Сравнительный анализ различных хирургических методов лечения уролитиаза.

Abstract

Introduction. Urolithiasis is one of the most common urological diseases with a trend towards stable growth in different countries. Thanks to the active development of minimally invasive surgery, lithotripsy has become possible in any part of the pelvicalyceal system, practically replacing open surgery for urolithiasis. Aim: to compare the clinical efficacy and safety of various methods of surgical treatment of urolithiasis. Materials and methods. The study included patients with urolithiasis who underwent surgical treatment in the Department of Urology of the State Budgetary Institution of Regional Administration of the City Clinical Hospital No. 11 (Ryazan) in the period from January 2015 to December 2020. Statistical data processing was performed using Microsoft Excel 2003 and Statistica 10 software. Results. During this period, 4415 patients whith urolithiasis were treated in the hospital. The total number of operations performed is 5655, including the necessary repeated operations associated with the formation of residual concretions after surgical treatment. The greatest number of repeated operations was required after extracorporeal shock wave lithotripsy (ESWL) and amounted to 56.1% in the localization of stones in the PCS and 47.0% in the ureter. The average number of complications in the form of residual concretions after contact lithotripsy was 13.3%, which is significantly less than the results after ESWL. The average number of days spent in the hospital was significantly higher after open surgical interventions and amounted to 12 days, while after contact and remote lithotripsy methods 4 and 7 days, respectively. The level of postoperative pain on the VAS scale (Visual Analog Scale) varied in the range of points 6-9 after open surgical interventions and persisted for a longer time in comparison with small and non - invasive interventions, where the level of postoperative pain varied in the range of 1-4 points. Conclusion. The results obtained by us confirm the safety and effectiveness of minimally invasive methods of lithotripsy. The main disadvantage of ESWL and lithotripsy methods using Ho-YAG laser is the frequent formation of residual concretions, however, such advantages as a shorter recovery period, less need for the use of non-opioid analgesics in the early postoperative period do not raise doubts about the need for their use and a reduction in the number of more traumatic surgical interventions.