Shock-wave lithotripsy or percutaneous nephrolithotomy in large and staghorn stones: technical features and complications

Treatment of large kidney stones, especially, staghorn stones is one of the most difficult problems in urology. It is obvious that there is a need for active treatment of these patients, due to significant renal function deterioration caused by urinary tract obstruction and inflammatory process. Treatment choice is dependent on the stone burden and its shape, and evaluation criteria included stone-free rate, operative complications, and a need for repeated (unexpected) interventions. Renal stones’ treatment results showed that, currently, the most efficient and prevalent method for stone elimination is percutaneous nephrolithotomy. To the other hands, shock-wave lithotripsy (SWL) requires higher mean treatment time despite minimally invasive nature. However, currently a use of SWL in treatment of large and staghorn calculi should not be ignored. SWL showed efficiency in pediatric patients with stones located in intrarenal pelvis, with density < 600 HU and size < 2 cm.Лечение крупных камней почек, а особенно коралловидных конкрементов является одной из самых трудных проблем в урологии. Необходимость активной тактики ведения зтой категории больных является очевидной, так как окклюзии мочевых путей и воспалительный процесс ведут к значительным потерям функции почки. На выбор метода лечения влияют размер и форма конкрементов, а критериями оценки результатов лечения служат полнота удаления камня, осложнения проведенного лечения, необходимость применения повторных (внеплановых) оперативных пособий. Результаты лечения камней почек показали, что наиболее эффективным и превалирующим методом элиминации конкремента на сегодняшний день является перкутанная нефролитотомия. В то же время дистанционная литотрипсия при низком уровне радикальности имеет высокую среднюю продолжительность лечения. Тем не менее, на современном этапе отказываться от применения ДЛТ в лечении крупных и коралловидных конкрементов не следует. Отмечена ее эффективность у детей, при лоханочных камнях внутрипочечного типа плотностью менее 600 HU и размерами менее 2 см

PPARgamma inhibits hepatocellular carcinoma metastases in vitro and in mice

Background: We have previously demonstrated that peroxisome proliferator-activated receptor (PPARγ) activation inhibits hepatocarcinogenesis. We aim to investigate the effect of PPARγ on hepatocellular carcinoma (HCC) metastatic potential and explore its underlying mechanisms. Methods: Human HCC cells (MHCC97L, BEL-7404) were infected with adenovirus-expressing PPARγ (Ad-PPARγ) or Ad-lacZ and treated with or without PPARγ agonist (rosiglitazone). The effects of PPARγ on cell migration and invasive activity were determined by wound healing assay and Matrigel invasive model in vitro, and in an orthotopic liver tumour metastatic model in mice.Results:Pronounced expression of PPARγ was demonstrated in HCC cells (MHCC97L, BEL-7404) treated with Ad-PPARγ, rosiglitazone or Ad-PPARγ plus rosiglitazone, compared with control (Ad-LacZ). Such induction markedly suppressed HCC cell migration. Moreover, the invasiveness of MHCC97L and BEL-7404 cells infected with Ad-PPARγ, or treated with rosiglitazone was significantly diminished up to 60%. Combination of Ad-PPARγ and rosiglitazone showed an additive effect. Activation of PPARγ by rosiglitazone significantly reduced the incidence and severity of lung metastasis in an orthotopic HCC mouse model. Key mechanisms underlying the effect of PPARγ in HCC include upregulation of cell adhesion genes, E-cadherin and SYK (spleen tyrosine kinase), extracellular matrix regulator tissue inhibitors of metalloproteinase (TIMP) 3, tumour suppressor gene retinoblastoma 1, and downregulation of pro-metastatic genes MMP9 (matrix metallopeptidase 9), MMP13, HPSE (heparanase), and Hepatocyte growth factor (HGF). Direct transcriptional regulation of TIMP3, MMP9, MMP13, and HPSE by PPARγ was shown by ChIP-PCR. Conclusion: Peroxisome proliferator-activated receptor-gamma exerts an inhibitory effect on the invasive and metastatic potential of HCC in vitro and in vivo, and is thus, a target for the prevention and treatment of HCC metastases. © 2012 Cancer Research UK All rights reserved.published_or_final_versio

[Comparative analysis of the efficacy and safety of percutaneous nephrolithotomy for staghorn calculi].

The widespread introduction of percutaneous nephrolithotomy has led to a significant narrowing of the traditional indications for surgery for staghorn calculi. We analyzed the efficacy and safety of percutaneous nephrolithotomy, depending on the stage ofstaghorn nephrolithiasis. In a period of 2008-2011, 120 patients with staghorn calculus underwent percutaneous nephrolithotomy. Data from spiral computed tomography were used in planning the surgical approach. In the preoperative period, staghorn calculi SN1-SN2 were diagnosed in 31.7% of patients (Group 1), and complex forms of stones corresponding SH3-SN4--in 68,3% (Group 2). The between-group analysis showed that the average time of surgery was significantly (p \u3c 0,01) higher in patients in Group 2, the same group reported more frequent blood loss requiring to stop operation, as well as hyperthermia, hypotension during surgery, but the difference was not significant compared to Group 1 (p \u3e 0,05). Conversion to open surgery was required in 2,6 and 2,7% of patients in Group 1 and Group 2, respectively. Application of PNL allowed to completely remove SN1-SN2 calculi in 94,7% of cases in Group 1, but similar result was achieved only in 63.4% of cases in most difficult group of patients with SN3-SN4

[Estimation of renal function reserve in percutaneous nephrolithotomy of coral nephrolithiasis].

