RU2763979C1 - Method for percutaneous cystolithotripsy in patients with bladder outlet obstruction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to operative urology. Described is a method for percutaneous cystolithotripsy in patients with bladder obstruction, which includes sequential introduction of a trocar into the bladder under ultrasound guidance, installation of the Amplatz sheath along a safety wire. Further, under the control of a nephroscope, a laparoscopic bag is carried out, followed by placing a stone inside the bag, crushing it and washing off stone fragments inside the bag. In this case, a 4x16 "blown" Khachin basket is placed on the patient, with the help of which a stone is grasped and placed in a laparoscopic bag, and the stone is crushed inside the basket. In this case, a laparoscopic bag with a memory string is used. In addition, before the operation, a cystostomy 3-way Foley catheter Ch 20 is installed in the patient. 3-5 days before and after surgery, the combined gel Coletex-ADL and sodium hyaluronate are installed daily into the bladder with an exposure of 30 minutes. 3 hours before the operation and 24 hours after the operation, a solution of fosfomycin is taken orally.

EFFECT: method allows to reduce the risk of damage to the bladder wall during cystolithotripsy, which will reduce the risk of hematuria, postoperative inflammatory process in the bladder; not to immerse the patient in anesthesia or to carry out spinal anesthesia, which allows the proposed surgical aid to be carried out for patients with a burdened history; increase the effectiveness of cystolithotripsy; reduce the operation time due to the absence of the need for regular washing of stone fragments; no need for a second session of cystolithotripsy, no risk of injury to the urethra after the operation.

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Description

The invention relates to the field of medicine, namely to a method for performing a urological operation, and can be used to treat patients with cystolithiasis with stones of various densities in infravesical obstruction.

Urolithiasis or urolithiasis occupies one of the leading places in the structure of urological diseases in terms of prevalence. Bladder calculi (cystolithiasis) is a form of manifestation of urolithiasis with a prevalence of 5-10%. [Ivanov V.Yu., Malkhasyan V.A., Semenyakin I.V., Pushkar D.Yu. Bladder stones and their endoscopic treatment. Modern view of the problem. "Experimental and clinical urology" 2017; (3), 44-50.] Of these, more than half are patients suffering from benign prostatic hyperplasia [Wei Huang. Risk factors for bladder calculi in patients with benign prostatic hyperplasia. J.Medicine (Baltimore). 2017 Aug; 96(32)]. Most of the patients in this group are of active working age. The combination of cystolithiasis with BPH leads to hematuria, dysuria, pain during physical exertion, which negatively affects an active daily and working life. Analysis of scientific papers on cystolithiasis shows that this problem has not been studied enough [Mekke S., Roshani H., van Zanten P., et all. Simultaneous transurethral resection of the prostate and cystolithotripsy: A urological dilemma examined. Can Urol Assoc. 2020. Dec 15. DOI: 10.5489/cuaj.6743. PMID: 33382366]. The question of how to treat these patients remains controversial. The combination of BPH and cystolithiasis makes it difficult to choose the optimal tactics for treating patients, especially the elderly, complicates the technique for performing a number of surgical interventions, and increases the risk of postoperative complications. This necessitates the improvement and optimization of treatment methods for patients with bladder calculi [Nazarov, T.Kh., Akhmedov M.A., Rychkov I.V. et al. Urolithiasis: etiopathogenesis, diagnosis and treatment. Andrology and Genital Surgery. 2019. 3. 43-51 p.].

