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Abstract:
Complicated nephrolithiasis and ureterolithiasis were surgically treated in 87 and 79 patients aged 18-80 years, respectively. Of them elderly patients constituted 62%. Unilateral calculi occurred in 90.9%, coral calculi in 21 patients. Of 195 complications observed acute purulent pyelonephritis (PP) developed in 150 patients. It proved to be the most threatening and frequent complication. Therapeutic policy and choice of surgery were decided upon with consideration of the stone location, anatomic and functional status of the kidneys, preexisting somatic pathology, age of the patient. Because most severe pyelonephritis was reported in patients with nephroliths and prepelvic ureter, these patients have undergone nephrectomy most often (47%). Conservative surgery has been performed in 53%, pyelolithotomy without renal drainage in 9 (5.4%) patients with non-destructive pyelonephritis. Calculous pyodestructive pyelonephritis should be treated early according to the scheme: cleaning of the purulent foci, removal of the stone and nephrostomy. Used in 23 (13.9%) patients, this scheme failed (lethal outcome) only once. PP in patients with ureteroliths required two-stage treatment. Early nephrostomy (stage 1) preserved the kidney and prevented septic complications in 37 patients. Extracorporeal lithotripsy of ureteroliths (stage 2) is beneficial in clinically cured pyelonephritis and is indicated only in functioning nephrostomy. Conventional ureterolithotomy is valid in cicatricial ureteral stenosis in need of plastic surgery. Renal drainage and surgical elimination of the obstruction in the urinary tracts or on-demand nephrectomy resulted in a 90.4% cure. Hospital lethality in septic complications of calculous PP was 9.6%.