Urolithiasis is one of the most common diseases. The incidence of urolithiasis
has reached 2-5% of the global population, and patients with urolithiasis account for
30-45% of all urological inpatients with around 50% of them suffering from
nephrolithiasis. Urolithiasis is manifested by acute and chronic pyelonephritis, and
frequent relapses, which in turn leads to kidney failure, disability, and mortality.
Based on the above, the aim of our study was to enhance the efficacy of
treating urolithiasis by using minimally invasive percutaneous nephrolithotripsy. In
accordance with the goals set at the Department of Urology of Shupyk National
Healthcare University of Ukraine the study analyzed 190 cases of urolithiasis. The
findings indicated the presence of calculi of the kidney and the upper third of the
ureter up to 30 mm in size. All patients underwent operative treatment, namely minipercutaneous nephrolithotripsy at the Department of Urology of the Kyiv Regional
Clinical Hospital.
Depending on the method of mini-percutaneous nephrolithotripsy, the
following 3 groups of patients were distinguished. The main Group I (n = 102),
which underwent mini-PNL according to the standard technique with the installation
of a nephrostomy, the II (n = 47) and III (n = 41) control Groups, which were
operated on without nephrostomy and without drainage, respectively.
Out of a total of 190 patients, there were 98 men, which accounted for 51.58%,
and 92 women, and respectively, 48.42%. The age of the patients who underwent
surgery ranged from 18 to 74 years. The majority of the patients were working-age
population aged 18 to 60 years – 154 individuals (81.05%).
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Examination of patients was carried out in accordance with modern standards
and recommendations of the European Association of Urologists, and included data
on patient complaints, anamnesis collection, physical examination, laboratory
methods of examination, sonographic examination, radiation methods - inspection
and excretory urography, computer tomography.
In this study, the following procedures were performed: 102 (53.68 %) miniPCNL completed with a standard procedure; 47 (24.73 %) mini-PCNLs without a
nephrostomy tube but with a JJ stent insertion and 41 (21.57 %) total tubeless miniPNLs. During the surgeries the following instruments were used: endoscopic
instruments from Karl Storz (Germany); Aloka SSD ultrasound machine (Japan);
Dornier H20 laser contact lithotripter (France) and Lumenis Versa Pulse PowerSuite
20w (Israel); Karl Storz pneumatic contact lithotripter (Germany); digital radiography
system (Siemens, Germany); radiolucent multifunctional surgical table (Maquet,
Germany).
The standard mini-percutaneous nephrolithotripsy technique was most
frequently performed on patients aged 45-59 (42.16 %) and 25-44 years (37.25 %),
followed by those aged 60-74 years (15.69 %), and least frequently in the 18-24 age
group (4.9 %). The tubeless procedure was most often performed on patients aged 45-
59 (40.43 %), followed by those aged 25-44 (27.66 %) and 60-74 (23.4 %) years, and
the least frequent age group is older than 18-24 (8.51 %). The total tubeless
procedure was performed in the largest number of patients aged 45-59 (39.02 %) and
25-44 (34.15 %) years, followed by patients aged 60-74 years (21.95 %), and the 18-
24 (18.24 %) age group underwent the least amount of surgeries.
103 (54.21%) operations were performed on the right kidney, 87 (45.78%) on
the left kidney. At the same time, calculi were most often located in the kidney bowl
80 (42.11%) and in the upper third of the ureter 47 (24.74%), then the stones were
most often located in the lower kidney cup 40 (21.05%) and were in the smallest
amount in the middle and upper cups, which was 12 (6.32%) and 11 (5.78%),
respectively.
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Operative treatment was carried out using conductive epidural or spinal
anesthesia in 187 (98.42%) patients, or endotracheal anesthesia in 3 (1.58%) patients.
