inovmedИнновационная медицина КубаниInnovative Medicine of Kuban2541-9897Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 110.35401/2541-9897-2023-26-2-93-99inovmed-678Research ArticleСЛУЧАИ ИЗ КЛИНИЧЕСКОЙ ПРАКТИКИCASE REPORTSОпыт одномоментной лапароскопической пластики стриктуры лоханочно-мочеточникового сегмента с интраренальной гибкой хирургией нефролитиазаSimultaneous laparoscopic surgery for ureteropelvic junction obstruction and retrograde intrarenal surgery for nephrolithiasishttps://orcid.org/0000-0002-4625-9689СергеевВ. В.SergeevV. V.

Сергеев Владимир Витальевич, к. м. н., заведующий отделением урологии № 1

350012, Краснодар, ул. Красных Партизан, 6/2

Vladimir V. Sergeev, Cand. Sci. (Med.), Head of Urology Unit No. 1

ulitsa Krasnykh Partisan 6/2, Krasnodar, 350012, Russian Federation

Sergeev_vladimir888@mail.ruhttps://orcid.org/0000-0001-8335-2578МедведевВ. Л.MedvedevV. L.

Медведев Владимир Леонидович, д. м. н., профессор, заведующий кафедрой урологии; заместитель главного врача по урологии, руководитель краевого уронефрологического центра

Краснодар

Vladimir L. Medvedev, Dr. Sci. (Med.), Professor, Head of the Urology Department; Chief Physician Assistant (Urology), Head of the Regional Uronephrology Center

Krasnodar

https://orcid.org/0000-0002-0755-903XГабриэльС. А.GabrielS. A.

Габриэль Сергей Александрович, д. м. н., главный врач; профессор кафедры хирургии № 3

Краснодар

Sergey A. Gabriel, Dr. Sci. (Med.), Chief Physician; Professor at Surgery Department No. 3

Krasnodar

https://orcid.org/0000-0002-2565-3003ЗамулинГ. Ю.ZamulinG. Yu.

Замулин Георгий Юрьевич, врач-уролог, отделение урологии № 1

Краснодар

Georgiy Yu. Zamulin, Urologist, Urology Unit No. 1

Krasnodar

https://orcid.org/0000-0002-6442-6161ЧурбаковВ. В.ChurbakovV. V.

Чурбаков Василий Вячеславович, врач-уролог, отделение урологии № 1

Краснодар

Vasiliy V. Churbakov, Urologist, Urology Unit No. 1

Krasnodar

https://orcid.org/0000-0003-1057-1328КоротченкоЯ. Ю.KorotchenkoYa. Yu.

Коротченко Ярослав Юрьевич, студент 5го курса лечебного факультета

Краснодар

Yaroslav Yu. Korotchenko, 5th Year Student, Faculty of General Medicine

Krasnodar

https://orcid.org/0009-0003-0735-5509РасуловА. А.RasulovA. A.

Расулов Амиль Ашраф оглы, студент 6го курса лечебного факультета

Ярославль

Amil А. Rasulov, 6th Year Student, Faculty of General Medicine

Yaroslavl

Краевая клиническая больница № 2РоссияRegional Clinical Hospital No. 2Russian FederationКубанский государственный медицинский университет; Научно-исследовательский институт – Краевая больница №1 им. проф. С.В. ОчаповскогоРоссияKuban State Medical University; Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1Russian FederationКубанский государственный медицинский университет; Краевая клиническая больница № 2РоссияKuban State Medical University; Regional Clinical Hospital No. 2Russian FederationКубанский государственный медицинский университетРоссияKuban State Medical UniversityRussian FederationЯрославский государственный медицинский университетРоссияYaroslavl State Medical UniversityRussian Federation202330062023029399Copyright © Сергеев В.В., Медведев В.Л., Габриэль С.А., Замулин Г.Ю., Чурбаков В.В., Коротченко Я.Ю., Расулов А.А., 20232023Сергеев В.В., Медведев В.Л., Габриэль С.А., Замулин Г.Ю., Чурбаков В.В., Коротченко Я.Ю., Расулов А.А.Sergeev V.V., Medvedev V.L., Gabriel S.A., Zamulin G.Y., Churbakov V.V., Korotchenko Y.Y., Rasulov A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.innovmedkub.ru/jour/article/view/678Цель

Цель: Определить хирургические возможности одномоментной лапароскопической пластики стриктуры лоханочно-мочеточникового сегмента, осложненной нефролитиазом, с помощью интраренальной гибкой хирургии.

