Сроки рецидивирования после полного удаления конкрементов в разных отделах мочевой системы. Опыт пятилетнего наблюдения

Abstract

The usage of minimally invasive technologies (MIT), such as: extracorporeal shock wave lithotripsy (ESWL), transurethral ureterolithotripsy (URS), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotripsy (PNL), allows to remove the stones from the calyx and pelvis system with 71- 96% of patients, and those from the ureter in 96.2% cases. However, a high incidence of stone recurrences (35-75%) demands the necessity of repeated lithotripsies and the search of the most appropriate methods of lithotripsy for reduction this indicator. The main goal. To determine the number of patients with recurrence of stone formation during five years after different types of lithotripsy in different parts of the urinary system. The results of the process were analyzed with 491 patients, who had been devided into two groups: group I - 358 patients suffering from the concrements of the ureter; group II - 133 patients having stones in kidney. According to the age criterion, the sample data did not differ from each other (50 years for both groups (p=0.576). The initial number of lithotripsies with complete removal of stones was 80.7% in group I and 70.7% in gr. II, the repeated lithotripsy with usage of the same method was 5.9% and 12.8%, respectively. The usage of an additional method in repeated lithotripsy was necessary in 13.4% and 16.5% of cases respectively. There were differences between the sizes of stones in groups (p<0.0001), besides both groups showed the difference in recurrence time of stone formation (p=0,014). In gr. I weak negative correlation (-0.28) between age and time of recurrence was revealed. The age difference between men and women in both groups (p=0.00001 and p=0.0492, respectively) was found. There occurred differences in the size of stones in men and women groups (p=0.0000001 and p=0.0000001, respectively) and in the time of recurrence between men and women in I gr. (p=0.043). Most of stones were compose of CaOx, the second most important element was Uric Acid. All this testifies to peculiarities of the diet in the region of residence of the patients under control - the Republic of Bashkortostan, where people generally use meat and milk products. The usage of MIT opened the possibility of complete stone removal from the urinary system with the most sparing technique. The lithotripsy of stones with any composition having been conducted, additional stone crushing is carried out with 21-59% of patients within 5 years. The investigation of patients detected a great number of recurrences of stones in the kidney stones group. 1. After lithotripsy the recurrences during two years did not exceed 4,2% with patients in gr. I and 8,2% in gr. II patients. 2. Significant dependence of recurrent stone formation of gender composition was identified in gr. I and the time of recurrence was less in women. 3. The quantity of CaOx urolithiasis corresponds to global indicators. However, a large number of stones with Uric Acid in the composition indicates possible peculiarities of the patients diet. 4. The highest number of recurrences were in patients with CaOx (42.3%) and CaOx with CaF in the composition (23.1%), and in third place were patients with uric acid stones (19.2%).