CENTRAL ASIAN JOURNAL OF MEDICAL AND NATURAL SCIENCES

Volume: 04 Issue: 04 | Jul-Aug 2023 ISSN:2660-4159

www.cajmns.centralasianstudies.org/index.php

CHOICE OF SURGICAL METHODS IN PATIENTS WITH

URINARY STONE DISEASE
ABSTRACT: Evaluation of the effectiveness of various
1. Nurillaev J.Y, methods of treating patients with urolithiasis, and
2. Muxamadiev N.K., recommending the best methods of minimally invasive
3. Nurillaev X.J.. surgical interventions. Patients and methods. To
systematize the main clinical material, all patients,
depending on the location of the calculus, were divided into
two groups: the first group - patients with ureteral stones;
the second group - with kidney stones. Depending on the
method of performing surgical intervention, both groups
Received 2ndMay 2023,
Accepted 3rdJun 2023, were divided into 4 options, in options II, III, IV, minimally
Online 10th Jul 2023 invasive technologies were used as monotherapy, as well as
their combinations. The comparison group consisted of
patients who underwent traditional open surgery. The
Samarkand Medical University1, results of treatment were assessed clinically in the near and
Samarkand State University2, long term. Treatment was considered ineffective in the
XN samturk group LLC3, presence of residual stones not removed during this
Samarkand, Uzbekistan hospitalization.
Keywords: Urolithiasis, distant shock wave lithotripsy,
contact ureterolithotripsy, percutaneous nephrolithotripsy,
nephrolithiasis.

Introduction
The terms of wound drainage and stenting of the urinary tract, healing of urinary fistulas, and the
length of stay in the hospital were compared. Long-term results of treatment were assessed by clinical
indicators, the number of relapses and late postoperative complications.
The duration of the postoperative period after minimally invasive interventions is significantly
shorter than after open ones. The performance of endoscopic operations in terms of time approaches
the traditional ones, but they are favorably distinguished by the absence of blood loss, a favorable
course of the postoperative period, and minimal rehabilitation periods. There is practically no need for
repeated manipulations. Both in endoscopic operations and in ESWL, blood loss is estimated as zero.
Significant differences were noted in the time of anesthesia and surgery when removing a stone from

392 Published by “ CENTRAL ASIAN STUDIES" http://www.centralasianstudies.org

CAJMNS Volume: 04 Issue: 04 | Jul-Aug 2023
open access and PCNL, URLT. The duration of open surgeries was 51.6 ± 2.3 min, and for ESWL —
30.4 ± 3.1 min. There were no intraoperative hemorrhagic complications. Intraoperative blood loss
during open ureterolithotomy was 123.2±12.4 ml, and URLT was 0.
Conclusion. It should be noted that the tendency of modern urology to expand the indications for
minimally invasive surgical interventions in KSD is justified, their effectiveness has been proven by
practice and a long period of observation of patients, and good functional results. Minimal invasive
surgical aids have become standard methods of treating KSD, which is due to both medical and
economic efficiency (short postoperative period, shortening of the patient's stay in the hospital).
Urinary stone disease (STD) is one of the most common urological diseases, second only to non-
specific inflammatory diseases of the kidneys and urinary tract in the world, and occurs in at least 5%
of the population. Among all urological diseases, its share is about 40%. In Europe, the prevalence of
STK is 5-10%, in the USA - 7-15%, in eastern countries - 1-5%. In Russia in 2016, the annual increase
in the number of patients with newly diagnosed STK was 21.3%. In 2016, 866,742 patients diagnosed
with urolithiasis were registered (1,5,8,9). The increase in the disease, the severity of complications,
the tendency to relapse, and the large number of young and able-bodied people have made the
treatment of nephrolithiasis one of the most important problems of surgery (2,3).
Despite the increased incidence, mortality from urolithiasis has decreased significantly in recent
decades, because extracorporeal shock wave lithotripsy (EZTL), contact ureterolithotripsy (KULT),
percutaneous nephrolithotripsy (PNLT), retrograde ureterolithotripsyurotropy (RIRS) has been widely
used. due to its use, today the mortality is reduced to zero (4). Until 2007, EZTL was the main
treatment method for nephrolithiasis due to its non-invasiveness and high efficiency (6,7). A
retrospective analysis of the results of treatment of patients with CTK (1985-2014) showed that the
share of remote technologies decreased over the years from 85.6% to 21.3%, and retrograde
endoscopic methods increased from 4.4% to 76%. 'raised (10) .
The purpose of this work is to evaluate the effectiveness of surgical methods in the treatment of
patients with urinary stone disease and to recommend the best methods of minimally invasive surgical
interventions.
The results of the study and treatment of 205 patients with STK observed in the urology
department of Samarkand clinics became the basis for achieving the goals set in the work and solving
the tasks. Patients were divided by gender as follows: men - 109 (53.2%), women - 96 (46.8%). The
average age of patients was 50.7±3.5 years.

