Surgical treatmen of complicated urolitiasis in children

Aim. Optimization of surgical treatment methods of children with complicated urolithiasis.

Material and research methodos. The results of treatment of 200 sick children with complicated urolithiasis were analyzed. Patients were assigned to the study group 150 (75%) and comparable group 50 (25%). Children from 0 to 15 years old. In children with urolithiasis, the following clinical symptoms were most common: proteinuria in 47 (23,5%) patients, discoloration of urine in 34 (17,5%) and pyuria in 32 (16,0%) patients. Hematuria was observed in 31 (15,5%) children, weakness and fatigue in 29 (14,5%) and pain in 27 (13,5%) patients. For an objective assessment of the severity of urolithiasis in children, X-ray and radiation diagnostics data were taken into account (Ultrasound, plan radiography, excretory urography, CT scan and Magnetic resonance imaging -MRI). Renal circulation studies (Rehberg – Tareev test, doppler sonography), glomerular filtration rate (CFL) according to Kunahan Barrats formula.

Research results and their discussion. We divided the surgical methods of treatment of complicated urolithiasis into three parts: minor surgery methods or pollative, radical and reconstructive plastic surgery methods. The method of minor surgery was carried out as a measure of preparation for radical and reconstructive plastic surgery. Methods of radical surgery in sick children with urolithiasis include pyelolithotomy (40), nephrolitosthomy (30), ureterolitothomy (32), epicystolitothomy (47), percutaneous nephrolithotripsy (33)and contact ureterolithotripsy (18). In relation to reconstructive plastic surgery, it should be noted that the most performed operations are intrarenal plastic surgery of the cervix of the greater calyx. The narrowing of the neck of the large calyx of the kidney was revealed, which led to a violation of urodynamics in the cavity formation of the kidneys and was the cause of the formation of stones due to stagnation of urine.

Conclusions. There is no single approach to both surgical and conservative treatment for complicated urolithiasis. Double drainage of the PCS and stend-by after surgery showed good results. In treating children with complicated urolithiasis, there should be an individual approach depending on the type of complications, the degree of renal dysfunction, the degree of hydronephrosis, and the activity of the inflammatory process.

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