According to statistics, every tenth person sooner or later faces kidney problems. Urolithiasis (UCD), or urolithiasis, is the leading pathology among kidney diseases. It affects 1-3% of the population. In men, stones are formed 2 times more often, but women mostly develop severe forms of the disease. Nephrolithiasis is the formation of stones in the kidneys themselves. Kidney stones are nothing but deposits of various s alts.
Causes of stone formation
Main predisposing factors to their appearance:
- bad food;
- abuse of certain foods;
- hardness of drinking water;
- a- and hypervitaminosis D;
- disturbed metabolism;
- hot climate;
- lack of drinking regimen;
- heredity;
- kidney and ureter infections;
- hypodynamia;
- receptioncertain drugs (glucocorticoids, tetracyclines);
- condition after chemotherapy.
Mechanism of stone formation
On average, the formation of any stones originates from the concentration of urine and changes in its chemical composition (oversaturation with s alts). The precipitation of s alts is surrounded by pathogenic cells, and they are covered with a membrane. They are formed from a mixture of minerals and organic substances. First, sand appears, which, as the pathology progresses, is converted into stones. With proper treatment, this transformation can be avoided.
Classification of stones
Stones differ not only in size, but also in composition. They come in 4 types:
- oxalate;
- phosphate (70% of stones);
- urates (10%);
- struvite (20%).
The pure look is rare, more often the stones are mixed.
Why do doctors try to determine the type of stone? It depends on the tactics and choice of treatment. By location, stones are single-sided and double-sided. In shape: flat and round, with spikes, coral-like and granular. In size - from a few mm to 3 cm or more. But more often stones are 1.5-2.5 cm. They can form in all parts of the urinary system - in the kidneys, bladder, urethra.
Symptomatic manifestations
Kidney stones form differently for everyone: sometimes in a month, in others - for years. For a long time they do not bother. But if only the calculus has moved, the very famous renal colic occurs, which is not removed by any analgesics and requires an urgent operation. Amongsymptoms:
- sharp pains in the abdomen, side and back above the waist;
- bloody urine (hematuria);
- vomiting and nausea;
- increased and painful diuresis;
- temperature;
- urine contains protein and s alts.
Treatment measures
Any stone treatment goes through 3 stages:
- Remove stones in the best way.
- Rehabilitation period after that.
- Prevention of relapse.
Each stage requires separate lighting.
Medicinal method
Treatment begins with medication, as the safest. Medicinal method - removal of stones from the kidneys without surgery. At the same time, increased diuresis is used - drugs increase the amount of urine excreted while simultaneously consuming a large amount of fluid. This method is justified only when stones are less than 4 mm in size, then their passage through the urethra is free.
It is possible to dissolve stones due to herbal infusions. This is justified with organic stones and urates. Urate is soluble in 25-35% of cases. The most common stones are oxalates and phosphates, they are insoluble. But even if the stones began to decrease in size, there is no 100% guarantee of their dissolution.
If the drugs are ineffective, the stones are large or there are a lot of them, complications develop, an operation is prescribed to remove the stone from the kidney. Many urologists are in favor of radical treatment, as this solves the problem completely.
Indications for kidney surgery
Operation shown if:
- outflow of urine is impossible due to obstruction;
- Bouts of renal colic have become more frequent;
- constant severe pain;
- frequent pyelonephritis;
- AUR - Acute Urinary Retention - Emergency;
- damage to a vessel in the kidney and subsequent bleeding;
- ureter obturation;
- kidney failure;
- kidney carbuncle - purulent necrosis of the tissue where the stone was located;
- purulent inflammation of the kidney;
- the desire of the patient to be operated on.
Methods of surgical intervention:
- Unilateral urolithiasis. At the same time, the functions of the urinary system are preserved.
- Bilateral urolithiasis - carried out simultaneously or in 2 stages with a break of 1-3 months.
Types of operation
In different cases, the operation will be different.
Removal of stones from the kidneys is carried out in 3 ways:
- open (open operation);
- laparoscopy;
- lithotripsy.
