Introduction. Modern surgical techniques for nephrolithiasis do not exclude the development of intraoperative irrigation complications, with the most significant ones being associated with uncontrolled increases in intracavitary pressure. Monitoring pressure during surgery plays a special role in timely prevention of further septic complication progression.
Materials and methods. A study was conducted to assess pressor values during treatment of 120 patients in the Center of Urology, Nephrology and Lithotripsy of Clinical Hospital Russian Railway-Medicine named after N.A.Semashko, who underwent percutaneous nephrolithotripsy of various access variants and sizes. The patients were divided into two groups based on the size of the skin-to-kidney channel used: standard percutaneous nephrolithotripsy using a tube with a diameter of 28 Ch was performed in 50 patients, while mini-percutaneous nephrolithotripsy with an external tube diameter of 16 Ch was carried out in 70 patients.
Results. Intraoperative monitoring of intravesical pressure was carried out after retrograde drainage of the upper urinary tract, in real time, using a disposable kit for measuring invasive intravascular pressure and an anesthesiological monitor with a unit for implementing and reflecting the above function. The accuracy of intravesical pressure measurement was ensured by the optimal positioning of the proximal end of the ureteral catheter in the lumen of the pelvis. Patients were divided into 4 groups according to the maximum threshold value of the pressure level during monitoring for 60 seconds or more. The study determined a direct relationship between the level of intra-ureteral pressure and the risk of developing infectious complications in the postoperative period. Moreover, an increase in intra-ureteral pressure above 40 cm H2O during more than a minute led to a significant increase in the proportion of patients with infectious complications from 5% (30 cm H2O) to 32% (40 cm H2O).
Conclusion. The conducted study allowed us to determine the quantitative indicators of pressure that affect the risk of postoperative infectious complications.
