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Retrograde intrarenal surgery (RIRS) is being actively implemented in the treatment of renal stones and other diseases. If necessary, RIRS can be combined with percutaneous procedures.To study the results of RIRS in patients with nephrolithiasis and various renal disorders.A total of 106 patients who undergone RIRS were included in the study. There were 66 men (63.4%) and 40 women (36.6%). Mean age was 46.8+/-15.6 years. The indication for RIRS in 84 (79.2%) patients was renal stones. Calculus in calyceal diverticulum were diagnosed in 6 (5.7%), encrusted stents in 8 (7.7%), urinary fistulas after partial nephrectomy in 5 (4.7%), pelvis tumors in 2 (1.9%), pelvis perforation after marsupialization of parapelvic cyst in 1 (0.9%) patient, respectively. Simultaneous retro- and antegrade procedures were performed in 27 (25.5%) cases. In those with nephrolithiasis and encrusted stents, lithotripsy was done with the removal of stone fragments. Two patients underwent endoscopic resection of the pelvis tumor. In six patients, the neck of the diverticulum was incised after lithotripsy, while in five cases retrograde endoscopically controlled percutaneous treatment urinary fistulae was performed. In one case, laser fulguration of the pelvis defect with stenting was done.RIRS was effective in 72 (85.7%) of 84 patients with renal stones. The operation time was 70.8+/-10.2 minutes. In 12 (14.3%) cases with residual fragments, extracorporeal shock-wave lithotripsy (n=7) and repeated RIRS (n=5) were performed. The efficiency of RIRS after two sessions was 91.7%. Complications were observed in 11 (10.4%) patients. With encrusted stents, the operation time was 95.0+/-16.5 min. After laser fragmentation of encrustations in the lower part of the stent, percutaneous lithotripsy was performed with antegrade removal of its upper half. The time for RIRS in those with diverticula was 60.0+/-8.5 min, the average stone size was 8 mm (from 6 to 10 mm). In all cases lithotripsy with mucosal fulguration was successfully done. The procedures for urinary fistulae were also effective (operation time was 45.0 +/- 20.5 minutes) and there were no complications.RIRS is a safe and effective treatment for patients with nephrolithiasis and other kidney disorders. Modern flexible ureteroscopes allows to examine the collecting system and to perform lithotripsy and removal of stone fragments.

The results of organ-preserving interventions are analyzed in 12 patients (7 males and 5 females) with neoplasms of the renal pelvis and ureter. Endoscopic operations were performed in 4 patients with the normally functioning contralateral kidney and in one patient with the single kidney. Early complications developed in 2 of the 12 patients and were infectious and inflammatory. The mean duration of endoscopic surgery was 32.8±4.9 min; intraoperative blood loss is 83.0±15.3 ml; the duration of open surgery averaged 157.2±29.7 min and intraoperative blood loss was 1930±69.3 ml. After 4 years of a follow-up, the frequency of tumor relapse was 40%; 5-year survival was 80%. Thus, in patients with upper urinary tract neoplasms, organ-preserving operations are a justifiable alternative to nephroureterectomy with urinary bladder resection and most reasonable in uni- and bilateral renal tumor. Urinary tract endoscopic examination assessing the possibilities of freely manipulating an endoscope in the ureteral lumen and renal cavitary system for biopsy of a tumor and its further removal is a major and determining factor in defining indications for this type of intervention.

The paper analyzes procedures for internal drainage of the upper urinary tract in ureteral tumor obstructions. It details indications for and contraindications to ureteral stenting or endoprostethic replacement, subcutaneous nephrovesical bypass. Postoperative complications and procedures for their prevention and treatment are considered. The data available in the literature on rare drainage procedures for the upper urinary tract, such as ureteral endoprosthetic replacement and nephrovesical bypass, are summarized.