Abstract: To assess the efficiency of laparascopic pyelolithotomy and laparoscopic pyeloplasty (LP) in patients suffering from ureteropelvic junction (UPJ) obstruction in combination with renal stones. A total of 96 patients (42 males and 54 females) underwent laparoscopic pyeloplasty of UPJ at the urology clinic of North-Western State Medical University. The age of the patients ranged from 20 to 64 years (mean 30.4 ± 4.8 years). Fifty two patients underwent right laparoscopic pyeloplasty and 44 patients underwent left laparoscopic pyeloplasty. All procedures were performed using transperitoneal approach with the patient placed in lateral position. Fourteen patients (14.6%) who suffered from UPJ obstruction in combination with stones of kidney underwent laparoscopic pyelolithotomy followed by laparoscopic pyeloplasty. After the resection of UPJ intraoperative pyelocalicoscopy was performed using rigid ureteroscope, which provided the access for examination of all groups of renal calyxes with subsequent remove of the renal stones. No conversion was seen. The leakage of urine occurred in 4 patients. In 3 patients the leakage stopped spontaneously and 1 patient underwent laparoscopic re-pyeloplasty and suture of anastomotic disruption. Three patients experienced the recurrence of UPJ stricture, 2 of them underwent retrograde endopyelotomy and 1 of them underwent open re-pyeloplasty. These cases occured at the stage of experience acquisition. However, these patients did not undergo pyelolithotomy. The stones were fully removed in all patients and pyeloplasty was performed in all of 14 patients. We did not notice any postoperative complications. LP is defined as a procedure of choice in patients suffering of primary UPJ stricture. In the case of hydronephrosis coupled with renal stones intraoperative pyelocalicoscopy is preferred. The procedure should be performed using rigid ureteroscope, which provides a possibility to remove all stones with minimal postoperative risk of complications.

Management of large and staghorn renal calculi is an actual urology problem. Authors analyzed 808 percutaneous nephrolithotomies (PNL), performed for 613 patients since 2010 to 2014. There were used most modern PNL procedures: multiple access, miniPNL, combined approach to kidney. Demonstrated high effectiveness of this method – 74% stone free rate, associated with low complication level for Clavien scale – 3 level – 5,6% of patients, 4 – 1,6%. No deaths and nephrectomies were observed. Procedures, which authors rated as optimizing treatment and decreasing complications, include miniPNL, tubeless PNL. Prone position is recommended as most comfortable. Puncture is performing using ultrasound probe, without adapter (free hand technic). Third part of all operations were done without previous retrograde ureter catheterizing, this trick allows do operation faster, decreases invasiveness and time of fluoroscopy. Optimal technic of access dilating was found using one or two shots Amplats sheath placement. Most dangerous complications are urosepsis and bleeding. 5 cases of arterio-venous fistula or pseudoaneurism were noticed, which are treated endovascular. PNL demonstrate well results and low complication level for treating of large and staghorn renal stones.

Abstract. The article discusses the diagnosis of contamination of urine in patients with severe kidney stones. It is shown that the diagnostic value of Intral-peratsionnogo urine collection during chreskozhnyhendoskopicheskih operations. The study demonstrates that a sterile urine culture in the presence of stones is not always an indicator of the absence of infection in the urinary system.

 

In clinical practice, urologists and nephrologists abnormalities called structural and / or functional abnormalities of the urinary and reproductive systems, caused by disturbance of embryonic development. A significant increase in the number of birth defects may be due to the fact that in embryogenesis kidney is the target organ for exposure to various damaging factors in nature, among which a special place is occupied by medication and physical status of the mother. Violation of prenatal development of the kidneys can often be combined with defects of the lower urinary tract. This condition is often called CAKUT in the development of the role played by the combination of gene mutations. In this article, we describe the majority of congenital anomalies of the kidneys and urinary tract. Significant improvement in antenatal diagnosis of malformations also contributed to the increase in this indicator. Understanding the embryology urinary organs allows to diagnose disorders in the mother-placenta-fetus system.