To date, patients with bladder stones undergo surgery to remove these stones. Complications after cystolithotripsy occur in 7.8% of cases. Among the postoperative complications that appear over time, urethral stricture is distinguished [Ankur Bansal, Manoj Kumar, Satyanarayan Sankhwar, Sunny Goel, Madhusudan Patodia et all. Prospective randomized comparison of three endoscopic modalities used in treatment of bladder stones. // Urologia 2016; 83 (2): 87-92 DOI: 10.5301/uro.5000171]. Some studies show that the complication rate for cystolithotripsy is 16% on average. The most common perioperative complications during cystolithotripsy are hematuria, cystitis, pyelonephritis, very rarely bladder perforation [Papatsoris AG, Varkarakis I, Dellis A, Deliveliotis C. Bladder lithiasis: from open surgery to lithotripsy. Urol Res. 2006 Jun;34(3):163-7. doi: 10.1007/s00240-006-0045-5. Epub 2006 Feb 10. PMID: 16470391].

There are several possible ways to remove stones from the bladder, such as open and endoscopic surgical aids, as well as remote cystolithotripsy.

Among open operations, open cystolithotomy is currently used, usually combined with one-stage transcystic adenomectomy. Of the variations of this operational tool, the most commonly used was suprapubic extraperitoneal cystolithotomy. It is still the option of choice, even in well-equipped facilities, for patients with large stones or prostate volumes greater than 150 cm3.

V. Bhatia et al. back in 1994 pointed out that open cystolithotomy, in comparison with alternative options, is the simplest in technique and with a relatively low risk of complications.

This operation may be accompanied by a number of complications. The most common are damage to the pubic-vesical ligament, which takes part in the fixation of the bladder and a low wall incision, at the pubic symphysis. As a result, low drainage installation, which irritates the wall and internal opening of the urethra throughout the entire postoperative period. Insufficient revision of the bladder cavity with damage to the peritoneum is the most dangerous complication, if left unnoticed [Bhatia V, Biyani CS. Vesical lithiasis: open surgery versus cystolithotripsy versus extracorporeal shock wave therapy. Urol. 1994, 151(3): 660-2. DOI: 10.1016/s0022-5347(17)35041-3. PMID: 8308976]. As mentioned, this operation is combined with transvesical adenomectomy, in which case it is important not to damage the urethra intraoperatively. Other complications include:

• formation of vesical fistula;

• urinary stagnation;

• peritonitis, if damage to the peritoneum was missed;

• osteitis of the pubic bones - non-infectious inflammation of the symphysis;

• suppuration of the wound and the divergence of its edges.

Remote cystolithotripsy, in clinical practice, is quite rare and with small stones. The main advantage over open and endoscopic treatment options is low trauma and low invasiveness. The main disadvantages of the method are [Askarov M.S., Rudenko V.I. Remote cystolithotripsy in patients with benign prostatic hyperplasia. Electronic scientific and educational bulletin "Health and education in the XXI century" No. 1, 2006 (Vol. 8)]:

• excretion of calculi occurs after surgery by the patient himself, which causes risks of injury to the urethra, or acute urinary retention;

• it is inappropriate to use in patients with infravesical obstruction and with a calculus size of more than 2 cm.

There are 2 main options for endoscopic cystolithotripsy:

1. Transurethral;

2. Percutaneous.

Transurethral cystolithotripsy is traditionally performed in an aquatic environment. This method is most often the option of choice in the presence of instruments for endoscopic urological operations, due to its ease of use and the absence of the need for additional expensive equipment.

There is also a method of transurethral contact cystolithotripsy in a gas (CO2) environment [Patent No. 2532016 "Method of endoscopic cystolithotripsy for large and multiple bladder stones" priority dated 04.12.2013. Glybochko P.V. et al.], which consists in the fact that after passing the cystoscope into the bladder, carbon dioxide is injected into it until the bladder expands, cystoscopy is performed, during which the calculus is visualized and contact cystolithotripsy is performed to small fragments, followed by their washing with saline. EFFECT: method makes it possible to exclude such a side effect as hypermobility (increased mobility) of the calculus, which prevents its rapid destruction and complicates the surgeon's work, and also provides a qualitatively better intraoperative visualization, and reduces the operation time. The considered method does not take into account all the links in the pathogenesis of the development of postoperative complications, and there is also a high risk of developing perioperative complications mentioned above. Even in experienced hands, transurethral cystolithotripsy is fraught with serious urethral complications.

