Topicality. Kidney stone disease is referred to wide spread diseases. According to the literature data its prevalence is 732,8 cases per 100 000 of Ukrainian population. During the last years the usage of minimally invasive techniques, such as: extracorporeal shock-wave lithotripsy (ESWL) and ureteroscopy with contact lithotripsy has significantly increased, but percutaneous lithotripsy (PNL) remains as a technique of choice among basic methods of treatment of large size kidney stones.The purpose of the work. To evaluate the effectiveness of the percutaneous shock wave lithotripsy (PNL) in treatment of kidney stones larger than 50 mm.Materials and methods. Twenty-eight patients, among them twenty-five (89,28%) male patients and three (10,71%) female patients, with large > 50 mm kidney stones treated in NMMCC from April 2016 to March 2020 were included to the research. Stone-free rate and complications rates were examined. Results. In thirteen cases (46.42%) the stones were located in the right kidney, in fifteen cases (53,57%) the stones were located in the left kidney. The nineteen patients (67,85%) did not have any residual stones, and nine patients (32,14%) had residual stones. The extracorporeal shock-wave lithotripsy had been performed in 4 patients (14%), in 5 (17%) cases – contact lithotripsy of residual stones, which migrated to the lower third part of the ureter. After repeated intervention in 5 cases (17,86%) stone-free status was obtained. Stone-free rate index was 85,71%. Average duration of operation was 115±24,64 min. Hemoglobin level before and after operative intervention was 142 (117–159) g/l and 119 (94–132) g/l respectively (р <0,005). Length of hospital stay was 5,07 (4–9) days. Complications were observed in six patients (21,5%). Stone-free status was defined as absence of any residual stones during radioscopy at 1 day after the operation or during computer tomography after 3 months. Residual stones d Ј 4 mm and > 4 mm were considered as insignificant and significant respectfully.Conclusions. Percutaneous nephrolitotripsy is an effective and reliable method of treatment and should be a method of choice in treatment of staghorn stones and large size stones of the kidneys.
It is known that any surgery can lead to the risk of development of the late postoperative complication – lymphocele, which can occur in a period from about 2 weeks to 6 months after surgery. The objective: to analyze the frequency of lymphocele formation and its outcomes after open retropubic prostatectomy (ORP) and extended lymph node dissection (ELND) in patients with localized prostate cancer (PC). Materials and methods. The study included patients after ORP and ELND who were observed after operation for a period more than 6 months. All operations were performed by the retropubic extraperitoneal access by one surgeon. All patients received low molecular weight heparins to prevent thromboembolic complications. In the postoperative period, patients had control ultrasound examination (USE), the frequency and outcomes of lymphocele were studied retrospectively. If the results of USE were normal, no imaging study was performed for the next 6 months. Results. The results of treatment of patients with localized PC were analyzed. The mean observe period was 16.2 months. Lymphocele developed in 4% of cases and was symptomatic in 1.5 % of men. In all patients, lymphocele was detected within 1 month after surgery. In 74% of cases, lymphocele regressed within 3 months after surgery according to results of USE. In 64% of patients with lymphocele more 3 months the symptoms associated with cystic infection that required adequate drainage developed. Patients with diabetes had a higher risk of infected lymphocele development. Other symptoms which were associated with lymphocele have been found rarely. Comparison of preoperative characteristics of the patients with and without lymphocele did not demonstrate reliable prognostic indicators of possible lymphocele formation in a retrospective analysis of these persons. Conclusions. The risk of the development of symptomatic lymphocele after open retropubic prostatectomy and extended lymph node dissection is quite rare. However, ultrasound examination for 3 months after surgery is considered appropriate. It is recommended to perform the percutaneous drainage of the pathological cavity under ultrasound control in case of the detection of symptomatic lymphocele, because this procedure is safe and effective.
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