Исследование методов улучшения лечения осложнений, возникающих при эндоурологических операциях при мочекаменной болезни (обзор литературы)

Аннотация

Endourological procedures, such as percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), and retrograde intrarenal surgery (RIRS), are widely used for the treatment of urinary stone disease. Despite their effectiveness, these procedures can lead to various complications, including infections, bleeding, ureteral injuries, and residual stones. This response explores methods to improve the treatment of these complications, drawing on insights from recent research papers. Keywords: prevention, endourological procedures, complications, antibiotic prophylaxis, intraoperative imaging Prevention of Complications in Endourological Procedures 1.Preoperative Antibiotic Prophylaxis Antibiotic prophylaxis is a critical measure to prevent infectious complications, which are among the most common issues following endourological procedures. Studies have shown that the use of antibiotics such as ciprofloxacin can significantly reduce the incidence of postoperative urinary tract infections (UTIs) and sepsis. For instance, one study demonstrated that preoperative and postoperative antibiotic administration decreased the rate of postoperative pyelonephritis from 40% to 16.7% in patients with chronic urinary infections [13]. Similarly, another study emphasized the importance of interpreting stone and urine cultures to guide appropriate antibiotic use, thereby minimizing the risk of urosepsis [4]. 2.Suction Devices in Endourological Procedures The incorporation of suction devices during endourological procedures has been shown to improve outcomes by facilitating stone debris removal and reducing intrarenal pressure. In PCNL, the use of suctioning sheaths has been associated with higher stone-free rates (SFR) and lower rates of infectious complications. For example, suctioning during RIRS has been shown to reduce the risk of postoperative infections and improve SFR [1]. These findings highlight the importance of suctioning as a preventive measure against complications. 3.Intraoperative Computed Tomography (ICT) Volume 2 Issue 3 | 2025 | Page | 21 Tel: +99833 5668868 | Tg: @Anvarbek_PhD ISSN ORIENTAL JOURNAL OF MEDICINE AND NATURAL SCIENCES 3030-3591 “Innovative World” Scientific Research Center www.innoworld.net The use of intraoperative computed tomography (ICT) during endourological procedures has emerged as a promising tool for detecting residual stones and reducing the need for reintervention. A systematic review and meta-analysis found that ICT significantly improved SFR compared to conventional fluoroscopic-guided procedures, with SFR increasing from 41.4% to 84.5% in the ICT group [5]. Additionally, ICT reduced radiation exposure and reintervention rates, making it a valuable tool for minimizing complications. 4. Preoperative Patient Selection and Imaging Proper patient selection and preoperative imaging are essential for minimizing complications. For example, in PCNL, preoperative imaging helps identify anatomical abnormalities and plan the optimal approach, reducing the risk of bleeding and visceral injuries. Similarly, in URS, preoperative imaging can help identify ureteral strictures or other anomalies that may complicate the procedure [18]. Management of Complications 1. Infectious Complications Infectious complications, such as UTIs and sepsis, are common following endourological procedures. The management of these complications involves the use of antibiotics, drainage of infected urine, and, in severe cases, supportive care for sepsis. Studies have shown that the early recognition and treatment of infections can significantly reduce morbidity and mortality [4] [13]. 2. Bleeding and Hemorrhagic Complications Bleeding is a common complication of PCNL, with reported rates ranging from 0.6% to 1.4%. The management of bleeding typically involves conservative measures such as blood transfusions, electrocoagulation, and maintaining constant renal saline flow. In severe cases, selective embolization or surgical intervention may be required [14]. 3. Ureteral Injuries and Strictures Ureteral injuries and strictures are potential complications of URS. The management of these complications often involves endoscopic or percutaneous interventions, such as ureteral stenting or balloon dilatation. In cases of severe strictures, open surgical repair may be necessary [3] [10]. 4. Residual Stones Residual stones are a common issue following endourological procedures, with rates ranging from 12.6% to 32.6% in some studies. The management of residual stones typically involves reintervention, either through a second endoscopic procedure or shock wave lithotripsy (SWL). The use of ICT has been shown to reduce the incidence of residual stones and the need for reintervention [5]. Table: Key Strategies for Preventing and Managing Complications in Endourological Procedures Volume 2 Issue 3 | 2025 | Page | 22 Tel: +99833 5668868 | Tg: @Anvarbek_PhD ISSN ORIENTAL JOURNAL OF MEDICINE AND NATURAL SCIENCES 3030-3591 “Innovative World” Scientif