COMPENSATOR MECHANISMS OF HEMOSTASIS AFTER CONTACT URETEROLITHOTRIPSY IN THE UPPER THIRD OF THE URETER
Now there is no concept of the formation of compensatory mechanisms hemostasis after minimally invasive surgical interventions on the kidneys of the urinary tract. 36 АКТУАЛЬНЫЕ ВОПРОСЫ Баринов Э.Ф., Малинин Ю.Ю. Компенсаторные механизмы гемостаза … Том 6, № 4, 2021 © ИНВХ Вестник неотложной и восстановительной хирургии Aim of the study was to establish causal relationships based on the analysis of the functional activity of platelets, reflecting the participation of pathogenetic and compensatory mechanisms in the development of hematuria after contact ureterolithotripsy (URLT) in the upper third of the ureter with ineffective lithokinetic therapy. Material and methods. The study included 21 patients after standard lithokinetic therapy for 7 days. in which, according to imaging control, there was no displacement of calculus from the pyelo-ureteral zone to the middle third of the ureter. After minimally invasive surgery, non-steroidal anti-inflammatory drugs and antibiotics were prescribed for 7-10 days. Platelet aggregation was assessed by the turbidimetric method using a ChronoLog analyzer (USA). Statistical analysis was performed using the MedCalc 18.10.2 package. Results. After 72 hours vs 24 hours after surgery, microhematuria decreased 2.9 times (p <0.001). The cluster of functional activity of platelet receptors was characterized by normoreactivity of α2-adrenergic receptor, GPVI-receptor, AT1-receptor, A2A-receptor, PAF-receptor, P2X1-receptor and hyporeactivity of P2Y-receptors, β2-adrenergic receptor. Hyporeactivity of platelet P2Y-receptors may be the reason for a decrease the efficiency of thrombogenesis. The correlations between the activity of receptors indicate that the development of compensatory processes of hemostasis after URSL is initiated by a local factor - type IV collagen of the basement membrane vessels, the effect is potentiated by the interaction of the α2-adrenergic receptor, AT1 receptor, P2X1 receptor and is limited by adenosine. Conclusion. Analysis of platelet receptor sensitivity allows predicting the risk of developing gross hematuria and identifying ways to improve conservative therapy after URLT in the upper third of the ureter with ineffective lithokinetic therapy.