Peculiarities of Renal Blood Flow in the Treatment of Non-coral Kidney Concrements Using ESWL and FURS

The purpose of the study was to investigate the features of renal blood flow in patients with non-corneal nephrolithiasis based on Doppler ultrasound examination using extracorporeal shockwave lithotripsy (EWL) and fibroureteroenoscopy (FURS) with contact lithotripsy (CLT), as well as a comparative assessment of the degree of these disorders. Material and methods. We examined 167 patients with urolithiasis, concrements in kidneys, complete or partial unilateral renal obstruction, and 7 days after the end of treatment with ESWL. All patients underwent conventional ultrasound examination in black and white, vascular architectonics was visualized using color Doppler mapping (CDM). All patients were divided into three groups: group 1 included 82 patients (49%) who were given 1-2 ESWL sessions for crushing and complete elimination of the calculus. Group 2 consisted of 53 patients (31%) who completed 3 to 5 sessions of ESWL. The third group consisted of 32 patients (20%) who received more than 5 ESWL sessions to achieve the therapeutic effect. A similar design for the study of intrarenal hemodynamics was used in 158 patients, who were treated with fibroureterorenoscopy (FURS) with contact laser nephrolithotripsy (CLNL). The first group included 68 patients (43%), the duration of the CLNL session was about 30 minutes; the second group consisted of 54 patients (34%) with a duration of the FURS with CLNL from 30 to 60 minutes; the third group consisted of 36 patients (23%), whose CLNL lasted 60 minutes or more. Results and discussion. Patients in the first group, who had the minimum number of ESWL sessions, did not make statistically significant changes in the level of RI in comparison with the intact kidney (p> 0.05). In the second group of patients, which was performed from 3 to 5 sessions of ESWL, 7 days after the end of treatment, resistance indexes were significantly increased (p <0.05), Δ RI was 0.13 ± 0.04. In the third group, with more than five sessions of ESWL, the resistance of arteries to the peripheral renal bed 7 days after treatment was significantly higher, Δ RI was 0.16 ± 0.06. Thus, significant violations of intragranular hemodynamics arise with an increase in the number of ESWL sessions of more than three, significant violations of intragastric hemodynamics occur after five or more sessions and persist for a long (more than 7 days) time after treatment (p <0.05). Conclusions. The study of renal hemodynamics in patients with non-vertebral forms of nephrolithiasis after successful treatment by various methods showed that the damaging effect of wave energy in ESWL with the number of sessions of more than 2 on the renal parenchyma is more pronounced than the local effect on the kidney parenchyma in the course of FURS with CLNL.