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.