[The treatment of urological complications by percutaneous interventions in patients after kidney transplantation].
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Emergencies↗
Biomedical subjects
S M Kulachkov
Publications and source records attributed to S M Kulachkov.
[Current approach to solving the problem of urolithiasis].
The article analyses experience in the management of about 1,500 patients with urolithiasis who underwent in- and out-patient treatment at the Urological Clinic of the Moscow Regional Scientific Research Clinical Institute in 1990-1993. Indications were determined for applying lithotripsy in patients with stones in anomalous kidneys, in cases of a solitary kidney, and children with urolithiasis. The tactics of management of large kidney stones is described. The use of endoscopic methods of treatment (percutaneous and transurethral) is evaluated. Modern methods of urolithiasis treatment were applied instead of an open operation in 90% of patients.
Adolescent↗
[Telemetric shock-wave lithotripsy on a new Russia LGK-Kompakt 9701U lithotriptor].
During clinical tests of a new Russian [symbol: see text]K-Kom[symbol: see text]akt 9701[symbol: see text] lithotriptor, the Urological Unit of the Moscow Regional Research and Clinical Institute performed 73 sessions of telemetric shock-wave lithotripsy (TIWL) in 43 patients with urolithiasis (20 females and 23 males whose age ranged from 23 to 78 years). The tests indicated that the new device meets all present medical and engineering requirements for lithotriptors having an ultrasound stone-picking-up system and has some advantages over the analogues made in foreign countries in both medical and engineering indices. The device provides good images of renal calculi and destroys them effectively, of peripelvic and intramural portions of the ureter, and the urinary bladder. A positive effect of TIWL was achieved in 37 patients (calculous fragments moving away in full), minor calculous fragments remained in 6 patients (their treatment is under way). No complications associated with the action of shock waves generated by the [symbol: see text]K-Kom[symbol: see text]akt 9701[symbol: see text] lithotriptor on the kidney and adjacent organs were observed during the clinical tests. Post-TIWL control follow-ups (within the first 24 hours to 6 months after TIWL) revealed no noticeable structural changes in the renal parenchyma or worse renal function.
Adult↗
[Extracorporeal shock-wave lithotripsy of bladder stones in patients with benign prostatic hyperplasia].
In urological department of Moscow Regional Research Clinical Institute, extracorporeal shock-wave lithotripsy (ECSWL) or bladder stones in patients with benign prostatic hyperplasia (BPH) has been made prior to TUR from 1991. This treatment was given to 52 patients aged 54-79 years with prostatic volume 40-120 cm3. Complete or partial fragmentation of the vesical calculi was achieved after 1 to 3 ECSWL sessions (a total of 105 sessions, 2000-3000 impulses a session). Pretreatment with ECSWL of bladder stones significantly facilitates TUR in BPH patients with vesical calculi of big size (2.5 cm and more in diameter). Extracorporeal fragmentation of large stones prior to TUR makes surgery of such patients less traumatic and reduces the risk of intraoperative complications compared to endoscopic cystolithotripsy or cystolithotomy. ECSWL of cystolithes expands indications for drug therapy or thermal non-endoscopic BPH treatment in aged patients with poor somatic status and in young sexually active males rejecting surgery.
Aged↗
[Use of ureteral stents in patients with kidney transplantation].
The aim of the study was to determine indications for application of ureteral stents for draining urinary tracts of the renal transplant, after low-invasive surgical interventions, for timing drainage, prevention and correction of complications. Ureteral stent insertion for management of urological complications after transplantation of the kidney was made in 36 patients (25 of them have ureteral stricture, 11 had ureteral necrosis). Low-invasive operations were made in 28 patients, open reconstructive plastic operations were conducted in 12 patients. According to 6-12 follow-up of the stented patients, recurrent ureteral stricture was detected only in 4 patients (11.1%). The stricture was corrected transcutaneously by antegrade ureteral stenting. It is concluded that stenting of the urinary tracts of the transplanted kidney in the treatment of urological complications--necrosis and ureteral stricture--in the course of low-invasive roentgenoendoscopic and open reconstructive-plastic operations raises treatment efficacy and prevents recurrent stricture.
Cystoscopy↗
[Urolithiasis in children].