From percutaneous methods of cystolithotripsy, different methods are distinguished.

The method of cystolithotripsy described by Jae Seung Hwang [Jae Seung Hwang, Jeong Hwan Son, Seok Heun Jang, Jae Won Lee, Dae Sung Cho et al. was chosen as a prototype. . The Initial Experience of Pneumovesicoscopic Bladder Stone Removal Using a Laparoscopic Entrapment Sac. "Urology" Volume 84, ISSUE 5, P1234-1239, November 01, 2014]. The bladder is filled with CO2 gas up to 15 mm Hg. A prepared laparoscopic bag is inserted through the suprapubic trocar. Transurethral under visual control, the laparoscopic sac is deployed and its opening is expanded using nephroscopic forceps. Bladder stones are placed in a bag using nephroscopic forceps. After confirming that all bladder stones are in the sac, the opening of the sac is retracted extracorporeally with removal of the suprapubic trocar. Then extracorporeal lithotripsy is performed. The air medium is used in this case in connection with the collapse of the laparoscopic bag in a liquid medium.

The disadvantages of this method are:

• the need to inject gas (CO2) into the urinary system;

• the need for transurethral installation of the endoscope, which can cause postoperative complications in the urethra;

• fragmentation of the calculus inside the laparoscopic bag in the air can lead to its damage, sharp fragments of the calculus, which will affect the course of the operation and increase its time.

In the case of the method proposed by us, the laparoscopic bag is used with a string with a memory effect, and the basket, in this case, is a frame for the laparoscopic bag and prevents damage (perforation) of the bag during crushing of the calculus. Laser cystolithotripsy in the "spray" mode is carried out in a liquid, natural for the bladder, medium. The Khachin basket 4x16 “inflated”, with a diameter of 20 mm, 5 Fr, serving as a frame, does not damage the walls of the bag with fragments of calculus, which makes it possible to completely fragment the calculus to small (1-2 mm) fragments, and after crushing, wash and remove all fragments from the bag . Lithotripsy calculus in the bag and basket reduces the risk of damage to the bladder wall in contrast to the prototype.

The technical result is to increase the effectiveness of treatment of patients with cystolithiasis that has arisen against the background of infravesical obstruction, due to:

• reducing the risk of damage to the bladder wall during cystolithotripsy, which will reduce the risk of hematuria, a postoperative inflammatory process in the bladder;

• no need to immerse the patient in anesthesia or spinal anesthesia, respectively, will be limited to the use of local anesthesia, which allows the proposed surgical aid to be applied to patients with a aggravated anamnesis;

• no need for a second session of cystolithotripsy;

• increasing the efficiency of cystolithotripsy by placing the calculus in a basket and fixing the calculus;

• no risk of injury to the urethra after the operation;

• reducing the risk of urethral stricture and bladder neck sclerosis after surgery;

• reduction of operation time, due to the absence of the need for regular washing of calculus fragments.

The technical result is achieved by the fact that in the method of percutaneous cystolithotripsy in patients with infravesical obstruction, including the installation of a trocar under ultrasound control, the sequential introduction of the Ch 30 shell Amplatz into the bladder along the insurance guide and the laparoscopic bag under the control of a nephroscope, according to the invention, the patient is placed with a Khachin basket 4x16 " inflated”, with the help of which the stone is captured and placed in a laparoscopic bag, and the crushing of the stone is carried out inside the basket.

The use of a basket for capturing the stone, moving it into the laparoscopic bag and fixing it during crushing ensures the convenience of the method, reducing the risk of rupture of the bag from the sharp edges of stone fragments, which significantly increases the effectiveness of treatment and reduces the number of possible complications. The most preferred option is to use for these purposes the Khachin 4x16 “inflated” baskets.