From November 2010 to December 2011, 56 patients with coral nephrolithiasis underwent percutaneous nephrolithotomy. To assess the renal function before surgery and before discharge (6 to 7 days after surgery), glomerular filtration rate (GFR) by Cockcroft-Gault equation was defined. Preoperative renal functional reserve was evaluated by method using a single oral loading of protein drugs. 46.4% of patients have decreased GFR before surgery, and before discharge the proportion of such patients was 39.3%. In 80% of patients with reduced GFR, postoperative filtering function of the kidneys in response to a protein load was increased, but did not reach the pre-operative no-load values, and in 7.5% of cases corresponded to a load indicators. Filtering function of the kidneys before discharge below baseline and load levels was observed only in 8.9% of cases. The data obtained in most cases allowed to predict GFR decline in the postoperative period in patients with coral nephrolithiasis. 87.5% of patients before surgery were characterized by the absence of renal functional reserve, but in 28.6% of patients in the postoperative period there was an increase in GFR, indicating the positive impact of endoscopic percutaneous nephrolithotomy on the functional state of the kidneys in the immediate postoperative period

EFFECTIVENESS AND SAFETY OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR UNCOMPLICATED PELVIC CONCREMENTS

Introduction. Extracorporeal shockwave lithotripsy (ESWL) allowed to improve the treatment results for patients suffering from the kidney stone disease (KSD), decrease the number of complications, optimize the nearest and distant therapy results; however, its success depends on the initial size and shape of the stone. Purpose of the study. Тo examine the clinical effectiveness and safety of electromagnetic ESWL used on simple renal calculi taking their sizes into account. Materials and methods. The survey included 110 patients with simple renal calculi who passed electromagnetic ESWL procedures. The first group consisted of 75 patients with calculi ≤ 15 mm in diameter, the second group included 35 patients with stones &gt; 15 mm. Results. Complete disintegration of stones ≤ 15 mm was accomplished in 74,7% of cases in 1-2 lithotripsy sessions, and after 3 months residual fragments were found in 4% of cases only. Elimination of stones &gt; 15 mm from the renal collecting system takes considerably longer, all patients require more than 1 lithotripsy session. In 3 months following the ESWL residual stones were found in 17,2% of analysed cases. Stone sizes had no bearing on the pain syndrome frequency and severity as well as activation of urinary infection. Macrohematuria, renal haematomas, and an increase of blood creatinine level compared with the original value were more frequent in patients with stones &gt; 15 mm. Conclusions. Electromagnetic ESWL is an efficient and safe method for monotherapy of patients with uncomplicated pelvic concrements. Clinical ESWL effectiveness for stones ≤15 mm by the 3rd month of monitoring reaches 96,0%, for stones &gt; 15 mm it is 82,8% (р&lt;0,05). The level and severity of complications is higher in case of pelvic stones &gt;15 mm compared with the stones &lt; 15 mm in diameter (р&lt;0,05)

[X-ray phase analysis of stag-horn concrements in citizens of south Russia].

It is known that recurrent nephroliths form in about half of the operated patients within 5 years after operation while 60% of all recurrences occur 3 years after removal of the primary concrement. To prevent recurrent nephroliths, it is important not only to detect metabolic disturbances but also to investigate chemical composition of uroliths. Mineral composition of 112 stag-horn concrements from patients living in the south of Russia was studied with x-ray phase analysis which showed that 62.9% concrements had mixed composition. Compared to patients with primary stag-horn nephrolithiasis, patients with recurrent one more often had calcium-phosphate and calcium-oxalate concrements than urate concrements. Chemical composition of the concrements depended on features of the relief of the region where the patients live. Newly established mineral characteristics of stag-horn concrements in the citizens of south Russia should be taken into consideration both in surgical treatment and follow-up of such patients

MICROBIOTA URINE BEFORE AND AFTER LITHOTRIPSY FOR RENAL STONES

Extracorporeal shock wave lithotripsy (ESWL) in spite of the low invasiveness and high efficiency is accompanied by an infectious- inflammatory complications and renal parenchymal injury . Dynamics of microbial spectrum urine and the impact of postoperative antibiotic therapy currently remains unexplored. The study included 30 patients subjected to ESWL. Bacteriological study was midstream morning urine before ESWL, 1, 3 days after ESWL, and midstream urine in the first urination after ESWL. All patients were divided into 2 groups. Group I consisted of patients (46.7%) with antibiotic therapy . Group II patients (53.3 %) antibiotic therapy was performed. In most cases (97.8 %) were bacteriuria , while in 75% of cases highlighted in the various options bacterial associations representation aerobic- anaerobic mixed infection, among which was dominated by non-clostridial anaerobic bacteria in all samples. Revealed that after ESWL microbial spectrum urine does not change in any case within 3 days , except for Enterobacteriaceae, but the frequency of occurrence and level of bacteriuria vary for different periods after surgery and fees or absence of antibiotic therapy