Клинический случай

Клинический случай: В урологическое отделение № 1 ГБУЗ «Краевой клинической больницы № 2» г. Краснодара поступил пациент А., 36 лет, с жалобами на боль тянущего характера в поясничной области справа. Пациенту выполнено ультразвуковое исследование, компьютерная томография почек и динамическая ангиореносцинтиграфия. Диагностировано расширение чашечно-лоханочной системы правой почки: чашечки до 22 мм, лоханки до 50 мм, выявлено 5 чашечковых конкрементов и 2 конкремента лоханки размерами от 6 до 8 мм; обнаружена стриктура на уровне лоханочно-мочеточникового сегмента справа протяженностью до 10 мм. Гидронефроз III степени справа по классификации акад. Н.А. Лопаткина.

Заключение

Заключение: Лапароскопический метод в сочетании с интраренальной хирургией при помощи гибкого уретерореноскопа и гольмиева лазера является эффективным и безопасным способом лечения стриктуры лоханочно-мочеточникового сегмента, осложненной нефролитиазом.

Objective

Objective: To determine the surgical possibilities of the one-stage laparoscopic repair in the obstructed ureteropelvic junction (UPJ) complicated with nephrolithiasis in combination with the retrograde intrarenal surgery.

Case report

Case report: The patient A., a 36-year-old male complaining about dragging pains in the right lumbar region was admitted to Urology Unit No. 1 of Krasnodar Regional Clinical Hospital No. 2. The patient underwent ultrasound examination, CT, and dynamic renal scintigraphy. The findings were as follows: the enlargement of pelvicalyceal system in the right kidney (calyx up to 22 mm, pelvis up to 50 mm), 5 calyx concrements and 2 pelvic concrements 6 to 8 mm in size, obstruction at the level of the right UPJ up to 10 mm in length, III grade hydronephrosis on the right according to Lopatkin classification.

Conclusions

Conclusions: The combination of laparoscopic surgery and retrograde intrarenal surgery with the flexible ureteroscope and holmium laser is an effective and safe method for the treatment of UPJ obstruction complicated with nephrolithiasis.