393 Published by “ CENTRAL ASIAN STUDIES" http://www.centralasianstudies.org

CAJMNS Volume: 04 Issue: 04 | Jul-Aug 2023

The distribution of patients by gender and age is presented in Table 1.

Table 1.
Age of patients in years Number of patients
Men Women

21-30. 12 17
31-40 25 22
41-50 38 31
51-60 21 16
61-70 11 9
Over 70 years old 2 1
Total: 109 96

Patients of working age (from 18 to 50 years) accounted for 70.4%, which indicates the socio-
economic importance of the problem.
A comprehensive urological examination was carried out to make a diagnosis, determine the
indications and plan the operation, including the study of complaints and medical history, physical
examination, clinical tests of blood and urine, determination of sensitivity to antibacterial drugs by
bacteriological analysis of urine. , ultrasound, radiologic diagnostic methods (general and excretory
urography, mutispiral computer tomography), radioisotope scintigraphy of kidneys.
X-ray examination was carried out on a digital X-ray machine of the General Electric company
and includes a general image of the urinary tract, excretory, retrograde or antegrade (according to
indications) urography. To diagnose urological diseases, including urolithiasis, Multispiral Computed
Tomography (MSCT) has been implemented in BrightSpeed Multispiral Computed Tomography from
General Electric.
The advantage of the method is that it is non-invasive and gives high information - it has the
ability to obtain information not only about the structure of the pyelocaliceal system, but also about the
angioarchitectonics of the kidney (the presence of large segmental vessels in the puncture zone) and
the condition of the surrounding tissues. This information, together with traditional diagnostic
methods, allows careful planning of planned surgical intervention, especially percutaneous
nephrolithotripsy. Among the non-invasive methods for studying nephrolithiasis, ultrasound is the
most widely used.
To systematize the main clinical material, all patients were divided into two groups depending
on the location of the stone: the first group - patients with urinary tract stones - 132 patients, the
second group - patients with kidney stones - 73 patients. 73 (35.6%) of those examined had kidney
stones, 23 (11.2%) had stones in the upper third of the ureters, 27 (13.2%) had stones in the middle
third of the ureters, Stones in the lower third of the urinary tract in 82 (40.0) people. In 104 (50.7%)
patients, kidney and ureter stones were located on the right side, in 85 (41.5%) on the left side, and in
16 (7.8%) patients, bilateral localization was noted.
Bacteriuria was detected in 28 (13.6%) patients. In nephrolithiasis, Escherichia coli has been
identified as the main cause of pyelonephritis. Traditional open operations - ureterolithotomy,

