Personalized tactics for the treatment of nephrolithiasis in the intrarenal pelvis

Abstract

Objective. Improving the results of treatment of nephrolithiasis in the intrarenal pelvis.Material and methods. The study involved 154 patients with nephrolithiasis in the intrarenal pelvis. They were divided into two groups: the main group comprised 78 (50.6%) patients who underwent personalized surgical procedures using modern technologies, while the control group of 76 (49.4%) patients received conventional one-stage traditional surgical interventions. Results. In the main group, one-stage percutaneous puncture nephrolithotripsy was conducted for 55 patients, representing 70.5% of the cases. However, in 5 (6.4%) cases of complex variants of nephrolithiasis, it was required to convert the access to a lumbotomy with subcortical pyelolithotomy. Of note, 11 patients (14.1%) presented with either complicated purulent calculous pyelonephritis (5 patients) or II-degree hydronephrosis (6 patients). For these patients, the treatment was staged. Initially, a nephrostomy was carried out using ultrasound guidance. Following this, 7 patients underwent percutaneous puncture nephrolithotripsy, while 4 patients had a lumbotomy subcortical pyelolithotomy paired with nephrostomy. In another subset of the main group, 12 patients (15.4%) required one-stage traditional surgery through lumbotomy access due to specific medical criteria. Patients in the control group (n=76) underwent open libotomy for removal of kidney stones. Postoperative complications in patients of the main group were noted in 7 (9.0%) cases, with no lethal outcomes. Whereas in patients of the control group, postoperative complications occurred in 18 (23.7%) cases. Lethal outcomes were recorded in 3 (3.9%) cases. Conclusion. In determining the appropriate surgical approach for patients with nephrolithiasis in the intrarenal pelvis, it’s essential to prioritize a personalized treatment plan. Minimally invasive interventions are recommended wherever possible