The paper reviews the experience of the urological clinic in the treatment of 106 children with urolithiasis. The necessity of careful pretreatment examination to reject associated anomaly of the upper urinary tracts as a cause of lithogenesis is emphasized. Surgical treatment and extracorporeal lithotripsy which has proved highly effective against uroliths in children are considered.
Adolescent↗
[The treatment of stones in the transplanted kidney].
The paper reports 3 cases of positive results achieved at extracorporeal lithotripsy for concrements in the transplanted kidney. To avoid such potential complications as subcapsular hematoma, rupture of the transplant, its ureter occlusion by the stone fragments, acute pyelonephritis, lithotripsy should be conducted in sparing regimen (low and moderate power, number of impulse per a session not more than 2000) under ultrasound control. In defective urine outflow from the transplant as a result of pretreatment obstruction by the stone or posttreatment obstruction by its fragments a drainage must be done by means of transcutaneous puncture nephrostomy.
Adolescent↗
[The treatment of ureteral stricture in patients following kidney transplantation].
Ureteral strictures in kidney recipients are serious urological complications often responsible for the transplant rejection and sometimes for the recipient's death. The stricture-related slight and nonspecific symptoms often underlie its late diagnosis and inadequate treatment. Obligatory follow-up ultrasonic investigations promote early detection of ureteral stenosis. Eight kidney recipients with ureteral stricture initially underwent transcutaneous puncture nephrostomy preserving the transplant function and preventing aggravation of the condition. In view of threatening infection and weak reparative capacity of immunosuppressed patients, less traumatic transcutaneous interventions seem preferable in further treatment: bouginage, balloon dilatation or the stricture dissection followed by insertion of the inner stent. In uneffective transcutaneous surgery due to extended ureteral strictures or complete obstruction of the ureter it is valid to conduct pyeloureterostomy with the recipient's own ureter.
Female↗
[Extracorporeal lithotripsy in certain forms of urolithiasis].
Therapeutic results of remote lithotripsy have been analyzed for 1016 patients with urolithiasis. The authors also focus on specific features of remote lithotripsy in anomalous stones, in nephroliths on the single and transplanted kidney, in location of the stone in the ureter. The efficacy of the procedure is reviewed in pediatric patients. Satisfactory results were achieved in 962 patients (95%). Remote lithotripsy is considered to be a valuable component of combined treatment of urolithiasis replacing successfully open surgery in 95% of the cases.
Adolescent↗
[Extracorporeal lithotripsy in the treatment of urolithiasis].
The material gained in the urological clinic of the Moscow Regional Research Clinical Institute covers 2000 cases of uroliths treated with extracorporeal lithotripsy (ECL) for 4 years. Factors implicated in the treatment outcomes, measures to prevent ECL complications, recommendations for ECL regimens in different clinical forms are specified.
Adult↗
[The treatment procedure in patients with a combination of kidney tumor and urolithiasis].
Renal carcinoma and urolithiasis combine rather rarely. Postnephrectomy patients often consult the urologist when the condition is serious because of complications resultant from uroliths in the contralateral kedney. In view of solitary kidney, progressive chronic pyelonephritis, associated chronic renal failure surgical treatment of the condition becomes risky and necessitates individual approach to choice of therapeutic policy and definition of indications to urolithiasis treatment in patients after nephrectomy for renal carcinoma. This includes the decision whether to perform nephrolithiasis before or after nephrectomy and whether to attempt any surgery in the absence of urolithiasis clinical symptoms.
Adult↗
[Use of stent-nephrostomy in the treatment of renal transplant urologic complications by percutaneous surgical techniques].
Ureteral complications including stricture of the ureter and necrosis of the ureter with urinoma are the most frequent urological complications after renal transplantation. About 1-12% of recipients suffer from these complications. Percutaneous techniques allow correction of ureteral complications by less traumatic than open surgical operations and sufficiently effective method. Ureteral complications were registered in 20 cases (3.6%) out of 561 renal transplantations carried out in our institute from 1990 to 1995. Only in 5 cases open surgical correction was necessary, 15 patients after percutaneous nephrostomy underwent bougienage and/or balloon dilatation of ureter with further antegrade stenting. In all percutaneous operations special stent-nephrostoma developed in our department was used. Use of the stent-nephrostoma with its further transformation into the ureteral stent has some substantial advantages versus routine stent procedure.
Follow-Up Studies↗