394 Published by “ CENTRAL ASIAN STUDIES" http://www.centralasianstudies.org

CAJMNS Volume: 04 Issue: 04 | Jul-Aug 2023
pyelolithotomy, nephrolithotomy - were performed according to classical instructions and methods.
Soft tissue was performed with a lumbotomy incision. The retroperitoneal cavity was opened, and the
lower pole of the kidney, the posterior or anterior surface of the extrarenal pelvis, and the upper third
of the ureter were dissected sequentially.
Depending on the method of surgical intervention, both groups are divided into 4 groups.
I I - group - traditional open surgical treatment: ureterolithotomy and pyelithotomy or
nephrolithotomy (19 patients).
II II - group - - X-ray endourological operations: contact ureterolithotripsy (KULT) and
percutaneous nephrolithotripsy (PNL), RIRS (115 patients).
III III - group - distance shock wave lithotripsy (DZTL) of urinary tract and kidney stones - (104
patients).
IV IV - group - combined minimally invasive interventions for complex clinical forms of
urolithiasis - 25 patients.
Thus, in groups II, III, IV, minimally invasive technologies were used as monotherapy, as well
as their combination. The comparison group consisted of patients who underwent traditional open
surgery.
Percutaneous stone removal was performed in one or two stages in a special operating room on
an x-ray urological table. Single stones were removed in 77 of 128 operations (60.2%), and multiple
stones were removed in 36 (28.1%). In 2 (1.6%) similar operations were performed for standard
nephrolithiasis (K-2, K-3), 13 (10.5%) - for removal of residual stones. One-stage operations were
performed under intubation anesthesia or epidural anesthesia and began with cystoscopy and
retrograde ureteral catheterization on the operative side.
A 26 Sch nephroscope manufactured by Karl Storz was used. It was performed under the
ultrasound and X-ray examination in the puncture of the cup-jam system. After viewing the stone in
the pyelocaliceal system, assessing its size, shape and composition, the stone is removed completely or
after preliminary disintegration. Stones up to 0.5 cm in diameter were completely removed using
forceps. Hard forceps of various designs were used for extraction. If the size of the stones is larger
than 1.5 cm, the stones are removed after disintegration using laser or ultrasound.
Contact ureterolithotripsy was performed with a ureterorenoscope 9 Sh under intravenous
anesthesia or epidural anesthesia. If necessary, dilation of the urethral opening was performed with
flexible bougies under visual control to 12 on the Sharier scale, then a rigid or flexible ureteroscope
was inserted. On top of the stone, under vision control, Dormie's ring was passed. After
ureterolithotripsy, stenting was completed to prevent exacerbation of renal colic and calculous
pyelonephritis. The duration of the stay of the stent is determined individually. During drainage, all
patients received antibiotic prophylaxis for postoperative pyelonephritis. Ultrasound lithotripsy was
often used for kidney stones, and laser lithotripsy was used for ureteral stones.
Distance lithotripsy was performed on a Dorner Med Tex Delta 2 device. Patients underwent
DZTL without anesthesia under X-ray or ultrasound guidance. The hardness of the stones ranged from
600 to 1500 HU. The number of shock-wave impulses required to destroy the stone varies from 800 to
3200 (average 2200) per DZTL session.
We evaluated the immediate and long-term outcomes after the operative period shown in Table 2.

395 Published by “ CENTRAL ASIAN STUDIES" http://www.centralasianstudies.org

CAJMNS Volume: 04 Issue: 04 | Jul-Aug 2023

Table 2.
Evaluation of recent and long past results depending on the type of operations

Indicator Type of treatment

I (n=19) II n=(115) III (n=104) IV (n=25)

Recent treatment results

Duration of manipulation 51,6, ± 2,3 43,9 ± 1,6 30,4 ±3,1 55,1 ±4,4
(minutes)
Duration of anesthesia 60,6±4,1 51,8±2,1 0 60,8 ± 2,2
(minutes)
Blood loss (in milliliters) 123,2±12,4 41,2±6,1" 0 41,7±7,8"
Sleep duration (hours) 1,8 ± 0,9 24 0 24

Duration of wound 3,7±0,6 24 0 3,2±0,3

drainage (kidney cup) -
hours
A complication of the 4 (21,0 %) 7 (6,1%) 6 (5,8 %) 2 (8%)
immediate past after the
operation
Bed day after surgery 8 ±1,7 2± 0 8,4±1,7
0,4
Transversion 0 2 (1,7 %) 6 (5,8 %) 0

Treatment is a long time in the past

Rehabilitation period 14±3,1 5 ±1,1" 0 12,1±1,3
(days)
Reintervention within 2 (10,5%) 5 (4,3 %) 0 0
1 year
Recurrence 1 (5,2 %) 2 (1,7 %) 1 (0,96 %) 1 (4,0 %)
Complications 1 (5,2 %) 1 (0,9 %) 0 1 (4,0 %)
Wound drainage and ureteral stenting, treatment of urinary fistulae, and length of hospital stay
were compared. Long-term results of treatment were evaluated by clinical parameters, number of
recurrences and late postoperative complications.
After minimally invasive interventions, the duration of the postoperative period is significantly
shorter. In terms of time, endoscopic operations are close to traditional operations, but they are
distinguished by the absence of blood loss, a mild postoperative period, and minimal rehabilitation

