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CNAA / Theses / 2017 / July /

Contemporary management in metaphylaxis of recurrent urolithiasis


Author: Banov Pavel
Degree:doctor of medicine
Speciality: 14.00.40 - Urology
Year:2018
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 12 July, 2017
Approved by NCAA on the 11 May, 2018

Abstract

Adobe PDF document – 0.69 Mb / in romanian

Thesis

CZU 616.613.-003.7-084(043)

Adobe PDF document 3.84 Mb / in romanian
164 pages

Keywords

reccurent renal lit hiasis, lit hogenesis, risk factors, recurrence, metaphylaxis, ant irecurrence therapy, shock wave lithotripsy, open pielolytotomy, ureteroscopy, chronic pyelonephritis.

Summary

Field of study: Urology.

Purpose: to improve the results of antirecurrence therapy in patients with recurrent urolithiasis by developing algorithms of diagnostic and metaphylactic treatment.

The research objectives: Invest igat ion o f clinical-paraclinical aspects in pat ients with recurrent urinary lithiasis subjected to different treatment methods; Identification and analysis of causes of lithogenesis and risk factors for relapse, including the investigation of inflammatory disorders, oxidative stress and antioxidant system in patients with recurrent urolithiasis; Performing a complex research based on the chemical composition of calculi and metabolic disturbances present in patients with recurrent urolithiasis; Analysis of relapses according to the method of treatment of primary lithiasis; Development of an algorithm of individual metaphylaxis indicat ions.

The novelty and the scientific originality: A mult ilateral clinical trial focused o n the metaphylaxis o f the recurrent urolithiasis has been performed, and factors that favor recurrent urolithiasis have been identified. The influence of a number of factors related to the lifestyle, the sex and age of the patients, the chemical composition of the calculi, the location of the renal and ureteral calculi, the urodynamics and inflammatory disorders on the likelihood of recurrence of the urinary lithiasis were appreciated. It has been determined that recurrences of urolithiasis occur more frequently in patients with an increase in oxidative stress and diminished antioxidant activit y, and immunodeficiency.

The scientific solved problem: consists of ident ifying the factors that promote the development of the recurrences of urinary lithiasis and the elaboration, on the basis o f these records, of a scientifically argued algorithm o f diagnostic, behavioral and metaphylactic treatment applied to patients with recurrent urolithiasis, an innovation that allowed to reduce the recurrence of the disease.

The theoretical significance: The value of complex clinical-paraclinical assessment of patients was demonstrated for the prediction of recurrence of urolithiasis and for the selection appropriate metaphylaxis method. Based on metabolic balance and immunological changes, by researching oxidative stress and the state of the antioxidant system, investigating the chemical composition of calculi in patients with recurrent urinary lit hiasis, the efficacy o f metaphylaxical treatment of recurrent urolit hiasis was argued.

The applicative value of the thesis: Were developed the methodology of management and the metaphylactic differentiated treatment algorithm of patients with recurrent renal and ureteral calculi, depending on the chemical composition of the calculus, the metabolic disorders and the previously applied treatment method. Promoted criteria and recommendations for differentiated anti-recurrent metaphylaxical treatment of patients with urolithiasis reduce morbidity, prevent the decrease of renal function and complications that affect work capacity, result in organ loss or disabilit y.

The implementation of the scientific results: The result s o f the thesis were implemented in the didactic and curative processes at the Department of Urology and Surgical Nephrology of the SUMP "Nicolae Testemitanu", at the Urology Clinic of the Republican Clinical Hospital and at other Urology Departments of the Republic of Moldova.