Impactul tratamentului chirurgical al chistului renal solitar asupra tensiunii arteriale, în perioada pre și post operatorie

Department of Urology and Surgical Nephrology, Nicolae Testemitanu SUMPhBackground. In most patients, solitary renal cyst (SRC) is asymptomatic and is occasionally determined at USG. SRC is manifested by pain syndrome, hypertension, urinary tract infections, and hematuria. Hypertension is the only complication that is associated with an increased mortality rate. Objective of the study. Study and analysis of blood pressure levels in patients diagnosed with solitary renal cyst in the pre and postoperative period ,depending on the topographic location of the cyst. Material and Methods. The patients included in the study were divided into 3 groups depending on the topography of the renal cyst. Group 1 (G1) 87 (44%) patients with solitary renal cyst located at the upper pole of the kidney. Group2 (G2) 42 (21%) of patients with medial renal located renal cyst. Group 3 (G3) 69 (35%) patients with solitary renal cyst located at the lower pole of the kidney. Results. Systolic BP(BPs) in 198 patients preoperatively on average was 135.5mmHg (min.105;max.200), diastolic BP(BPd) on average was 85.5mmHg (min.60;max.115). Postoperative: G1:was observed a decrease in BP in 72(82,7%) patients which averaged 8mmHg (p<0,05 )for BPs and 6.9mmHg (p<0,05) for BPd. In 15(17,3 %) patients no decrease in BP was determined. G2:was observed a decrease in BP in 32(76,2%) patients which on average was 5.2mmHg for BPs and 4.0 mmHg for BPd. In 10(23,8%)patients the BP did not decrease. G3:was observed a decrease in BP in 45(65,2%) patients which on average was 4.5mmHg for BPs and 4.9mmHg for BPd. In 24(34,8%) patients the BP did not decrease. Conclusion. The postoperative evolution of patients with SRC demonstrates a statistically significant reduction in blood pressure in the postoperative period. The highest value is attested in patients operated with SRC located at the upper pole of the kidney.Introducere. La majoritatea pacienţilor chistul renal solitar (CRS) este asimptomatic şi este determinat ocazional la USG. CRS se manifestă prin sindrom algic, hipertensiune arterială, infecţii urinare şi hematurie. HTA reprezintă unica complicaţie care este asociată cu rata sporită de mortalitate. Scopul lucrării. Studierea și analiza nivelurilor tensiunii arteriale la pacienții diagnosticaţi cu chist renal solitar, în perioada pre şi post operatorie, în dependenţă de localizarea topografică a chistului. Material și Metode. Pacienții incluși în studiu au fost divizați în 3 loturi, în funcție de topografia chistului renal. Lotul 1(L1) 87(44%) de pacienți cu chist renal solitar, localizat la polul superior al rinichiului. Lotul 2(L2) 42(21%) de pacienți cu chist renal localizat mediorenal. Lotul 3(L3) 69(35%) de pacienţi, cu chist renal solitar, localizat la polul inferior al rinichiului. Rezultate. TA sistolică (TAs) la 198 pacienţi preoperator în medie a fost de 135,5mmHg(min.105;max.200), TA diastolică (TAd) în medie a fost de 85,5mmHg (min.60;max.115). Postoperator: L1:distingem o scădere a TA la 72(82,7%) de pacienţi, care în medie a constituit 8mmHg(p<0,05) pentru TAs şi 6,9mmHg(p<0,05) pentru TAd. La 15(17,3 %) pacienţi nu s-a determinat o scădere a TA. L2:distingem o scădere a TA la 32(76,2%) de pacienţiâ, care în medie a constituit 5,2mmHg pentru TAs şi 4,0mmHg pentru TAd. La 10(23,8%) pacienţi nu s-a micșorat TA.L3:distingem o scădere a TA la 45(65,2%) de pacienţi, care în medie a constituit 4,5mmHg pentru TAs şi 4,9mmHg pentru TAd. La 24(34,8%) de pacienţi nu s-a micșorat TA. Concluzii. Evoluţia postoperatorie a pacienţilor cu CRS demonstrează o reducere statistic semnificativă a tensiunii arteriale în perioada postoperatorie. Cea mai mare valoare se atestă la pacienţii operaţi cu CRS localizat la polul superior al rinichiului

Contemporary management in patients with chronic calculous pyelonephritis

Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Urolithiasis takes an important place in the structure of urological pathology, thanks to its high incidence, its recurrence frequency and the complications it might cause. There are many scientific publications dedicated to the study of urinary infection as an etiological factor of urolithiasis. Chronic pyelonephritis has the important etiologic and pathogenic role in the development of urolithiasis, but stone formation as a complication is possible in chronic inflammation of the upper and lower urinary tract. In some cases, urinary infection precedes the development of urolithiasis and may serve as a trigger for kidney stones formation. In other cases, it associated with urolithiasis, arising from other infectious causes. The association of metabolic factors and the infection usually forms chemically mixed renal stones containing phosphates, which in most cases are recurrent. In general, urinary tract infection is detected in 80% of cases of urolithiasis

