Treatment methods for urolithiasis completely depend on the size of the stones, their location, their quantity, the presence or absence of complications and other negative factors affecting the patient’s body. An important point in the treatment of pathology is to conduct a study of the calculus, namely, its composition, activity, the presence or absence of renal failure, the patient’s age, and the presence of other infectious diseases. There are several modern and effective methods for treating urolithiasis. In this article we will talk about methods of treating urolithiasis. Let's look at the situations in which endoscopic removal of kidney stones is used.
Features of the postoperative period
At the end of the operation, the renal pelvis is drained using an external nephrostomy - a hollow flexible tube through which urine flows into a special transparent urinal. Based on the nature of the urine discharge, the recovery process in the kidneys is controlled and possible complications are diagnosed in a timely manner. The next day after the operation, if the patient feels well, he is allowed to walk.
If the postoperative course is calm, the nephrostomy is removed on days 3–4, and the surgical tract closes on its own after 2–3 days. At the puncture site in the lumbar region, an inconspicuous cosmetic seam up to 1 cm long remains.
The rehabilitation period lasts 10–12 days, after which the patient leads his usual lifestyle.
The examination plan before surgery includes:
Computed tomography of the kidneys, which determines the shape, size and density of stones.
Nephroscintigraphy, which is performed to determine the functional safety of the renal parenchyma.
Shock wave (remote) lithotripsy
Remote crushing of kidney stones is recognized as a standard method of treating urolithiasis.
Remote crushing of kidney stones is recognized as a standard method of treating urolithiasis. This method is based on the shock wave effect on the stone. The procedure is performed using a machine called a lithotripter.
The essence of the method is that, under the control of X-rays and ultrasound, a specialist focuses an ultrasonic shock wave at the location of the stones. In this case, the calculus is destroyed into small fragments, which subsequently independently pass through the urinary tract. To perform the operation, it is not necessary to make incisions on the patient’s body and give him general anesthesia.
Apaan Mudra for the treatment of diseases and restoration of the kidneys
No specific preparation of patients is required. But all patients are prescribed infusion therapy, antibiotics and vitamins before the procedure.
Attention: stones of high density and large sizes cannot be destroyed by the remote shock wave method.
Advantages and disadvantages
External lithotripsy for kidney stones has many advantages.
External lithotripsy for kidney stones has the following advantages:
- Possibility of providing emergency assistance in case of intractable renal colic. The operation can also be scheduled.
- There is no need to make any incisions in the skin.
- The method can be used in pediatric practice.
- The procedure does not require general anesthesia.
- The rehabilitation period is minimal, which reduces the length of hospital stay.
- This method is three times cheaper than other methods.
- Minimal number of complications compared to open surgery and minimally invasive techniques.
This technique is not without its drawbacks, including the following:
- There is a possibility of damage to surrounding tissues and renal parenchyma. As a result, 9 out of 10 patients may experience hematuria, that is, blood will be present in the urine.
- If there are many stones and they are large in size, then there is a high probability of relapse of the disease.
- If the stone density is high and its size is more than 2.5 cm, the method is ineffective.
Contraindications
This method is not suitable for pregnant women.
This method is not suitable for the following patients:
- Women during menstruation.
- Problems with blood clotting (congenital, acquired, or caused by taking certain medications). In this case, there is a high risk of bleeding.
- Obesity, scoliosis and other disorders of the musculoskeletal system that will not allow accurate focusing of the shock wave.
- Tuberculosis, acute infectious and inflammatory diseases, purulent processes in other organs.
- Various renal neoplasms.
- Chronic diseases of the digestive system in the acute stage. In this case, the shock wave can damage the intestinal wall and cause bleeding.
- Pregnancy.
- Heart rhythm disturbances, as well as decompensated respiratory and heart failure. Patients with an implanted pacemaker. However, with the use of modern lithotripters, the procedure can be applied to these categories of patients.
Complications
- Kidney hematomas. The prerequisites for this complication are inflammatory processes, menstruation, and blood clotting disorders.
- Hematuria (blood in the urine). This phenomenon is usually observed in all patients the first couple of urinations after the procedure and goes away on its own.
- Blockage of the urinary tract and the “stone path”.
- Residual kidney stones can lead to recurrence of the disease.
Indications for percutaneous litholapaxy
The presence of a large number of large stones (more than 2 cm) of increased density in the renal collecting system. Removing stones using ESWL will require several sessions, which is undesirable, since the risk of complications after the procedure increases (rupture of renal vessels with bleeding, formation of hematomas).