мочекаменная болезньстриктура лоханочно-мочеточникового сегментаинтраренальная хирургияnephrolithiasisureteropelvic junction obstructionretrograde intrarenal surgeryReferencesRivas JG, Alonso Y Gregorio S, Sánchez LC, et al. Approach to kidney stones associated with ureteropelvic junction obstruction during laparoscopic pyeloplasty. Cent European J Urol. 2014;66(4):440–444. PMID: 24757538. PMCID: PMC3992453. https://doi.org/10.5173/ceju.2013.04.art13Rivas JG, Alonso Y Gregorio S, Sánchez LC, et al. Approach to kidney stones associated with ureteropelvic junction obstruction during laparoscopic pyeloplasty. Cent European J Urol. 2014;66(4):440–444. PMID: 24757538. PMCID: PMC3992453. https://doi.org/10.5173/ceju.2013.04.art13Husmann DA, Milliner DS, Segura JW. Ureteropelvic junction obstruction with concurrent renal pelvic calculi in the pediatric patient: a long-term follow up. J Urol. 1996;156(2 Pt 2):741–743. PMID: 8683773. https://doi.org/10.1097/00005392-199608001-00049Husmann DA, Milliner DS, Segura JW. Ureteropelvic junction obstruction with concurrent renal pelvic calculi in the pediatric patient: a long-term follow up. J Urol. 1996;156(2 Pt 2):741–743. PMID: 8683773. https://doi.org/10.1097/00005392-199608001-00049Fahmy O, El-Fayoumi AR, Gakis G, et al. Role of laparoscopy in ureteropelvic junction obstruction with concomitant pathology: a case series study. Cent European J Urol. 2015;68(4):466–470. PMID: 26855804. PMCID: PMC4742439. https://doi.org/10.5173/ceju.2015.627Fahmy O, El-Fayoumi AR, Gakis G, et al. Role of laparoscopy in ureteropelvic junction obstruction with concomitant pathology: a case series study. Cent European J Urol. 2015;68(4):466–470. PMID: 26855804. PMCID: PMC4742439. https://doi.org/10.5173/ceju.2015.627Skolarikos A, Dellis A, Knoll T. Ureteropelvic obstruction and renal stones: etiology and treatment. Urolithiasis. 2015; 43(1):5–12. PMID: 25362543. https://doi.org/10.1007/s00240-014-0736-2Skolarikos A, Dellis A, Knoll T. Ureteropelvic obstruction and renal stones: etiology and treatment. Urolithiasis. 2015; 43(1):5–12. PMID: 25362543. https://doi.org/10.1007/s00240-014-0736-2Stravodimos KG, Giannakopoulos S, Tyritzis SI, et al. Simultaneous laparoscopic management of ureteropelvic junction obstruction and renal lithiasis: the combined experience of two academic centers and review of the literature. Res Rep Urol. 2014;6:43–50. PMID: 24892032. PMCID: PMC4036597. https://doi.org/10.2147/RRU.S59444Stravodimos KG, Giannakopoulos S, Tyritzis SI, et al. Simultaneous laparoscopic management of ureteropelvic junction obstruction and renal lithiasis: the combined experience of two academic centers and review of the literature. Res Rep Urol. 2014;6:43–50. PMID: 24892032. PMCID: PMC4036597. https://doi.org/10.2147/RRU.S59444Hüttenbrink C, Kelm P, Klein T, Distler F, Pandey A, Pahernik S. Combination of robotic pyeloplasty and percutaneous renal surgery for simultaneous treatment of ureteropelvic junction obstruction and calyx stones. Urol Int. 2021;105(7–8):637–641. PMID: 33691328. https://doi.org/10.1159/000513457Hüttenbrink C, Kelm P, Klein T, Distler F, Pandey A, Pahernik S. Combination of robotic pyeloplasty and percutaneous renal surgery for simultaneous treatment of ureteropelvic junction obstruction and calyx stones. Urol Int. 2021;105(7–8):637–641. PMID: 33691328. https://doi.org/10.1159/000513457Scarcella S, Tiroli M, Torino G, Mariscoli F, Cobellis G, Galosi AB. Combined treatment of ureteropelvic junction obstruction and renal calculi with robot-assisted laparoscopic pyeloplasty and laser lithotripsy in children: case report and non-systematic review of the literature. Int J Med Robot. 2021;17(3):e2246. PMID: 33626232. https://doi.org/10.1002/rcs.2246Scarcella S, Tiroli M, Torino G, Mariscoli F, Cobellis G, Galosi AB. Combined treatment of ureteropelvic junction obstruction and renal calculi with robot-assisted laparoscopic pyeloplasty and laser lithotripsy in children: case report and non-systematic review of the literature. Int J Med Robot. 2021;17(3):e2246. PMID: 33626232. https://doi.org/10.1002/rcs.2246Мартов А.Г., Ергаков Д.В., Гусейнов М.А. и др. Первоначальный опыт клинического применения тулиевой контактной литотрипсии в трансуретральном лечении мочекаменной болезни. Урология. 2018;(1):112–120. PMID: 29634144. https://doi.org/10.18565/urology.2018.1.112-120Martov AG, Ergakov DV, Guseinov MA, et al. Initial experience of clinical application of thulium contact lithotripsy for transurethral treatment of urolithiasis. Urologiia. 