V.M. Artyshchuk, D.Z. Vorobets, R.Z. Sheremeta, D.R. Sheremeta

Impact of the percutaneous nephrolithotripsy and extracorporeal shockwave lithotripsy of the lower pole renal stones on the regional kidney function

Renal scintigraphy methods are widely used in the urology practice mainly for the estimation of functional condition of the kidneys. Scintigraphy diagnostical system in every point of the kidney projection or in the limits of a certain zone of interest allows to analyses the entering, accumulation and extraction of radioactive substance, obtain digital values of this analysis according to the definite programme with the help of computer means. Dynamics of radio-activity in every point of the observation is successively deflected by the vascular (the entering of the radiopharmpreparation into the vascular system of the kidney) and the secretory (the passing of the radiopharmpreparation through the renal tubules is finishing by the point of the highest elevation of the curve with the help of which the period of the maximum accumulation of the preparation is determined) segments of a renographical curve, and the extraction of the preparation - its secretory segment (a steep abatement of the curve, linked with the extraction of radiopharmpreparation from the kidney, the time of which is estimated according to the period of halfextraction of the preparation).

The aim of the research was to estimate the influence of extracorporeal shockwave lithotripsy and percutaneous nephrolithotripsy of the lower pole stones within 0.6 and 2 cm on the velocity on renovation of the regional kidney function with the help of dynamic angionephroscyntgraphy with 99mTс-DTPA.

It has been substantiated that the existent of lower pole stone up to 2 cm does not influence on the kidney function, estimated by scintigraphy indices. Even in 45 days after extracorporeal shock wave lithotripsy the deterioration of the half-extraction of radiopharmpreparation has been observed, which probably points to the disturbance of the kidney function due to the damage of parenchyma by the shock waves.

In comparison of the angio- and nephroscyntygraphical indices before and after extracorporeal shockwave lithotripsy of lower pole renal stones with the obtuse infundibulopelvic angle the same tendencies have been observed as with the acute infundibulopelvic angle. The arterial influx, the symmetry of renal blood circulation, the deposit into a general accumulation, half blood clearance (pі0.14) have not been observed before and after operations for a certain period of time.

It has been admitted that extracorporeal shockwave lithotripsy causes the essential deterioration of the cured kidney function, examined due to sluggishness of the 99mTс-DTPA halfexcretion by 24.2 percent relative to the preoperational index (p<0.05). After percutaneous nephrolithotripsy the function of the operated kidney in 45 days has been renovated better than after extracorporeal shockwave lithotripsy, the time of maximum accumulation of radiopharmpreparation has been shortening in average by 23.7 percent, the time of halfextraction of radiopharmpreparation has been shortening by 19.7 percent, the deposit into a general accumulation has been increasing by 5.7 percent (p<0.05).