Urology and Andrology

Specificities of surgical treatment of patients with multiple renal calculi

The objective. To find an effective method of treatment that would ensure complete clearing of the kidneys in patients with multiple calculi located in hard-to-reach calyces. Patients and methods. From 2010 to 2012 26 patients were examined with multiple renal calculi located along with the renal pelvis in poorly accessible calyces connected with the pelvis by a narrow long neck. At this stage of examination in all patients multi-slice  computed  tomography  (MSCT)  both  in  native-phase  and  with  intravenous  contrast  was  performed.  All  patients underwent  percutaneous  laser  nephrolithotripsy.  For  control  after  operative  treatment  additional  native-phase  MSCT  was administered. Results. The main approach in surgery was performed through the calyx containing the largest concrement. After preliminary catheterization and ureteropyelography in combination with intraoperational ultrasound control the calyces requiring additional approach were finally chosen: in 13 patients one additional approach was required, in 8 – two, in 2 – 3 and in 3 – 4. Through additional mini-accesses ureterorhenoscope 9–11 Fr was introduced and laser nephrolithotripsy with subsequent transfer of fragments into the renal pelvis was performed. The sizes of removed concrements were from 5 to 30 mm. In 9 patients trans fistula  laser  fibronephrolithotripsy  was  performed,  4  patients  underwent  laser  infundibulotomy  with  subsequent  prolonged intubation  of  the  calyx  neck,  which  permitted  to  restore  adequate  urodynamic.  Complete  clearance  of  the  kidneys  from concrements was obtained in 22 patients (84.6%). No complications were noted. Conclusion.  Laser  calycolithotripsy  performed  through  additional  mini-accesses  in  patients  with  multiple  renal  calculi  is  an effective and safe method of treatment in this group of patients.