The method is carried out as follows:

At the first stage of surgical treatment for patients with cystolithiasis, a cystostomy 3-way Foley catheter Ch 20 is installed. 3-5 days before the proposed lithotripsy and 3-5 days after it, complex drug therapy is performed, which includes daily instillation of the combined Coletex-ADL gel into the bladder in a volume of 20 ml, as well as sodium hyaluronate 40 mg in a volume of 50 ml with an exposure of 30 minutes. 3 hours before the operation and 24 hours after the operation, a solution of fosfomycin 3 g is administered orally.

Under local infiltration anesthesia, a cystostomy 3-way Foley catheter Ch 20 is removed and an Amplatz sheath Ch 30 is installed into the bladder cavity along the fistulous tract along the insurance guide, a silicone valve is installed on it, then a laparoscopic bag with the effect is inserted into the bladder under the control of a nephroscope. memory. Through the working channel of the Ch 14.5 nephroscope, a Khachin basket 4x16 "inflated" is carried out, with the help of which a bladder stone is captured. Together with the basket, the stone is placed in a laparoscopic bag. The latter is pulled up to the Amplatz shell, thereby providing insulation for the stone in the basket and bag. A laser fiber with a diameter of 600 μm is passed through the working channel of the nephroscope and laser cystolithotripsy is performed in the "spray" mode with a power of 40 W (Fiberlase U2 Apparatus) over a fixed stone in a basket. If it is impossible to fix the stone in the basket due to its large size from 2.5 to 5 cm, and in some cases, opening the bag allows you to move stones up to 10 cm in size, the stone is placed in a laparoscopic bag using a nephroscope tube, a short session of lithotripsy is performed in the center of the stone using a laser fiber in the "fragmentation" mode with a power of 40 W in order to obtain 2-3 fragments, followed by their capture in a basket and cystolithotripsy according to the above method. The operation is completed by sequential removal of the basket, washing of the stone fragments from the bag, followed by removal of the bag and Amplatz sheath, installation of a 3-way Foley catheter Ch 20 through the cystostomy hole to continue instillation of the bladder for 3-5 days. The patient is discharged from the hospital under the outpatient supervision of the urologist of the polyclinic with recommendations. The cystostomy catheter is removed after a planned operation to eliminate the infravesical obstruction.

In the proposed scheme, the complex preparation Coletex-ADL consists of dioxidine, lidocaine, sodium alginate. Dioxidine as an antibacterial drug to eliminate the pathogen and prevent infectious complications before and after surgery; Lidocaine as a local anesthetic to relieve pain and pollakiuria; Sodium alginate to enhance adhesion to the urothelium, as a result, providing a long-term effect of dioxidine and lidocaine.

Sodium hyaluronate, as a viscoelastic protector of the intercellular substance of the bladder urothelium, creates a viscoelastic film on the surface of the mucous membrane, protecting it from the negative effects of calculi, and accelerates the recovery of the bladder in the postoperative period.

Fosfomycin, as an antibacterial drug, is used to eliminate the pathogen and prevent infectious complications before and after surgery.

Due to the percutaneous installation of the Amplatz membrane into the cavity of the bladder through a previously performed cystostomy, trauma to the urethra is excluded. The need to inject carbon dioxide into the bladder is also eliminated, since a bag with a string with a memory effect is used.

The use of the Khachin 4×16 “inflated” basket provides the best protection against bag rupture compared to similar devices. At the same time, this basket is quite reliable, including due to the special interweaving of the strings, which makes it possible to fix the stone with maximum radial force and perform lithotripsy without the risk of breaking the strings of the basket. The “parachute” type of the basket excludes perforation of the bladder during insertion of the basket, unlike other types of baskets that have an external stop at the distal end of the basket [Patent No. Khachin V.N. et al.].

Using the Fiberlase U2 machine with the above parameters ensures maximum stone fragmentation and atomization in a short period of time.

