Modern surgical treatment of patients with kidney stones of the size up to 2 cm and concomitant coronary artery disease.
Authors:   the urological department of branch No. 1 of the Federal State Budgetary Institution «GVKG named after. N.N. Burdenko» of Ministry of Defense, Junior Researcher at the Department of Urolithiasis of N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – branch of the National Medical Research Centre of Radiology of Ministry of health of Russian Federation, R.V. Royuk ,   Moscow, Russia, S.K. Yarovoy ,   N. Lopatkin Scientific Research Insti- tute of Urology and Interventional Radiology – branch of the National Medical Research Cen- tre of Radiology of Ministry of health of Russian Federation, clinical pharmacologist of Pletnev‘s municipal clinical hospital of the dept. of health service; Moscow, Russia, A.G. Martov ,   RAS, Head of the Department of Urology, Institute of Advanced Studies of the Federal Medical and Biological Agency (FMBA); Moscow, Russia
Published: May 2024

Introduction. While providing urological care to patients suffering with nephrolithiasis, prior attention is to be paid to choosing the appropriate surgical approach. Assessment of risk for commorbidities such as coronary artery disease (CAD) should affect the choice of surgical technique. The treatment tactics for such comorbid patients have not been sufficiently developed and are poorly covered in the scientific literature. An appropriate choice of surgical technique is not presented. Aim: to study the effectiveness and safety of high-tech surgical lithotripsy techniques in comorbid patients with CAD, taking into account the functional state of the cardiovascular system. Materials and methods. The study is retrospective, multicenter. Subject of the study: adult patients suffering from nephrolithiasis (single kidney stones 15-20 mm) and concomitant CAD (200 people); control group - similar patients without CAD (190 people). The examined groups were distinguished according to the surgical intervention performed (extracorporeal shock wave nephrolithotripsy, percutaneous nephrolithotripsy, transurethral nephrolithotripsy) and concomitant CAD. Primary endpoint: Stone-free rate, which was determined using ultrasound scanning and Х-ray techniques. The frequency of achieving the endpoint, the number of stages of surgical treatment, and the frequency of complications were also assessed. Results. In terms of the frequency of achieving Stone-free rate, all contact lithotripsy techniques were comparable in effectiveness, which in all groups exceeded 85%. Neither the presence of CAD nor chronic heart failure (CHF) affected the results. With extracorporeal shock wave lithotripsy, the presence of CAD did not in any way affect the likelihood of achieving a stone-free rate, however, with CHF, the percentage of complete sanitation of the urinary tract from stones decreased to 53.8%, which seems unacceptable for clinical work. When using extracorporeal shock wave lithotrypsin against the background of CHF in «mono mode», the average number of stages is significantly higher (2.79) than with contact techniques (<1.05). There is a clear inverse relationship between CHF, the number of stages of surgical treatment on the one hand, and the frequency of achieving stone-free rate on the other hand. Postoperative pyelonephritis more often develops in comorbid patients after contact lithotripsy techniques (up to 26.0%). Postoperative bleeding and cardiac risks occurred sporadically, mainly in the same situation – contact nephrolithotripsy in a patient with CHF. Conclusion. The more severe the patient’s comorbidities are, the more indications he has for immediate surgical treatment of nephrolithiasis. Of course, only if he is compensated for coronary artery disease. Percutaneous nephrolithotripsy is the method of choice. For small (<2 cm) stones, a mini-approach should be preferred, giving a better safety approach.