Impactul tratamentului chirurgical a chistului renal solitar asupra tensiunii arteriale la pacienţi, în perioada pre şi post operatorie

Catedra de urologie şi nefrologie chirurgicală, USMF “Nicolae Testemiţanu “Introducere. La majoritatea pacienţilor chistul renal solitar (CRS) este asimptomatic şi este determinat ocazional la USG. CRS se manifestă prin sindrom algic, hipertensiune arterială, infecţii urinare şi hematurie. HTA reprezintă unica complicaţie care este asociată cu rata sporită de mortalitate.Scopul studiului. Studierea și analiza valorilor tensiunii arteriale la pacienţii diagnosticaţi cu chist renal solitar în perioada pre şi post operatorie în dependenţă de localizarea topografică a chistului. Material si metode. Pacienții incluși în studiu au fost repartizaţi în 3 loturi, în funcție de topografia chistului renal. Lotul 1- 87 (44%) de pacienți cu CRS localizat la polul superior al rinichiului. Lotul 2- 42 (21%) de pacienți cu CRS localizat mediorenal. Lotul 3- 69 (35%) de pacienţi cu CRS localizat la polul inferior al rinichiului. Concluzii Evoluţia postoperatorie a pacienţilor cu CRS demonstrează o reducere statistic semnificativă a tensiunii arteriale. Rezumând datele studiului privind localizarea anatomică a CRS şi formarea hipertensiunii renale simptomatice, concluzionăm că aspectele patogenetice depind de localizarea chistului solitar al rinichiului. Cea mai mare valoare a ratei de succes se atestă postoperator la pacienţii cu CRS localizat la polul superior al rinichiului

Methods of diagnostic and contemporary treatment of renal solitary cyst. Clinic experience

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Renal Solitary cyst is one of the most common kidney pathologies and occurs in 50% of necropsy in people over 50 years of age. Most commonly, cystic formations develop in the kidney, usually asymptomatic. The etiology of renal cysts can be congenital, sporadic or acquired, and their development can occur at any level of nephron or collector tubes. Simple kidney cyst is specific to adult age, is not genetically transmitted, and is not accompanied by another chromosomal abnormality. In children, the incidence is reduced by 0.1-0.45%, but it increases in adult to 20% at 40 years and 33% to 60 years. Aim of the study. Analysis of the results obtained in the clinic following the treatment applied to patients with solitary renal cysts, treated by the classical surgical method and laparoscopic. Materials and methods.. The retrospective study was performed in the Department of urology and surgical nephrology of the State University of Medicine and Pharmacy Nicolae Testemitanu, within the Republican Clinical Hospital Timofei Moşneaga, on a batch of 92 patients diagnosed with solitary renal cyst, treated by different methods (laparoscopic resection, open cystectomy and cyst puncture) during the years 2017-2019. Results. From the total number of patients according to cyst localization: in 50 (54.3%) of patients the cyst was located on the left side and in 42 (45.7%) of patients on the right side. The distribution by sex was as follows: 48 (52,2%) men and 44 (47,8%) women diagnosed with solitary renal cyst. Anatomical location of the cysts: upper pole 48 patients (51%), lower pole 30 patients (32.6%), mediorenal 14 patients (16.4%). The size of the operated cysts ranged from 3 cm to 10 cm and more. The age of the patients in the study group with solitary renal cyst ranged from 25 years to 78 years, the average being ~ 53 years According to the Bosniak classification,we observe the prevalence of the classical surgical method in Bosniak cysts III. Laparoscopic method was performed in patients with Bosniak cysts I and II, cyst puncture was performed only in patients with Bosniak cysts I. Of the 92 patients diagnosed with solitary renal cyst in 57 (62%) of them, the laparoscopic treatment method was performed, open cystectomy 23 (25%) patients, and cyst puncture to 12 (13%) patients. Conclusions. Following this study we distinguish the advantages of the minimally invasive laparoscopic method which is of choice at the present moment, by the minimal aggressiveness of the surgical act, the absence of large postoperative scars, the decrease of the hospitalization period -3-4 days compared to -10-14 days after the open surgical method , minimum number of recurrences, rapid rehabilitation and reintegration into the social life and professional activity of patients