Here is an example from clinical practice:

Patient N., 27 years old, routinely turned to the clinic with complaints of frequent urination in small portions, difficulty urinating, blood in the urine, pain over the womb. Considers himself ill during the year when the above complaints first appeared. From the anamnesis it is known that the patient had an accident on a bicycle 2 years ago and suffered an injury to the urethra. An objective examination per rectum shows that the prostate is not enlarged in size, has an elastic consistency, the interlobar furrow is pronounced, palpation is painless. External genital organs of the male type, without features. The patient was examined on an outpatient basis. The patient underwent retrograde urethrography, which showed an extended stricture of the bulbous urethra. According to the results of TRUS of the prostate and bladder, the volume of the prostate is 22 cm3. The contents of the bladder are heterogeneous, a hyperechoic inclusion with an acoustic shadow (calculus) is determined, 1.8 * 2.1 cm in size, displaced with a change in body position, after micturition, residual urine with a volume of about 120 ml is determined. During hospitalization, the patient underwent the installation of a cystostomy in order to eliminate chronic urinary retention. Trocar cystostomy was performed under local

anesthesia, under ultrasound guidance, a 3-way Foley catheter Ch No. 20 was installed. To reduce inflammation of the bladder, the patient underwent antibiotic therapy with fosfomycin 3g No. 2 3 hours before surgery and 24 hours after surgery, as well as daily instillation of the combined Coletex-ADL gel in a volume of 20 ml, as well as sodium hyaluronate 40 mg into the bladder in a volume of 50 ml. with an exposure of 30 minutes for 3 days before surgery and 3 days after surgery.

Surgery was performed under local infiltration anesthesia. After removal of the cystostomy drain, an Amplatz sheath Ch 30 was percutaneously installed along the safety string into the bladder cavity, a silicone valve was installed on it, a nephroscope with a working channel of 14.5 Ch was inserted, then a laparoscopic bag with a string with a memory effect was inserted under vision control. Then, through the working channel of the nephroscope, a basket of Khachin 4x16 "inflated" was passed, with the help of which a calculus 1.8x2.1 was captured and placed in a laparoscopic bag. The latter is pulled up to the Amplatz tube, which led to the isolation of the stone in the basket and bag. A laser fiber with a diameter of 600 μm was passed through the working channel of the basket, after which laser cystolithotripsy was performed in the “spray” mode with a power of 40 W over a fixed stone in the basket (Fiberlase U2 Apparatus). The cart has been removed. Stone fragments were washed out of the laparoscopic bag. The laparoscopic bag and Amplatz sheath were successively removed. The operation was completed by placing a 3-way Foley catheter Ch 20 through the cystostomy hole. Postoperative period without complications. The patient was discharged on the 4th day after the operation, with cystostomy drainage, under the supervision of a polyclinic urologist. After 2 months, the patient underwent a planned operation to reconstruct the urethra. After 3 months, the patient urinates satisfactorily on his own. On the control ultrasound of the bladder - residual urine is not determined. Control clinical and biochemical blood and urine tests were within normal limits. The patient is under the supervision of a urologist at the polyclinic.

The results of treatment of 35 patients aged 27 to 82 years old, in whom the proposed method for the treatment of patients with bladder stones and infravesical obstruction, were tested. All operations were completed without complications, and the proposed method provided effective treatment of patients with cystolithiasis that occurred against the background of infravesical obstruction.

Clinical example No. 2.

