Modern radiology diagnostics of cup-pelvic system within surgical treatment planning in patients with nephrolithiasis
Pesegov S.V., Rudenko V.I., Sayenko V.S., Aleksandrova K.A., Serova N.S., Kapanadze L.B.
The most complex form of urolithiasis is coral nephrolithiasis (CN). The choice of surgical method of CN is one of the most controversial issue. Despite the most common type of normally developed kidney (50-70% of cases), it is necessary to remember about alternative versions of the structure of the cup-pelvic system (CPS), angioarchitectonics and anomalies of kidney development. The emergence of highly informative diagnostic technologies and improved methods of treatment of CN dictate the growth of interest in the study of the individual anatomy of the kidney and the pathological process. Materials and methods. The analysis of the influence of the form of CPL, the type of rotation of the cups and the stage of CN on the results of treatment. 143 patients with K2-K4 forms of CN were examined and treated. As monotherapy, percutaneous nephrolithotripsy was performed in 118 patients, combined treatment was required in 25 patients. The classification proposed by A. G. Martov (K1, K2, K3, K4) was used to separate patients within the group according to the stage of CN. Assessment of the type of structure of the CPS was carried out according to the classification proposed by F. Sampaio (AI, AII, BI and BII types). Options of rotation of the cups is distributed as belonging to Podlewska (Br.) or Hodson (N.) types. The survey found that of the 143 patients revealed K2 – 47, Q3 - 49, Q4 - 47 patients. Brodel's type of rotation of the cups was observed in 33 patients with the form of the structure of the CPS AI, AII-11, BI-16, BII-14, respectively. In patients with Chodanowski type of rotation of the cups is marked with the following occurrence of the forms of structures of CHLS – AI-26, II-14, BI-17, BII-12. Results. The overall effectiveness of treatment of K2-K4 forms of KN is 96.5%. The effectiveness of percutaneous nephrolithotripsy monotherapy is 82.52%. Depending on the type of rotation of the cups is marked complete elimination of CPS when performing percutaneous nephrolithotripsy monotherapy 78.3% of patients with Podlewski and 86.9% of patients with Chodanowski types. The highest degree of elimination when using percutaneous nephrolithotripsy monotherapy has AI form of CPS (94.92%). The worst in relation to the prediction of elimination were AII and BII forms of CPS-64% and 73.08% of cases, respectively. Conclusion. The key to the success of CN treatment is a detailed understanding of the variants of the structure of the CPS with the use of modern high-tech diagnostic methods. |
I.M. Sechenov First MSMU (Sechenov University). Moscow, Russia. |
Keywords: urolithiasis, coral nephrolithiasis, structure of the cup-pelvic system, percutaneous nephrolithotripsy, combined treatment, multispiral computed tomography.
Corresponding author: Pesegov S.V., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Pesegov S.V., Rudenko V.I., Sayenko V.S., Aleksandrova K.A., Serova N.S., Kapanadze L.B. Modern radiology diagnostics of cup-pelvic system within surgical treatment planning in patients with nephrolithiasis. REJR 2019; 9(3):127-133. DOI:10.21569/2222-7415-2019-9-3-127-133.
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Received: 14.06.19 Accepted: 22.08.19