Percutaneous surgery in treatment of urolithiasis

Introducere. Nefrolitotomia percutană (NLP) reprezintă o intervenție chirurgicală minim invazivă ce presupune extragerea calculilor renali printr-o incizie minimă la piele în regiunea lombară. Această procedură chirurgicală este acceptată ca tratamentul de elecție pentru diferite forme de litiaza renală inclusiv la pacienții cu calculi renali masivi și foarte rezistenți. Scopul studiului. Rata stone free în urma intervenției chirurgicale prin nefrolitotomie percutanată (NLP), aplicată pacienților cu urolitiază, timp de 4 ani (2019- 2023). Material și metode. Studiul a fost realizat în cadrul clinicii de Urologie și Nefrologie chirurgicală a Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu”, din cadrul Spitalul Clinic Republican „Timofei Moșneaga”, pe un lot de 175 de pacienți cu diagnosticul de Urolitiază. Rezultate. Distribuția după localizarea calculilor renali a fost următoarea: rinichi drept 81 (46,3%) pacienți, rinichi stâng 94 (53,7%) pacienți. Dimensiunile calculilor au variat de la 2 cm până la calculi masivi coraliformi (>4,5 cm). Perioada de spitalizare postoperatorie în medie a fost de 4,5 zile. Din grupul de pacienți, 5 (2,9%) dintre ei au fost tubeless (fără nefrostomă), 4 (2,3%) pacienți cu două traiecte de puncție,1 pacient cu 3 traiecte de puncție (0,6%). În lotul de studiu 4 (2,3%) pacienți au avut unic rinichi chirurgical. Stratificarea complicațiilor chirurgicale postoperatorii s-a făcut conform scorului Clavien-Dindo (SCD). SCD I, 145 (82,85%); pacienți cu SCD II: 26(14,85%) pacienți, SCD III: 4 (2,3%) pacienți. Pacienții cu CDS IV și V nu au fost detectați. Concluzii. Rata totală de succes stone-free este de 91 % după NLP primar și 100% după o procedură secundară cum ar fi ureteroscopia cu litotritie sau ESWL (Litotritia extracorporală cu unde șoc).Background. Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure to remove kidney stones by a punction through the skin in lumbar region. This procedure is accepted as standard of care for patients with kidney stones that are large and resistant to other forms of urolithiasis. Objective of the study. Stone free rate obtained in the clinic following PCNL intervention applied to patients with urolithiasis, during 4 years (2019-2023). Material and methods. The study was performed in the Department of Urology and Surgical nephrology of the Nicolae Testemițanu State University of Medicine and Pharmacy â, on a group of 175 patients with diagnosis of urolithiasis. Results. Anatomical distribution of renal stones: right kidney 81 (46.3%) patients, left kidney 94 (53.7%) patients. The stones size ranged from 2 cm up to massive staghorn stones (> 4.5cm). The after surgery hospitalization period on average was 4.5 days. Four patients had solitary kidney. From the group of study, 5 (2.9%) of them were tubeless, 4 (2.3%) were with two puncture channels, and 1 (0.6%) patient was with three puncture channels. The stratification of the surgical after surgery complications was evaluated according to the Clavien-Dindo score. CDS I: 145 (82.85%); patients CDS II: 26 (14.85%) patients, CDS III: 4 (2.3%) patients. Patients with CDS IV and V were not detected. Conclusions. The success of PCNL is dependent on many factors such as stone composition, stone size, and number of stones, localization, and body mass index. The stone free rate was 91% and 100% following by „second look” procedure: ESWL, Ureteroscopy

Methods of diagnostic and contemporary treatment of renal solitary cyst. Clinic experience

Catedra de urologie și nefrologie chirurgicală USMF „Nicolae Testemiţanu”, Al VII-lea Congres de Urologie, Dializã si Transplant Renal din Republica Moldova cu participare internațională 19-21 iunie 2019Chistul Renal Solitar este una dintre cele mai răspândite patologii renale și se întâlnește în 50% dintre necropsii, la persoanele cu vârsta de peste 50 de ani. Cel mai frecvent, formațiunile chistice se dezvoltă la nivel renal, de obicei iind asimptomatice. Etiologia chisturilor renale poate i congenitală, sporadică sau dobândită, iar dezvoltarea lor se poate produce la orice nivel al nefronului sau tubelor colectori. Chistul renal simplu este speciic vârstei adulte, nu se transmite genetic și nu este însoțit de altă anomalie cromozomială. La copii, incidența este redusă, de 0,1-0,45%, aceasta crescând însă la adult pîna la 20% la 40 de ani și 33% pîna la 60 de ani. Renal Solitary cyst is one of the most common kidney pathologies and occurs in 50% of necropsy in people over 50 years of age. Most commonly, cystic formations develop in the kidney, usually asymptomatic. The etiology of renal cysts can be congenital, sporadic or acquired, and their development can occur at any level of nephron or collector tubes. Simple kidney cyst is speciic to adult age, is not genetically transmitted, and is not accompanied by another chromosomal abnormality. In children, the incidence is reduced by 0.1-0.45%, but it increases in adult to 20% at 40 years and 33% to 60 years