If the shape of the stones is coral-shaped, and the preservation of the renal parenchyma is at least 20%.
The emergence of technical difficulties when performing lithotripsy using ESWL or URS with CTL methods, associated with the inability to remove crushed stones and sand through the natural urinary tract (congenital anomalies of various parts of the urinary system, prostate hypertrophy, strictures and deformations of the ureters and urethra). In such cases, it is advisable to remove kidney stones using percutaneous litholapaxy.
Methods of treating urolithiasis
As a treatment for urolithiasis, a conservative or surgical treatment method is used.
As a treatment for urolithiasis, a conservative or surgical treatment method is used. Conservative treatment is used in cases where small stones are removed, there are no problems with urine outflow, and there is no obstruction of the ureter without active inflammation. Medicines prescribed:
- pain reliever;
- antispasmodics;
- phytomedicines;
- drugs that relieve inflammation.
For information! A positive treatment result depends on the implementation of preventive measures, adherence to diet, and timely use of medications. If recommendations are ignored, kidney failure occurs, which can lead to organ loss.
Surgical treatment of stones includes several effective techniques. Characteristics of modern stone removal:
- Endoscopy - prescribed for large formations in the kidneys;
- Stone crushing or shock wave therapy - is prescribed to remove stones of any chemical composition, located inside the organ or in the upper part of the ureters;
- Lithokenetic therapy is used for small stones that can be dissolved; this result is achieved through drug treatment. Medicines relax and enlarge the ureter, causing stones to pass out on their own.
Contraindications
Since percutaneous litholapaxy is performed under general anesthesia, there are restrictions on surgical intervention due to the serious condition of the patient.
These include:
Multiple organ pathology: cardiovascular and respiratory failure.
Chronic diseases in the stage of decompensation and any conditions that increase the risk of death during surgery.
Blood diseases associated with a violation of the coagulation system.
Aneurysms of the aorta and renal artery.
Percutaneous lithotripsy
In the fight against coral stones, the most radical method of all minimally invasive technologies is used - percutaneous lithotripsy.
All of the above methods will not help in the fight against coral stones. In this case, the most radical method of all minimally invasive technologies is used - percutaneous lithotripsy of stones. In this case, access to the renal formation is through an opening in the skin in the lumbar region. Through this hole, using endoscopic equipment, the surgeon reaches the stone, destroys it and removes it.
Important: percutaneous lithotripsy is considered the gold standard in the treatment of staghorn formations. It successfully replaced open operations.
This procedure is performed under general or epidural anesthesia. After and before it, antibacterial therapy is required. Also, the intestines are carefully prepared before the operation. If the patient was taking anticoagulants, they are canceled a week before the operation.
Puncture of the pelvis and renal cups is carried out under X-ray and ultrasound control. The stone is destroyed through one of the cups. To visualize it, a contrast agent is injected into the kidney. After crushing and removing all the stones, a nephrostomy (special drainage) is installed.
Indications
Percutaneous nephrolithotripsy is performed if previously performed external lithotripsy did not produce an effect.
Percutaneous nephrolithotripsy is performed in the following cases:
- If there are contraindications for performing a remote procedure. Usually this is the impossibility of placing the patient in such a position that the focus of the shock wave hits the right place. It could also be an aneurysm of the abdominal aorta or renal arteries, or deformation of the musculoskeletal system.
- If previously performed external lithotripsy did not produce an effect.
- Elimination of obstructive complications that arise after a remote procedure.
- With impacted and infected kidney formations.
- The method is suitable for crushing multiple, large and coral-shaped stones.
- As part of combination therapy.
Contraindications
This method of crushing stones is not used:
- when a renal deposit is combined with a narrowing of the ureter caused by nephroptosis, an extended structure, an accessory vessel, etc.;
- when the stone is localized in a hard-to-reach place;
- impacted ureteral stones.
Why kidney stones form
Once in the digestive system, all these products invariably pass through the body's natural filter - the kidneys, poisoning and clogging such an important organ. In a healthy body and with a strong immune system, the kidneys are able to cope even with such a load, but if the protective functions weaken and a person is increasingly exposed to colds, this leads to the development of inflammation. And the inflammatory process, coupled with metabolic disorders, leads to the formation of kidney stones.
Chronic inflammation is especially dangerous for the kidneys, because the surface of the organ in these cases becomes rough and various salts cling to it - urates, oxalates, carbonates and phosphates. They then form stones in the kidneys, which ordinary people call stones.
