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CNAA / Theses / 2015 / July /

Open surgical treatment of staghorn kidney stones through nephrolithotomy and its variants


Author: Galescu Andrei
Degree:doctor of medicine
Speciality: 14.00.40 - Urology
Year:2015
Scientific adviser: Emil Ceban
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 8 July, 2015
Approved by NCAA on the 7 October, 2015

Abstract

Adobe PDF document – 0.51 Mb / in romanian

Thesis

CZU

Adobe PDF document 2.91 Mb / in romanian
140 pages

Keywords

staghorn stone, renal function, renal dimensions, inflammation, oxydative-antioxydative balance, open surgery, nephrolithotomy, sutures.

Summary

Structure of the thesis: This Ph. D. thesis contains 140 pages, including introduction, 4 chapters and 149 references, 9 tables, 152 pictures and 4 appendices.

Field of study:Urology.

Purpose: To increase the efficiency of the open surgery in patients with staghorn stones by implementing modern imaging techniques and selecting optimal variant of nephrolithotomy. Thesis objectives: Determination of the role of clinical-paraclinical and imaging modifications in the selection of the open surgery method, evaluation of both the inflammatory and oxydative-antioxydative balance indices before and after surgery, assessment of the risk of development of intra- and postoperative complications as well as monitoring of the evolution of both renal morphology and function in postoperative period (at discharge and 3 and 12 months after the surgery).

Study design: Comparative retro- and prospective study of different variants of open surgery for patients with staghorn stones. The data were obtained by consecutive enrollment of the patients and comparison of the surgery results at distance of 3 and 12 months.

Scientific novelty and originality: Determination of clinical, paraclinical and evolutive factors that influence the selection of the surgical method in treatment of staghorn stones as well as evaluation of both inflammatory and oxydative-antioxydative balance changes in such patients.

Solved scientific problem: Nephrolithotomy without blood flow interruption and consecutive sutures aplications is associated with the following amelioration of kidney function, in lesser degree affects kidney’s morphology as well as provides the lower rate of complications. It was studied risk factors’ assessment for staghorn lithiasis surgery as well as for its functional and inflammatory complications.

Theoretical and practical value of the thesis: It has been shown that nephrolithotomy is associated with more significant reduction of inflammatory and oxydative changes in comparison with other surgical treatments of staghorn stones. From practical point of view it is recommended to choose the nephrolithotomy without blood flow interruption (when it is possible) and with application of consecutive sutures. The thesis’ data were published in 19 reviewed scientifical works and were presented at 6 scientifical national and international events. The author has implemented 5 rationalization purposes in practical activity of the urological departament.