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Surgical treatment of urolithiasis
Surgical treatment of urolithiasis, stone removal
The stone in the urinary tract or renal pelvis system, which failed to get rid of the conservative way, removed by surgery. The problem of surgical treatment in this case, select the least traumatic for the patient and his method of kidney surgery. But we should remember that the removal of the stone is not a complete cure. The stone may appear again. So after conservative surgical treatment should be preventive treatment. By the operation the patient is prepared. Before the operation, prescribers improve vascular blood flow, anti-oxidants. If necessary, after controlling for the analysis of urine and blood can be given antibiotic therapy. If the stone completely blocks the urinary tract, you may need drainage of renal pelvis system.
Previously, the only way to remove the stone from the urinary tract has been open surgery, while often necessary to remove a kidney.
Now, thanks to new methods and improvement of surgical techniques kidney in most cases we can save.
At present, open surgery is performed at the most complex and severe forms of urolithiasis. If the stones are very large, with recurrent kidney stones if the stone is located in the kidney while the patient has purulent pyelonephritis with renal failure occurred, and if other methods are unavailable or contraindicated, conducted a large surgery. View this operation is mainly determined by the location of the stone:
If the stone is located in the renal pelvis, performed pelviolithotomy. At the same time cut through the pelvis, the stone is removed and the pelvis impose joint and put the drain. Pelviolithotomy is front, rear, bottom.
Sometimes, when a very large amount of stone can not be removed through an incision in the pelvis. In this case, the nephrolithotomy - incision is made through the kidney tissue.
If the stone is located in the ureter, the ureter is opened and the stone removed. The operation is called a ureterolithotomy. Currently, the stones from the ureter open surgically removed often. To do this, use other methods.
X-ray endoscopic techniques for removal of stones:
Transurethral ray endoscopic surgery. This method of removing stones from the urinary tract was made possible after a cystoscopy. Initially, the stone was destroyed to small pieces and removed through the cystoscope tube under the control of the surgeon. Now in connection with the creation of a new endoscopic technique (nephroscope, ureteropieloskopy), this method is one of the main methods for the treatment of kidney stones and other urinary tract diseases. Applied this method to remove the stones from the bladder, ureters and urethra. Contraindications for this type of treatment may be infectious processes in the urinary tract, prostate adenoma, which is not possible to introduce the endoscope into the bladder or some diseases of the musculoskeletal system, under which it is impossible to carry out the correct laying the patient on the operating table. Transurethral ureterolitotripsiya (destruction of stone in the ureter through the urethra) and litoekstraktsiya (stone removal) is performed in a specially equipped rentgenoperatsionnoy. In the ureter ureteropieloskop introduced, ureter examine and decide on how to break the stone. If the stone is small, it seized and removed. If the stone is larger, its fragmenting and removed piecemeal. Crushing stone is produced in various ways:
laser
ultrasonic
electro-
pnevmoticheskim
For the prevention of infectious complications in 1-2 days left in the ureter drain.
Sometimes when contraindications to other therapies used percutaneous endoscopic surgery x-ray. In this nephroscope is introduced into the system pyelocaliceal kidney through a puncture hole in the lumbar region. With this method of surgery removes stones from pyelocaliceal of the kidneys.
Remote shock wave lithotripsy:
This method of disposal or destruction of the stones used in 1980. It allows you to break the stone to the smallest particles, which then depart on their own urine. It uses a special reflector that transmits electro-wave to a distance and destroy the stones in the patient's body without direct contact with the stone.
Lithotripsy can be used even out-patient, can achieve good results with less trauma patient and to reduce the number of postoperative complications. Contraindications for lithotripsy can be very large weight of the patient (over 110 kg), the presence of an active current of pyelonephritis, the location of the stone, which does not allow him to bring into focus the shock wave, some abnormal heart rhythm disturbances in blood coagulation and pregnancy. This method does not require anesthesia. After crushing the stones they leave themselves with urine. Sometimes it may be accompanied by renal colic, which is usually easily docked.
