OPEN SURGICAL TREATMENT OF BILATERAL CORALLOID AND MULTIPLE NEPHROLITHIASIS COMPLICATED WITH CHRONIC RENAL FAILURE

Abstract

This articles describes the improved preoperative techniques for preparing to the surgical operations for bilateral coralloid and multiple nephrolithiasis complicated with chronic renal failure and discusses the treatment outcomes. Materials and methods. During 2000-2020, at the Department of Urology of the Azerbaijan Medical University, more than 3,000 open surgical operations were performed on for kidney and ureter stones. 974 (32.47±0.85%) paitents had the operations for coralloid and multiple nephrolithiasis; 700 (23.33±0.77%) of them were found to have unilateral and 274 (9.13±0.53%) had bilateral coral stones. Results. The results of open surgical operations of 274 patients operated on for bilateral coralloid and multiple nephrolithiasis in the 2000-2020 period were analyzed. 190 (69.3±2.8%) of them, 105 men and 85 women, had renal insufficiency, 162 (59.1±3.0%) patients (82 men, 80 women) had the diagnosis of chronic renal failure, and 28 (10.2±1.8%) patients (19 men, 9 women) had acute chronic renal failure. The implementation of the preoperative preparation techniques, taking into account the stage of chronic renal failure, was presented. Out of 274 operated patients, the intervention was performed in 47 (17.2±2.3%) with nephrostomy (24 right, 23 left), in 28 (10.2±1.8%) with pyelostomy (16 right, 12 left), in 110 (40.1±3.0%) with intrarenal stenting (60 right, 50 left), in 6 (2.2±0.9%) with nephrostomy and intrarenal stenting (2 on the right, 4 on the left). Along with this, 56 (20.4±2.4%) patients had clamping of the renal artery from one side or another. After surgery, 48 (17.5±2.3%) patients experienced the exacerbation of chronic pyelonephritis. In patients with diabetes, the exacerbation of chronic pyelonephritis had a more severe course. 26 (9.5±1.8%) patients experienced the exacerbation of chronic renal failure, of them, 6 (2.2±0.9%) had a creatinine level exceeding 500 mmol/l, that was the reason for haemodialysis. Anaemia was observed in 49 (17.9±2.3%) patients with chronic pyelonephritis and chronic renal failure in the postoperative period. In patients with anaemia, the haemoglobin level was 50-85 g/l (average 71.9 ± 0.4 g/l). 11 (4.0±1.2%) of them received blood transfusions in the postoperative period. In 5 (1.8±0.8%) cases, transfusion was performed during haemodialysis. In general, 270 patients out of 274 with bilateral coralloid and multiple nephrolithiasis had open surgical treatment completed successfully, and 4 (1.5±0.7%) had fatal outcomes. In 254 (92.7±1.6%) cases, an organ-preserving operation was performed on, and in 20 (7.3±1.6%) cases, surgical resections were carried out. The study has shown the preoperative preparation and the choice of the correct surgical tactics during the operation considerably contributes to successful treatment outcomes among the patients with severe chronic renal failure.