Stages of development of surgical treatment of staghorn nephrolithiasis

Abstract

The results of treatment of patients with staghorn nephrolithiasis for the period from 1974 to 2015 were analyzed. Particular attention was paid to patients with staghorn nephrolithiasis in stage K4, which was 1907 people. The analysis time was divided into three periods: 1974–1991 – period of traditional surgical interventions with a traditional incision in the lumbar region; 1991–2006 – with the use of ESWL; 2006–2015 – a period of minimally invasive interventions. All patients underwent a thorough general clinical examination, ultrasound and radionuclide research, plain and intravenous urography, as well as spiral CT. Contact lithotripsy was performed using surface active substances (surfactants), in the patient’s position on the abdomen. The use of surface active substances in contact lithotripsy made it possible to reduce the disaggregation time of the stone by a factor of 1.5–2. For minimally invasive interventions the equipment of Karl Storz and R. Wolf was used. Endoscopic dilatation of the puncture fistula allows to gain access to staghorn stone with minimal losses. Our studies has shown the advantage of modern minimally invasive methods of treatment, which is confirmed by a reduction in the period of inpatient treatment. To date, the effectiveness of endourologic treatment of large and staghorn stones in our clinic has reached 92%. The medicamentous perioperative reno-protective intensive therapy made it possible to facilitate the recovery period of the function of the operated kidney. Medicated renoprotective therapy at all stages of treatment of patients was aimed at preventing reperfusion injuries, improving circulation conditions in the microcirculation system of the ischemic kidney, reducing the intensity of the exudative and inflammatory process, which made it possible to reduce the number of blood transfusions in solving coral nephrolithiasis problems.