Сравнительная оценка эффективности коррекции дилатации чашечно-лоханочной системы почек в условиях применения различных вариантов дренирования верхних мочевых путей

Abstract

Introduction. Upper urinary tract (UUT) obstruction remains a socially significant problem due to its high frequency and serious pathogenetic consequences. Dilation of calyx-pelvic system (CPS) remains one of the pathognomonic manifestations of this condition, which should be immediately corrected. Percutaneous puncture nephrotostomy, internal stenting, and ureteral catheterization are the most commonly used methods for draining the upper urinary tract. However, the problem of choosing a drainage method in a specific clinical situation based on the criterion of the effectiveness of elimination of CPS dilatation has not yet been resolved. Purpose of the study. Comparative analysis of the efficiency of drainage of the upper urinary tract under the conditions of the use of three alternative methods –распредеpercutaneous puncture nephrostomy, internal stenting and ureteral catheterization – followed by substantiation of the choice in a specific clinical situation according to the criterion of the effectiveness of correction of the dilatation of the CPS. Materials and methods. We included in this study 300 patients with obstruction of the upper urinary tract due to urolithiasis, oncourological and oncogynecological pathology. The presence and resolution of dilatation of the CPS was determined using ultrasound diagnostics and intravenous urography. Results. Percutaneous puncture nephrostomy is the most effective in treating upper urinary tract obstruction in terms of eliminating CPS dilatation, ureteral catheterization is less effective, and internal ureteral stenting occupies an «intermediate position». Conclusion. When planning and implementing the treatment of upper urinary tract obstruction, one of the main criteria should be taken into account the effectiveness of correction of the dilatation of the CPS. In a specific clinical situation in which dilatation of the PCS will be of the greatest importance, percutaneous puncture nephrostomy will be the optimal method of drainage.