidney. The results of biochemical, autonomic and functional tests in this group of patients were taken as the conditionally normal rate characteristic of patients undergoing nephrectomy. RESULTS: In the course of the correlation analysis, when comparing the degree of anxiety of patients after nephrectomy (estimated by SBT according to the Tsung Anxiety Scale) with the calculated Kerdo vegetative index (VIC), a statistically significant positive relationship was found between them, especially pronounced during the first 7 days of the early postoperative period. At this time, the vegetative mediated by vasculogenic factors adaptation progressively worsened (VIC increased), while the GFR of a single kidney significantly decreased. CONCLUSION: Operational stress, together with all other predictors, may be a risk factor for the development of acute renal failure in the early postoperative period and the progression of CKD in the late period after surgery.

[Case report of rare co-occurrence of renal cell carcinoma and crossed renal dystopia (L-shaped kidney)].

L-shaped kidney refers to a rare anomaly of the relative kidney positioning. Due to low prevalence, the literature on the co-occurrence of this anomaly with malignancy is lacking. And, if the diagnosis of a renal anomaly does not present difficulties, if a tumor is detected in such a kidney, even MSCT does not always help differentiate a pelvic tumor from a tumor of the renal parenchyma spreading to the pelvicalyceal system. This has important implications for choosing an appropriate surgical strategy. A feature of the presented clinical observation is the co-occurrence of the rare anomaly of kidney position and locally advanced renal cell carcinoma spreading to the renal pelvis. Due to the massive spread of the tumor, an organ-sparing surgery was not feasible. Due to the suspicion of tumor spread to the renal pelvis, the patient underwent nephrureterectomy of the L-shaped kidney. Introduction to renoprival state with transfer to chronic hemodialysis became the only option to maintain homeostasis and extend the patients life. Histological examination revealed clear cell renal cell carcinoma with invasion of the pelvis and renal capsule, with no clear demarcation between the fused kidneys.

[FIRST EXPERIENCE OF ENTEROPLASTY OF EXTENDED URETHRAL STRICTURE. CLINICAL CASE].

Restoration ofpatency ofthe upper urinary tract in the extended lesions is a complex urological problems whose solution can significantly improve the quality of life of patients, and allows to avoid patient's disability. In the urological department of regional clinical hospital, for the first time we performed the plastic reconstruction of the left ureter for its extended (7 cm) stricture using segment of ileum, with good results in the early postoperative period. Restoration of the natural passage ofurine allows to hope for a good functional outcome in the long-term period.

[Factors of ischemic lesions in the kidney and its resection].

Resection of kidney is an organ-sparing operation finding an increasingly wider application. It is designed to preserve the maximum amount of functionally competent renal parenchyma. However, surgery produces multiple effects on the kidney resulting in ischemic lesions and dysfunction which has serious consequences for the clinical course of the early post-operative period and long-term outcome of the treatment. The causes and after-effects of ischemia are considered, much attention is given to its pathogenetic mechanisms and the process of healing of renal parenchyma depending on the surgical modality and method of hemostasis.