Rational choice of a minimally invasive method of treatment in uncomplicated nephrolithiasis with kidney calculi from 1.0 to 2.5 cm

Autor: А. І. Sagalevich, O. S. Vozianov, R. V. Sergiychuk, B. V. Dzhuran, V. V. Kogut, F. Z. Gaysenyuk, V. V. Ozhohin, F. V. Korytskyi
Jazyk: English<br />Russian<br />Ukrainian
Rok vydání: 2018
Předmět:
Zdroj: Zaporožskij Medicinskij Žurnal, Iss 1, Pp 58-62 (2018)
Druh dokumentu: article
ISSN: 2310-1210
2306-4145
DOI: 10.14739/2310-1210.2018.1.121993
Popis: Study purpose – to improve the solitary nephrolithiasis treatment effectiveness by determining the optimal conditions for ESWL or mini PNL application in the treatment of kidney calculi 1.0 to2.5 cm in size. Patients and methods. A comparative analysis of the results of minimally invasive methods application for nephrolithiasis treatment was performed in 210 patients treated with mini PNL (the group I) and 190 patients treated with ESWL (the group II). Patients with calculi more than 1.5 cm predominated in the group of mini PNL and with calculi less than 1.5 cm – in the ESWL group. The number of patients with calculi 1.5–2.0 cm in both groups was the same: 24.3 % and 24.2 % (P > 0.05). Results. It was noted that the calculi destruction effectiveness after 1–4 or more sessions of ESWL took place in 182 patients (95.8 %). At the same time, an increase in the mean density of calculi above 600 HU caused reduction (P < 0.001) of the primary ESWL session efficiency almost twofold. When performing the 221 mPNL, 97.1 % of the patients required one surgical treatment. The number of complications (bleeding, attack of pyelonephritis) in the group II was insignificantly higher in contrast to the group I – 26 (12.3 %) and 45 (14.1 %), respectively (P < 0.05). The stone-free status (up to one month) was noted in 62.6 % of patients after the completion of ESWL sessions that increases the risk of nephrolithiasis recurrence from 37.4 %. In treatment with mPNL, the stone-free status reached 97.1 % (P < 0.001), and in repeated mPNL applying in 2.8 % of cases – 100 %. The mean clinic postoperative treatment periods in the group I were lower in contrast to patients of the group II – 3.0 ± 1.5 and 12.5 ± 3.6, respectively (P < 0.001). Conclusions. This comparative analysis of features and results of uncomplicated nephrolithiasis with mPNL and ESWL treatment indicates that mPNL is the most preferred method for kidney calculi 1.0 to2.5 cm and more in size treatment.
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