[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.

[Peculiarities of upper urinary tract drainage during surgical treatment of staghorn and multiple nephrolithiasis].

This work was designed to evaluate methods of kidney drainage used in the surgical treatment of 250 patients with staghorn and multiple nephrolithiasis (SMN). All of them underwent open surgery that was followed by drainage of the upper urinary tract in 192 patients. Internal stenting was used in 111 cases, pyelostomy in 28, nephrostomy in 47, and internal stenting with nephrostoma in 6 cases. 91 and 20 patients had a stent inserted into the upper urinary tract in a retrograde and antegrade manner respectively. Retrograde stenting was bilateral in 14 and unilateral in 66 cases. 85% of the cases with ureter stents were followed up as outpatients for 4-5 weeks and only 10% for 6-7 weeks. Forty and ten patients with stents presented with marked dysuria and hematuria respectively. On the whole, combined antibacterial treatment with drainage of the upper urinary tract significantly improved long-term results of SMN treatment. It is concluded that nephrostomy and pyelostomy should be performed on days 14-18 and 10-12 respectively whereas the stent needs to be removed between weeks 2 and 8 after surgery.