The thesis presents a solution to a topical problem of improving treatment results and reducing the number of complications in patients with non-staghorn kidney stones by substantiating the tactics of using modern methods of minimally invasive treatment, depending on the size and density of the stone.
To achieve this goal, we examined patients with non-staghorn kidney stones who underwent extracorporeal shock wave lithotripsy, flexible ureterorenoscopy and contact laser lithotripsy, as well as mini-percutaneous nephrolithotripsy.
A total of 1107 patients were examined, 316 of them were examined by the method of shock wave lithotripsy. The treatment of 624 (56.4%) patients was carried out by flexible ureteroscopy. 167 (15.1%) patients were treated by the method of mini-percutaneous nephrolithotripsy.
Extracorporeal shock wave lithotripsy as a method of treating patients with kidney stones is quite effective in patients with stones no more than 10 mm in size and stone density up to 1200 HU. If a stone density is more than 1200 HU and its size is up to 10 mm, the effectiveness of this treatment method decreases due to the need to increase the number of extracorporeal shock wave lithotripsy sessions to 3, and to increase the duration of the fragments to 64 days.
The obtained results showed that flexible ureterorenoscopy in combination with contact laser lithotripsy is a highly effective method of treating patients with non-staghorn nephrolithiasis with stones of any density. In laser lithotripsy, the rate of destructing stones depends on the stone size, not on its density. At the same time, if a stone size is more than 16 mm, regardless of its density, the duration of flexible ureterorenoscopy gradually increases, reaching 72-87 minutes with a size of 28-29 mm. If a stone size is 30 mm or more, the duration of flexible ureterorenoscopy is 85-144 minutes. With such a duration of the intervention, the risk of intra- and postoperative complications increases, it is much more difficult to achieve the main goal of the operation and to obtain the status of "stone-free", that is, the advantages of minimally invasive surgery are lost.
With a kidney stone size of more than 1.5 cm, it is efficient to use other well-known, but more traumatic methods of surgical treatment, letting carry out the most effective treatment of patients with kidney stones.
The thesis scientifically substantiated the criteria and expediency of extracorporeal or intracorporeal retrograde disintegration of non-staghorn kidney stones, depending on their size and density.
The obtained results proved the dependence of the effectiveness of minimally invasive methods for the removal of non-staghorn kidney stones on its size, density, and the time of surgical intervention with minimal impairment of kidney function and blood flow.
We showed the effectiveness of flexible ureterorenoscopy in combination with contact laser lithotripsy in the treatment of patients with non-staghorn kidney stones up to 2 cm in size at any density. The number of complications depends on the size of the stone.
The research results substantiated the dependence of renal blood flow disturbances on the number of extracorporeal lithotripsy sessions, and the time of flexible ureterorenoscopy in combination with contact laser lithotripsy. We also scientifically grounded the time limit and the number of extracorporeal shock wave lithotripsy and flexible ureterorenoscopy sessions.
The developed algorithm of the optimal method for the removal of non-staghorn kidney stones, depending on the stone size, its density, using modern minimally invasive methods of destruction and removal of stone fragments, let us differentiate the treatment of urolithiasis, reduce the number of complications and improve the results.