Patient N., 82 years old, came to the clinic with complaints of difficulty urinating, periodic admixture of blood in the urine, and weakness. He considers himself ill for more than 5 years, when the above complaints first appeared. An objective examination per rectum shows that the prostate is significantly enlarged in size, has a dense elastic consistency, the interlobar sulcus is smoothed, painless on palpation. External genital organs of the male type, without features. From the anamnesis it is known that the patient suffered a myocardial infarction with stenting of the left coronary artery a year ago, and has been suffering from type 2 diabetes mellitus for 30 years, receiving hypoglycemic therapy. The patient underwent TRUS of the prostate and bladder, which determined the enlarged prostate due to hyperplasia of the transient zone, the volume of the prostate is 105 cm ³ . The contents of the bladder are heterogeneous, a hyperechoic inclusion with an acoustic shadow (calculus) is determined, 4.2 * 3.5 cm in size, displaced when the body position changes. Urination is frequent, difficult, there is a symptom of laying a stream of urine. Urine cloudy, yellow. According to the results of a biochemical blood test, there is an increase in creatinine to 196 µmol/l, urea 10.2 mmol/l. During hospitalization, urine culture was performed on the flora with the determination of sensitivity to antibacterial drugs, E. coli was detected at a concentration of 1 * 10 ⁶ , sensitive to fosfomycin, after which a cystostomy was installed in order to eliminate the symptoms of CRF. Trocar cystostomy was performed under local anesthesia, under ultrasound guidance, a 3-way Foley catheter Ch No. 20 was installed. The patient was recommended to take antibiotic therapy with fosfomycin 3g to reduce inflammation of the bladder. No. 2 3 hours before surgery and 24 hours after surgery, before surgery, daily instillation into the bladder of the combined Coletex-ADL gel in a volume of 20 ml, as well as sodium hyaluronate 40 mg in a volume of 50 ml. with an exposure of 30 minutes for 5 days.

Surgery was performed under local infiltration anesthesia. Percutaneously, after removal of the cystostomy catheter, an Amplatz sheath Ch 30 was installed along the insurance string, then a silicone valve was installed on it, through which a nephroscope with a working channel of 14.5 Ch was passed. A cystoscopy was performed, which showed trabecularity of the bladder walls, prostate hyperplasia protruding into the bladder, and a yellow calculus. A laparoscopic bag with a string with a memory effect was inserted into the bladder cavity under visual control. With the help of a nephroscope tube, the calculus is placed in a laparoscopic bag. The latter is pulled up to the Amplatz tube, which led to the isolation of the stone in the bag. A laser fiber with a diameter of 600 μm was passed through the working channel of the nephroscope, after which laser cystolithotripsy was performed in the “fragmentation” mode with a power of 40 W in the center of the stone to obtain 2 fragments without damaging the laparoscopic bag. Then, along the working channel of the profedene nephroscope, the Khachin basket 4 * 16 was “inflated” and the stone fragments were alternately fixed in the basket, after which laser lithotripsy was performed in the “spray” mode with a power of 40 W on the fixed stone fragments in the basket (Fiberlase U2 Apparatus). The basket was removed, the stone fragments were washed out of the laparoscopic bag, after which the bag and Amplatz sheath were removed in turn. The operation was completed by placing a 3-way Foley catheter Ch 20 through the cystostomy hole. Postoperative period without complications. In the postoperative period, the instillation of the bladder of the combined Coletex-ADL gel in a volume of 20 ml, as well as sodium hyaluronate 40 mg in a volume of 50 ml, was continued. with an exposure of 30 minutes for 5 days The patient was discharged on the 6th day after the operation under the supervision of a polyclinic urologist. A month later, the patient underwent a planned transurethral resection of prostatic hyperplasia without complications, he urinates satisfactorily on his own. On the control ultrasound of the bladder - no features. Control clinical and biochemical blood and urine tests were within normal limits. The patient is under the supervision of a polyclinic urologist.

Clinical example No. 3.