396 Published by “ CENTRAL ASIAN STUDIES" http://www.centralasianstudies.org

CAJMNS Volume: 04 Issue: 04 | Jul-Aug 2023
periods. There is practically no need for repeated manipulations. In both endoscopic operations and
DZTL, blood loss is estimated to be zero.
There were significant differences in anesthesia and surgical time for stone removal from
tradicion operación and PNLT, KULT. The duration of open operations was 51.6 ± 2.3 min, and 30.4
± 3.1 min for EZTL. No hemorrhagic complications were observed during the operation.
Intraoperative blood loss during open ureterolithotomy was 123.2±12.4 ml, and 0 during CULT.
Thus, it should be noted that the tendency of modern urology to expand the indications for
minimally invasive surgical interventions in CTK is justified, their effectiveness is confirmed by
practice and long-term follow-up of patients and good functional results. Minimally invasive surgical
care has become the standard method of treatment of CTK, which is related to both medical and
economic efficiency (short postoperative period, shortening of the patient's stay in the hospital).
List of used literatures:

1. Apolikhin O.I., Sivkov A.V., Komarova V.A., Prosyanikov M.Yu., Golovanov S.A., Kazachenko
A.V., Nikushina A.A., Shadyorkina V.A. Zabolevaemost urinary stone disease in the Russian
Federation (2005-2016 year). Experimental and clinical urology 2018(4):4-14.
2. Alyaev, Yu. G. Urinary tract disease. Sovremennyy vzglyad na problemu: Rukovodstvo dlya vrachey /
Yu. G. Alyaev, P. V. Glybochko. - M.: Medforum, 2016. - 148 p.
3. Glybochko, P. V. Osobennosti lecheniya retsidiva uratnogo nephrolithiaza / P. V. Glybochko, V. A.
Grigoryan, V. I. Rudenko [i dr.] // Therapy. – 2017. – No. 4. – S. 93–101.
4. Dzeranov N.K., Lopatkin N.A. Urinary tract disease. Clinical recommendations. - Moscow, Izdatelstvo
"Overley", 2007. - p. 296
5. Konstantinova, O. V. Epidemiological otsenka urothelial disease and ambulatory urological practice /
O. V. Konstantinova, V. A. Shaderkina. – Experimental and clinical urology. - 2015. - T. 1. – S. 11–14.
6. Lopatkin N.A. Urinary tract disease. Urology: national leadership. - M.: GEOTAR-Media, 2009. -
1024 p.
7. Martov, A. G. Rehabilitation of patients after vypolneniya sovremennykh endourologicheskikh
operatsii po povodu chechekamennoy disease / A. G. Martov, D. V. Ergakov // Urology. – 2018. – No.
4. – S. 49–55.
8. Nazarov, T.Kh. Comparative analysis of two-energy computer tomography data and results of
mineralogy issledovaniya of urinary stones in urolithiasis / T. X. Nazarov, I. V. Rychkov, D. G.
Lebedev, K. E. Trubnikova // Luchevaya diagnosis and therapy. – 2018. – No. 2 (9). - S.54-58.
9. Nurillaev J.Ya, Mukhamadiev N. K., Shodmonova Z.R., Rasulov R. Kh., Nurillaev Kh.J. //
Biomeditsiny i praktiki.. – 2022. Special edition No. 5.1. - S.201-206.
10. Nurillaev J.Ya., Mukhamadiev N.K., Nurillaev J.Ya., Khaidarova D.S. Sbornik trudov VIII
Rossiyskogo kongressa po endourologii i novym tekhnologim s mejdunarodnym uchastiem. Moscow,
2002. – P.18-19.
11. Doizi S., Raynal G., Traxer O. Evolution of urolithiasis treatment over 30 years in a French academic
institution. Prog Urol 2015;25(9):543-548.

397 Published by “ CENTRAL ASIAN STUDIES" http://www.centralasianstudies.org