The essence of Urolithiasis - one of the oldest diseases known by the mankind - is still not understood completely. For a long time the comprehension of Urolithiasis was based on matrix, colloid, ionic, inhibitory and precipitation theories. In these cases it was impossible to single out separate pathogenetic patterns. Besides, in spite of the absence of in vivo proofs the fact that new concrement nucleus forming (de novo nucleation) is only possible outside of the stone-forming metastability range should be taken into consideration for metaphilactic purposes. Fortunately, certain progress in understanding Urolithiasis started with the onset of studies devoted to detailed scrutiny of stone-forming patients’ metabolic peculiarities as well as with the introduction into clinical practice of the up-to-date digital endoscopes. Based on existing publications one may classify pathogenesis of stone-forming into 4 major groups: growth of calcium-oxalic stones on Randall’s plaques in patients with hypercalciumuria; excrescences on the of Belliny’s ducts’ “gags”; microlites forming within the internal medullar layer discharging tubules’ lumen in patients with cystineuria; stones forming in free solution. There is no doubt this classification is not the final one, neither does it exclude mixed variants, however better understanding of the aforementioned pathogenic variants would facilitate a novel view at Urolithiasis and in patients with kidney stones would increase anti-relapse measures’ effectiveness.

The lack of standards in the analysis of the chemical composition of the staghorn stones leads to a decrease in the effectiveness of metaphylaxis, and especially in those cases where the volume of the stone is much larger than the volume of the stone fragment being studied. The aim of this study was to develop standards in order to determine the composition of the staghorn calculi. In the Institute of urology from 2015 to 2016, we identified patients with urolithiasis, staghorn-stone nephrolithiasis who were eventually hospitalized. All patients underwent percutaneous nephrolithotripsy, and fragments of the stone were taken in order to analyze its chemical composition. An analysis of the composition of various fragments taken from different zones of the same calculus was made. Patients were divided into 4 groups depending on the composition of the stone. The first group included patients with a predominance of phosphate in the internal layer of the pelvic fragment of the stone, the second group – with a predominance of oxalates, the third – with a predominance of urates, the fourth – with cystine stones. Our experience, while doing stone analysis, showed that the composition did not coincide in 77% of cases, and in 41,6% of cases a new component in the chemical composition of the stone appeared. Complete coincidence of the composition in the cortical and internal layer of the stone was detected in 35% of the cases, and component coincidence in 58% of cases. In the cortical and internal layers of the pelvic fragments, the total and component coincidence of the composition was 38% and 58%, respectively. Thus, we show the importance of chemical analysis of stones and that the composition of the stone may vary, depending on its location. Timely detection of changes in the nature of the stone allows an adequate treatment of urolithiasis.

Objectives-The purpose of this study was to develop a fast, comfortable, and safe method of ureteral stent removal in women.Methods-From February 2014 to July 2015, a retrospective multicenter controlled study including 82 female outpatients was conducted. The control group was composed of 46 patients who underwent stent removal using a 22F cystoscope. The experimental group was composed of 36 patients who underwent stent removal under ultrasound guidance with a 15F spiral-ending device. Exclusion criteria were pelvic organ prolapse quantification stage II or higher and complicated stents (with migration or encrustation).Results-All studied patients had successful ureteral stent removal. No complications were seen in both groups. Differences between mean visual analog pain scale scores and stent removal durations were statistically significant in favor of the experimental group (P=.0077 and .0075, respectively).Conclusions-The proposed method for ureteral stent removal in women under ultrasound guidance was shown to be faster and to have lower visual analog pain scale scores, in comparison with removal by a cystoscope, which makes it an attractive option for outpatient urologic praxis in uncomplicated cases, and because it is free of the risk of ionizing radiation and more comfortable, it can be used in pregnant patients.

Objective: To develop a tool, both simple and reliable, for postoperative percutaneous nephrolithotomy (PCNL) stone-free failure prediction. Materials and methods: We analysed a sample of 116 patients, who underwent conventional PCNL from 2011 to 2014. Cases with residual stones ⩽ 4 mm in size were regarded as clinically insignificant and ‘stone-free’. Results: According to the low-dose computed tomography (CT) scan performed within 24 hours after operation, the patients were stratified as follows: 72 stone-free and 44 with residual stones. Among the analysed variables, three were derived as most important for prediction purposes: an additional stone in a calyx with an acute angle (⩽ 45°), represented by ‘A’; an additional stone in a long calyx (⩾ 10 mm) with a narrow infundibulum (⩽ 8mm), represented by ‘C’; and a stone size that is > 24 mm, represented by ‘S’. These were abbreviated as the ‘ACS’ score. Depending on the absence or presence of each of these three variables, a score of 0 or 1 was assigned. If the ACS score is 0, then the probability of being a stone-free patient was about 88%; however, when the ACS score is 3, then the probability of being stone free was just 8%. Conclusion: Use of the ACS score seemed to be a simple and reliable tool for PCNL stone-free failure prediction.

