Lithotripsy (removal of kidney stones)

Indications for the removal of kidney stones

Lithotripsy is indicated in the following cases:

• Concretions have been identified in the cup-pelvis system that do not respond to drug therapy;

• concretions reduce the patient's quality of life (they cause pain, blood impurity in the urine), or they can provoke a serious complication.;

• The stones are more than 1 cm in size or grow rapidly.;

• stones in women planning pregnancy;

• abnormalities of the development of the organs of the urinary system in combination with urolithiasis.

Types of kidney stone removal operations

If not so long ago the only way to remove a stone from a kidney was traumatic surgery, then modern medicine offers the opportunity to do this without abdominal surgery. Depending on the size and type of concretions, as well as the condition of the patients, the following methods can be used:

1. Retrograde flexible laser pyelolithotripsy In this procedure, stone crushing occurs by endoscopically inserting a miniature flexible endoscope into the kidney through the natural urinary tract, detecting the stone and destroying it with a laser to the smallest fragments.. The procedure provides a targeted effect on the stone without damaging the kidney tissue and allows the stone to be crushed into sand or even fine dust, which leaves the organ naturally or can be removed by aspiration. This operation is minimally invasive, does not require tissue incisions, and is well tolerated by patients. All manipulations are performed under anesthesia. Flexible lithotripsy is recommended for calculus sizes up to 2 cm, but in clinics with extensive experience, such operations can also be performed for large stones. The EMC Urological Clinic was the first in Russia to use these operations for urolithiasis.
2. Percutaneous (percutaneous) nephrolithotomy. This method is the gold standard for removing large and coral-like nodules. The operation is performed through a small puncture in the lumbar region of no more than 1 cm in size. A nephroscope is inserted into the hole, a device for examining the inner surface of the renal pelvis and performing microsurgical procedures. After visualization of the stone, its crushing is carried out using a thulium or holmium laser. Thanks to modern equipment, it is possible to eliminate even a large stone in just 60-80 minutes. After surgery, a catheter-stent or nephrostomy is inserted into the patient. After 2-3 days, the nephrostomy drainage is removed, and the patient is discharged from the hospital.

Laparoscopic or laparotomy surgery to remove kidney stones is currently performed very rarely, only if it is impossible to eliminate the stones by other means.

Contraindications

Lithotripsy is not performed in the following conditions:

• infectious and inflammatory processes in the acute stage;

• acute renal failure;

• severe somatic diseases, including pathologies of the cardiovascular system that prevent surgery under anesthesia.

It should be especially noted that retrograde flexible laser pyelolithotripsy can be performed in patients receiving anticoagulants without their withdrawal if necessary.

Postoperative rehabilitation

Retrograde flexible pyelolithotripsy is a one-day surgery. The patient is discharged either on the day of the operation or the next day.If percutaneous nephrolithotomy has been performed, the patient will be discharged from the hospital in 2-3 days.

In the postoperative period, the patient is recommended to drink at least 2 liters of water per day. Antispasmodics, painkillers and antibacterial drugs are prescribed.

In the postoperative period, symptoms such as frequent urination, short-term attacks of soreness, and the appearance of blood in the urine may occur. Normally, the symptoms disappear within 2 to 3 days, and a full recovery takes about a week.

To minimize the risk of recurrence, the patient will be offered recommendations for follow-up 4-5 weeks after surgery based on the results of chemical analysis of the removed stone. This is an extremely important component of treatment, since identifying the causes of stone formation allows the doctor to choose the right preventive treatment. If you do not prevent urolithiasis, then the probability of stone recurrence will be 50% in the first five years after surgery.

Frequently asked questions

What kind of anesthesia is used to remove kidney stones?

The operation is performed under general anesthesia, less often epidural anesthesia is used.

What can not be done after the removal of kidney stones?

After surgery, it is recommended to avoid excessive physical activity during the recovery period. It is necessary to reduce salt intake, in particular, do not drink more than 0.5 liters of mineral water per day, as it may contain large amounts of salts that provoke stone formation. Depending on the type of urolithiasis and the identified metabolic disorders, the doctor will recommend making some changes to the diet, including eliminating a number of foods (for example, foods rich in oxalic acid or purines, vegetables, berries, mushrooms, etc.others).

What are the possible consequences after crushing kidney stones?

Within 1-2 days after surgery, the patient may normally observe blood impurities or visually distinguishable concretions in the urine. This is considered normal. With a properly performed operation, complications develop extremely rarely. Complications are indicated by a significant increase in temperature, general weakness, impaired urine outflow, and pain in the lumbar region. If such symptoms occur, you should consult a doctor as soon as possible.

What size of kidney stone is dangerous?

Small stones (up to 0.5cm in size) are dangerous because they can migrate into the ureter or bladder. Thus, the concretion can block the outflow of urine and provoke renal colic. Medium-sized stones (1-1.5cm) cannot leave the kidney, but they can disrupt the outflow of urine from it, causing pain and blood admixture in the urine. Large stones (more than 1.5-2 cm) can grow, fill the kidney cavities and disrupt the activity of the organ up to complete loss of function. In some cases, the stone can reach a size of up to 10 cm. Over time, such a stone can lead to a life-threatening condition, up to kidney failure or sepsis.

Is it possible to live with kidney stones?

Concretions may take a long time to declare themselves, but over time they can provoke complications up to kidney failure. With timely treatment to a doctor, treatment of urolithiasis is possible with conservative or minimally invasive means without surgery.