What to choose - laser or ultrasonic crushing of kidney stones

  • What to choose - laser or ultrasonic crushing of kidney stones

    In the arsenal of a modern nephrologist there are several types of medical, surgical and combined methods of treatment. How to break stones in the kidneys depends mainly on the patient's condition, the presence of concomitant diseases, the type, size and form of the stones, and the prescription of the disease.

    Open( cavitary) methods of surgical treatment are used and at the moment, however, indications to them became much less thanks to new techniques - ultrasound and laser crushing of kidney stones. Nevertheless, open surgery is used in urgent conditions with acute obstructive pyelonephritis, the presence of very large concrements( coral stones).They are also used for planned operations with various abnormalities of the structure and location of the kidneys, concomitant tumor pathologies in the kidneys and other serious disorders, when only this kind of operation is possible to alleviate the patient's condition.

    Remote lithotripsy

    Stone crushing by ultrasound is also called lithotripsy. There are several types of lithotripsy - remote crushing of kidney stones and percutaneous lithotripsy. These methods can be combined with each other, as well as with litholithiasis, i.e.medicamental measures for the dissolution of stones. Remote lithotripsy perfectly copes with stones in both the kidneys and ureters, the maximum allowable size is up to 2.5 cm. With smaller stones, lithotripsy can be used isolated as monotherapy. Remote lithotripsy remains the only non-invasive technique for crushing stones.

    Lithotripsy is used only for crushing stones in the kidneys, and they take out pieces of broken stones using medication methods or they go out on their own. This moment is the most responsible. All patients after lithotripsy should be under medical supervision until the destroyed parts of the stone come out.

    After the operation, the patient is usually prescribed litholytic drugs - cystone, cystenal, kanefron, phytolysin;antispasmodics - no-spa, baralgin, analgin with papaverine or papaverine with platyphylline, spasmalgon;non-steroidal anti-inflammatory drugs( ibuprofen, diclofenac, nimesil);antibacterial agents for the prevention of pyelonephritis( cephalosporins, penicillins, fluoroquinolones), diuretics - leaves of birch, St. John's wort, horsetail, rue.

    Usually, after a day the patient can be discharged home, but with the condition of continuing prescribed litholytic therapy.

    Indications for remote lithotripsy are also non-medicamentous renal colic, or if it has too frequent recurrence.

    In cases where stones are difficult to destroy or difficult to visualize, and this happens in urates, ultrasound monitoring of surgical treatment and mandatory subsequent exposure to the stone by endoscopic contact methods of lithotripsy is necessary.

    Remote lithotripsy is convenient in that it eliminates the need to resort to endotracheal anesthesia, it is not required to produce skin incisions and it becomes possible to separate the stones. To crush a stone, up to 2-2.5 cm in size, an average of 1-2 sessions of remote lithotripsy should be performed.

    The most common crushing of stones is performed under intravenous anesthesia, the duration of one session usually takes no more than half an hour.

    The procedure is considered successful if it was possible to break the stone into small pieces or into fine dust.

    Nevertheless, despite the convenience of the technique, it has a number of contraindications:

    • Excessive weight of the patient( more than 120 kg);
    • The location of the stone in a place where it is impossible to direct a shock wave;
    • Violation of blood clotting processes;
    • Arrhythmias, artificial pacemakers;
    • Severe pulmonary or heart failure;
    • Significant decrease in the efficiency of the kidney;
    • Coral stones;
    • Tumor diseases of any location;
    • Pregnancy.

    In this case, percutaneous lithotripsy, ureteroscopy or ureterolithotripsy may be recommended to the patient. These techniques are easily transferred to the above category of patients, after them there are almost no complications and the period of the patient's incapacity for work is minimal.

    Endoscopic transurethral and percutaneous lithotripsy and lithoextraction

    Despite their invasiveness and comparative trauma, these methods are also used in the treatment of urolithiasis. Recently, there has been an improvement in endoscopic devices, which makes it possible to effectively use these techniques with minimal complications.

    Among the main contraindications to these types of treatment are anomalies of kidneys of anatomical and functional character, greater mobility of the kidney.

    Quite often, remote crushing of stones is combined with percutaneous contact lithotripsy, especially with coral stones. In addition, endoscopic operations have one important advantage - along with the removal of the effects of urolithiasis - stones, it is possible to eliminate the source of stone formation.

    The operation is always performed under endotracheal anesthesia( which is a minus), but it is possible to crush stones of much larger size than with other techniques.

    How to prepare for remote lithotripsy

    Ultrasound crushing of stones does not require significant preparation of the patient and therefore it is often produced in a polyclinic. On the eve before the operation, the patient should perform cleansing of the large intestine with an enema, and in the evening it is not recommended to eat food that leads to increased gas production - black bread, milk, fresh vegetables and fruits, sweet fizzy drinks. The last meal is desirable no later than 20 hours.

    Kidney stone fragmentation with laser

    The crushing of kidney stones with a laser has not yet become as widespread as the ultrasound technique, but every year it is used more often.

    This method also allows the destruction of concrements in the urinary tract, but it requires the simultaneous use of an endoscope inserted into the urethra and directed to the site of localization of the stone. In the endoscope is a laser, which, if necessary, includes and breaks the stone. In the future, the destroyed concrement is excreted outward with urine alone.

    Before the operation, the doctor tells the patient how the kidney stones are broken according to this method. This is done so that the patient does not fear the impending treatment and could easily transfer it.

    Undoubted advantage of the laser technique is the moment that it allows to crush stones located in the most inaccessible places. In addition, it has several advantages:

    • A single session is usually sufficient to break down the stone of any structure;
    • Complications in the postoperative period are extremely rare;
    • No need for pre-anesthesia;
    • Atraumatic manipulation;
    • Efficiency at any stone size, even the smallest;
    • Constant visual control of all operations performed.

    I would like to warn that any of the described methods of surgical treatment is not a guarantee that the stones will no longer form in the future. Surgical techniques give only a prerequisite for kidney health and elimination of urinary tract infection. That is why we can not discount the role of therapeutic nutrition, urolithic drug therapy and treatment of the underlying cause that caused stone formation.

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