The goal of the study was to assess the level of postoperative pain in patients undergoing PCNL after paratubal infiltration with local anesthetic to compare this method of anesthesia with a control group where local anesthesia was not provided. 63 patients were included with kidney stones, confirmed by computer tomography (CT), who were planned to undergo percutaneous nephrolithitomy (PСNL). During the observation 6 patients have been excluded in accordance with the exclusion criteria. The remaining 57 patients were randomized into 2 groups: group A (n= 28) at the end of the operation received paratubal infiltration of 0.5% sol. ropivacaine; group B (n= 29) (controls) — local anesthesia was not used. Postoperative pain was assessed by means of VAS-score 1 hour, 6 hours and 24 hours after surgery. Systemic analgesia was performed with NSAIDs (intramuscular injection of 100 mg ketoprofen) when requested by the patient (Patient-Controlled Analgesia). In patients with local anesthesia, the total VAS score evaluated after 1 and 6 hours after the operation was significantly lower than in the control group. The average amount of ketoprofen required for postoperative analgesia in the group of patients with paratubal infiltration was significantly lower than in the control group. Paratubal infiltration of local anesthetic after PCNL significantly reduced postoperative pain and tended to reduce the amount of NSAIDs to eliminate pain, which in turn may reduce the risk of complications associated with NSAID.

Goal: to develop mobile application for patients with kidney stone for compliance maintenance and possible reduction of recurrence rate. Material and methods. Existing mobile applications for urolithiasis were meticulously reviewed by three groups of doctors each from different urological facilities from Saint Petersburg, Russia. Information used in our mobile application was from main urolithiasis guidelines of different urological associations. Direct application development was done by professional programmers. After application release urologist from all over the Russia were questioned about the usefulness of this product. Results. As a result of combined work application “Urolithiasis: patient assistant” was produced. Among 102 respondents 96 % evaluated this application as very useful, 3 % as useful and only 1 % considered it as a weak tool. Conclusion. Application “Urolithiasis: patient assistant” being first and single in Russian language consists of tools for compliance maintenance and plenty of other useful information regarding recurrence risk reduction and thus may be used in patients with kidney stones.

Purpose: To investigate the usefulness of Plasticine biomodeling in surgical percutaneous management of complex renal stone. Patients and Methods: A total of 32 patients with complex renal stones (complete staghorn stones or partial staghorn stone with multiple caliceal stones) were included in this study from 2012 to 2013. Computed tomography (CT) urography with three-dimensional (3D) reconstructions was used as standard preoperative imaging in all patients. Preoperatively, Plasticine replication of the pelvicaliceal system was performed by the operating surgeon, based on the gathered 3D reconstructions. Then the model was taken to the operating room and used as a reference model in a sterile polyethylene bag during the operation. Results: Percutaneous renal access was achieved successfully in all cases. Twenty-nine (91%) patients were treated in the prone position and only 3 (9%) in supine position. There were 18 (56%) patients who had a single tract, 9 (28%) patients had two tracts, 3 (9%) patients had three tracts, and one (3%) patient needed four tracts. The mean operative time was 92 (±26) minutes. Second-look percutaneous nephrolithotomy (PCNL) was needed in 9 of 32 (28%) patients. All second-look sessions were performed in 2 to 3 days and/or on a normalized temperature. Six of 11 (54.5%) patients with complete staghorn stones needed a second-look PCNL session. Complete stone clearance was confirmed by low-dose CT, performed at 24 hours after surgery, in 89.4% of the patients treated by a single PCNL session and 82% in those who needed second-look sessions. The overall stone-free rate (SFR) in the study after second looks was 87.3%. Conclusions: The proposed Plasticine 3D model seems to provide better preoperative renal collecting system appreciation and to serve as a reference tool during the operation, which in turn might increase SFRs and lower the complications rate after PCNL.

The study involved 653 patients with nephrolithiasis. A multivariate based on discriminant analysis model predicting the risk of bilateral nephrolithiasis development was constructed. Clinical testing revealed high ability of the proposed mathematical model for predicting the development of bilateral nephrolithiasis. The relative risk criterion is highly informative to predict the risk of bilateral nephrolithiasis development. The signs of the high-risk are: urine pH rise over 6.1, concentration of the urine magnesium decrease under 2.26 mmole/l, level of the urine saturation with calcium oxalate over 3.27 and the relative tubular reabsorption under 97.5 %.