Sagalevych A. Improvement of minimally invasive treatments and endosurgical treatment modes of various forms of urolithiasis

3. This thesis presents the results of treatment of 2935 patients with various forms of urolithiasis: solitary and staghorn nephrolithiasis with common forms of nephrotoxicity urolithiasis with nephrolithiasis developed against the background of anomalous kidney and solitary kidney. The results of 3815 procedures of extracorporeal shock wave lithotripsy (ESWL), 815 percutaneous nephrolithotripsy (PCNL), and 54 ureterolithotripsy (URL) have been studied. A sharp decrease in the effectiveness of treatment of solitary kidney stones by means of ESWL for stone increasing more than 1.0 cm and a density of more than 600 HU was shown for the first time. An extremely low efficiency (up to 35.4 %) of staghorn nephrolithiasis ESWL-monotherapy has been proved. The thesis studied the effectiveness and the necessity of additional and supporting procedures when performing PCNL, which allows of an effectiveness raise of treatment up to 100 % for solitary nephrolithiasis and to 95.7 % for staghorn nephrolithiasis. The functional status of the renal parenchyma, the persistence of bacteriuria in the upper urinarytract and the dynamics of conducting clinical and laboratory parameters of blood by applying the minimally invasive treatment and endosurgical nephrolithiasis have been studied. PCNL preference in the treatment of not only staghorn but also solitary calculi has been proved. ESWL is considered to be a supporting method of treatment. We have also proposed a new algorithm for the treatment of nephrolithiasis. A new concept of minimally invasive treatment of nefroureterolithiasis has been developed. Treatment algorithms of complex and pervasive forms of nefroureterolithiasis and new therapeutic algorithms of nephrolithiasis in a solitary kidney have been suggested. The new ways of pin ureterolithotripsy with both retrograde and percutaneous access have been developed and introduced into clinical practice. An improved ureteroscope and a new way of ureterodilatation. A new concept of treatment of nephrolithiasis of an anomalous kidney, based on the criteria of the choice of treatment depending on the size of the "stone mass" in the system of the kidney cavity has been suggested. The leading role of endosurgical method of treatment has been shown.