Patient N., 27 years old, routinely turned to the clinic with complaints of frequent urination in small portions, difficulty urinating, blood in the urine, pain over the womb. Considers himself ill during the year when the above complaints first appeared. From the anamnesis it is known that the patient had an accident on a bicycle 2 years ago and suffered an injury to the urethra. An objective examination per rectum shows that the prostate is not enlarged in size, has an elastic consistency, the interlobar furrow is pronounced, palpation is painless. External genital organs of the male type, without features. The patient was examined on an outpatient basis. The patient underwent retrograde urethrography, which shows an extended stricture of the bulbous urethra. According to the results of TRUS of the prostate and bladder, the volume of the prostate is 22 cm ³ . The contents of the bladder are heterogeneous, a hyperechoic inclusion with an acoustic shadow (calculus) is determined, 1.8 * 2.1 cm in size, displaced with a change in body position, after micturition, residual urine with a volume of about 120 ml is determined. During hospitalization, the patient underwent the installation of a cystostomy in order to eliminate chronic urinary retention. Trocar cystostomy was performed under local anesthesia, under ultrasound guidance, a 3-way Foley catheter Ch No. 20 was installed. To reduce inflammation of the bladder, the patient underwent antibiotic therapy with fosfomycin 3g No. 2 3 hours before surgery and 24 hours after surgery, as well as daily instillation of the combined Coletex-ADL gel in a volume of 20 ml, as well as sodium hyaluronate 40 mg into the bladder in a volume of 50 ml. with an exposure of 30 minutes for 3 days before surgery and 3 days after surgery.

Surgery was performed under local infiltration anesthesia. After removal of the cystostomy drain, an Amplatz sheath Ch 30 was percutaneously installed along the safety string into the bladder cavity, a silicone valve was installed on it, a nephroscope with a working channel of 14.5 Ch was inserted, then a laparoscopic bag with a string with a memory effect was inserted under vision control. Then, through the working channel of the nephroscope, a basket of Khachin 4x16 "inflated" was passed, with the help of which a calculus 1.8x2.1 was captured and placed in a laparoscopic bag. The latter is pulled up to the Amplatz tube, which led to the isolation of the stone in the basket and bag. A laser fiber with a diameter of 600 μm was passed through the working channel of the basket, after which laser cystolithotripsy was performed in the “spray” mode with a power of 40 W over a fixed stone in the basket (Fiberlase U2 Apparatus). The cart has been removed. Stone fragments were washed out of the laparoscopic bag. The laparoscopic bag and Amplatz sheath were successively removed. The operation was completed by placing a 3-way Foley catheter Ch 20 through the cystostomy hole. Postoperative period without complications. The patient was discharged on the 4th day after the operation, with cystostomy drainage, under the supervision of a polyclinic urologist. After 2 months, the patient underwent a planned operation to reconstruct the urethra. After 3 months, the patient urinates satisfactorily on his own. On the control ultrasound of the bladder - residual urine is not determined. Control clinical and biochemical blood and urine tests were within normal limits. The patient is under the supervision of a urologist at the polyclinic.

The results of treatment of 35 patients aged 27 to 82 years old, in whom the proposed method for the treatment of patients with bladder stones and infravesical obstruction, were tested. All operations were completed without complications, and the claimed method provided effective treatment of patients with cystolithiasis, which arose against the background of infravesical obstruction.

Claims (1)

A method for percutaneous cystolithotripsy in patients with infravesical obstruction, which includes sequential introduction of a trocar into the bladder under ultrasound control, installation of an Amplatz sheath along an insurance conductor, then, under the control of a nephroscope, a laparoscopic bag, followed by placing a stone inside the bag, crushing it and washing the stone fragments inside the bag, characterized in that a Khachin basket 4 × 16 “inflated” is installed for the patient, with the help of which the stone is captured and placed in a laparoscopic bag, and stone crushing is carried out inside the basket, while using a laparoscopic bag with a string with a memory effect, in addition, before the operation to the patient a cystostomy 3-way Foley catheter Ch 20 is installed, 3-5 days before and after surgery, a combined Coletex-ADL gel and sodium hyaluronate are installed daily into the bladder with an exposure of 30 minutes, and 3 hours before surgery and 24 hours after op rations, a solution of fosfomycin is taken orally.