2018;(1):112–120. (In Russ.). PMID: 29634144. https://doi.org/10.18565/urology.2018.1.112-120Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM. Laparoscopic dismembered pyeloplasty. J Urol. 1993;150(6): 1795–1799. PMID: 8230507. https://doi.org/10.1016/s0022-5347(17)35898-6Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM. Laparoscopic dismembered pyeloplasty. J Urol. 1993;150(6): 1795–1799. PMID: 8230507. https://doi.org/10.1016/s0022-5347(17)35898-6Umari P, Lissiani A, Trombetta C, Belgrano E. Comparison of open and laparoscopic pyeloplasty in ureteropelvic junction obstruction surgery: report of 49 cases. Arch Ital Urol Androl. 2011;83(4):169–174. PMID: 22670313Umari P, Lissiani A, Trombetta C, Belgrano E. Comparison of open and laparoscopic pyeloplasty in ureteropelvic junction obstruction surgery: report of 49 cases. Arch Ital Urol Androl. 2011;83(4):169–174. PMID: 22670313Chen RN, Moore RG, Kavoussi LR. Laparoscopic pyeloplasty. Indications, technique, and long-term outcome. Urol Clin North Am. 1998;25(2):323–330. PMID: 9633588. https://doi.org/10.1016/s0094-0143(05)70021-5Chen RN, Moore RG, Kavoussi LR. Laparoscopic pyeloplasty. Indications, technique, and long-term outcome. Urol Clin North Am. 1998;25(2):323–330. PMID: 9633588. https://doi.org/10.1016/s0094-0143(05)70021-5Yin Z, Wei YB, Liang BL, et al. Initial experiences with laparoscopy and flexible ureteroscopy combination pyeloplasty in management of ectopic pelvic kidney with stone and ureter-pelvic junction obstruction. Urolithiasis. 2015;43(3):255–260. PMID: 25666341. https://doi.org/10.1007/s00240-015-0753-9Yin Z, Wei YB, Liang BL, et al. Initial experiences with laparoscopy and flexible ureteroscopy combination pyeloplasty in management of ectopic pelvic kidney with stone and ureter-pelvic junction obstruction. Urolithiasis. 2015;43(3):255–260. PMID: 25666341. https://doi.org/10.1007/s00240-015-0753-9Rivas JG, Alonso Y Gregorio S, Sánchez LC, et al. Approach to kidney stones associated with ureteropelvic junction obstruction during laparoscopic pyeloplasty. Cent European J Urol. 2014;66(4):440–444. PMID: 24757538. PMCID: PMC3992453. https://doi.org/10.5173/ceju.2013.04.art13Rivas JG, Alonso Y Gregorio S, Sánchez LC, et al. Approach to kidney stones associated with ureteropelvic junction obstruction during laparoscopic pyeloplasty. Cent European J Urol. 2014;66(4):440–444. PMID: 24757538. PMCID: PMC3992453. https://doi.org/10.5173/ceju.2013.04.art13Yang C, Zhou J, Lu ZX, et al. Simultaneous treatment of ureteropelvic junction obstruction complicated by renal calculi with robotic laparoscopic surgery and flexible cystoscope. World J Urol. 2019;37(10):2217–2223. PMID: 30661106. https://doi.org/10.1007/s00345-018-2608-9Yang C, Zhou J, Lu ZX, et al. Simultaneous treatment of ureteropelvic junction obstruction complicated by renal calculi with robotic laparoscopic surgery and flexible cystoscope. World J Urol. 2019;37(10):2217–2223. PMID: 30661106. https://doi.org/10.1007/s00345-018-2608-9An LZ, Xiong LL, Chen L, Wang HR, Chen WN, Huang XB. Laparoscopic pyeloplasty combined with ultrasonic lithotripsy via nephroscope for treatment of ureteropelvic junction obstruction with renal calculi. Beijing Da Xue Xue Bao Yi Xue Ban. 2022;54(4):746–750. (In Chinese). PMID: 35950402. PMCID: PMC9385502. https://doi.org/10.19723/j.issn.1671-167X.2022.04.026An LZ, Xiong LL, Chen L, Wang HR, Chen WN, Huang XB. Laparoscopic pyeloplasty combined with ultrasonic lithotripsy via nephroscope for treatment of ureteropelvic junction obstruction with renal calculi. Beijing Da Xue Xue Bao Yi Xue Ban. 2022;54(4):746–750. (In Chinese). PMID: 35950402. PMCID: PMC9385502. https://doi.org/10.19723/j.issn.1671-167X.2022.04.026Wong YS, Lo KL, Pang KKY, Tam YH. A combined approach of robot-assisted laparoscopic pyeloplasty and flexible endoscopy to treat concomitant ureteropelvic junction obstruction and calyceal stones in children: technical considerations and review of the literature. Front Pediatr. 2022;10:1017722. PMID: 36389392. PMCID: PMC9650079. https://doi.org/10.3389/fped.2022.1017722Wong YS, Lo KL, Pang KKY, Tam YH. A combined approach of robot-assisted laparoscopic pyeloplasty and flexible endoscopy to treat concomitant ureteropelvic junction obstruction and calyceal stones in children: technical considerations and review of the literature. Front Pediatr. 2022;10:1017722. PMID: 36389392. PMCID: PMC9650079. https://doi.org/10.3389/fped.2022.1017722Kadihasanoglu M, Yucetas U, Karabay E, Sonmezay E. Comparison of the outcomes of laparoscopic pyeloplasty with and without concomitant pyelolithotomy. Int Braz J Urol. 2019;45(5):965–973. PMID: 31626519. PMCID: PMC6844342. https://doi.org/10.1590/S1677-5538.IBJU.2018.0781Kadihasanoglu M, Yucetas U, Karabay E, Sonmezay E. Comparison of the outcomes of laparoscopic pyeloplasty with and without concomitant pyelolithotomy. Int Braz J Urol. 2019;45(5):965–973. PMID: 31626519. PMCID: PMC6844342. https://doi.org/10.1590/S1677-5538.IBJU.2018.0781

The authors declare that there are no conflicts of interest present.