Slabyy O. The synchronous bilateral transcutaneous nephrolithotripsy in the treatment of bilateral nephrolithiasis

The dissertation is dedicated to solution of the actual scientific problem of clinical urology – improving the effectiveness of treatment results of patients with bilateral nephrolithiasis by applying the bilateral percutaneous nephrolithotripsy, based on a comprehensive study of the criteria for its implementation in the dynamics. The comparative results of the surgical treatment of patients with the bilateral nephrolithiasis by different types of lithotripsy were studied; the advantages of the single-step bilateral transcutaneous nephrolithotripsy were proved. It was established: the anatomical prerequisites of performing the low-invasive methods of treatment of patients with the bilateral nephrolithiasis; the presence of coral-shaped, dense, large-sized renal concrements (more than 20mm); the significant decrease of renal function; infected recurrent renal concrements. The high effectiveness of a single-step bilateral transcutaneous nephrolithotripsy in the treatment of the bilateral nephrolithiasis was substantiated. The single-step nephrolithotripsy proved to be less traumatic for a patient in comparison with the two-step nephrolithotripsy. The carried-out investigations made it possible to circumscribe the indications and contraindications as to performing the transcutaneous nephrolithotripsy (coagulopathies that are resistant to medicamentous or instrumental therapy, anatomical changes of the urogenital system, exacerbation of pyelonephritis, nephrosclerosis, the presence of the organically-based reason of lithogenesis, potentially malignant tumour of the kidney). The high informativeness of indices of radioisotope renography before and after the procedure of transcutaneous bilateral nephrolithotripsy was proved; it allows to monitor the condition of secretory an excretory functions of kidneys. It was calculated and compared the total expenses, concerning the treatment of a patient with bilateral nephrolithiasis during the single-step and two-step transcutaneous nephrolithotripsy. It is established that the total cost price of the overall treatment of the patient for a single-step transcutaneous nephrolithotripsy in the urological units of the Western region according to the U-DRG system is equal to 13394,82 hrn, while the cost of the two-step transcutaneous nephrolithotripsy - 26125,26 hrn. i.e., 1,95 times less cost-based and more economically sound for the state. The algorithm of selection and preparation of patients with bilateral nephrolithiasis for single-step bilateral transcutaneous nephrolithotripsy was worked out and tested. Particularly, the indications for practical application of the conservative and surgical methods of treatment based on clinical signs, instrumental and laboratory methods of research were determined. The results of the carried-out research confirmed our scientific hypothesis, certifying the possibility of rendering the quality medical help to patients with bilateral nephrolithiasis at the time of the bilateral transcutaneous nephrolithotripsy. It proved to be save, economically beneficial and effective method of treatment of such patients and makes it possible to remove quickly the calculi from both kidneys.