Open method
Open abdominal surgery to remove a kidney stone involves capturing large areas of tissue to access the kidney. Therefore, the subsequent healing process becomes lengthy.
Indications for intervention:
- constant relapses;
- large stones that cannot be removed by other means;
- purulent inflammation.
The name of the operation to remove kidney stones is pyelolithotomy. The intervention is carried outunder anesthesia. On the side of the patient, a 10 cm incision is made from the affected side, the tissues are cut in layers. The kidney is cut, the stone is removed from the pelvis. The wound is sutured, and the stitches are removed after a week. The consequences of abdominal surgery are adhesions and aching pains due to them. There may be swelling at the incision site, which also delays healing.
If the stone is in the ureter, the abdominal operation to remove the stone from the kidney is called ureteroscopy. The position is the same. The incision is made over the area where the stone is stuck. The ureter is exposed, inspected, and the stuck stone is removed. Today, abdominal operations to remove a stone from a kidney are extremely rare. They are applicable when other methods have failed. Most surgeries today are minimally invasive.
What is the name of the operation to remove stones from the kidneys with partial removal of the kidney? This is a resection and it is a kind of open. This operation allows you to save the kidney, which is always important when the only working kidney.
Indications for resection:
- monopole multiple (multi-cavity) stones;
- frequent relapses;
- tissue necrosis;
- last stage of urolithiasis.
Progress of operation
The operation is performed under general anesthesia. The patient is placed on a he althy side on a roller. Layers dissect and push apart the tissue. The affected area is excised. The edges are sewn. A drainage tube is inserted, which is left for 7-10 days after the operation. If it remains dry and clean, it is then removed.
Laparoscopy
Several small incisions less than 12mm in size are made in the abdomen. Through them, a camera is inserted for viewing and a light source - a laparoscope. The image is fed to the monitor in the operating room.
Contraindications for laparoscopy:
- tight adhesions;
- complexity of anatomical access;
- gastric and duodenal ulcer;
- decompensation of the cardiovascular system;
- increased bleeding with decreased clotting;
- acute inflammatory pathologies in the body;
- stones over 2cm;
- 2nd half of pregnancy;
- obesity.
Laparoscopic stone removal is more often replaced by endoscopic surgery.
Endoscopic surgery
Depending on the location of the stone, the endoscope can be inserted into the urethra (urethra), bladder, ureter, or directly into the kidney, i.e. through a natural opening. The lower the stone, the easier it is to remove. General anesthesia or intravenous anesthesia is given for stones smaller than 2 cm.
Indications for endoscopic kidney stone removal:
- no result from lithotripsy;
- damage to kidney tissue after a crushed stone.
The ureteroscope has a tube with a mirror so that the removed stones can be seen and controlled by the surgeon.
Punctures during minimally invasive surgery are minimal, and the load on the surrounding tissues is also small. The patient is already 2-3 days afterOperations can move independently and conducts hygiene procedures. There are practically no complications after laparoscopy.
Lithotripsy
Another type of laparoscopic surgery is lithotripsy. When it is carried out, special nozzles for ultrasound are used to crush stones. The bottom line is that ultrasound freely passes through soft tissues without damaging them. When a wave meets a stone, it crushes and crushes it.
Types of lithotripsy
There are 4 types of lithotripsy:
- If the stone is crushed by ultrasound using an endoscope, this is percutaneous or percutaneous nephrolithotomy (PNL).
- Laser lithotripsy is the most effective, with it the stone literally dissolves.
- Pneumatic method - the stone came out of the kidney, but can not move further. Then a probe is inserted into the ureter and a series of shock air waves (SWL) is applied through it. The stone is destroyed after a few seconds. The fragments are removed with special tongs or loops. With a high stone density, this method does not work.
- If SWL is applied not through a probe, but through the skin, this is an external lithotripsy. There are no cuts or punctures here. The fragments are excreted in the urine. Many patients complain of pain during such manipulation. Visual control is always performed using ultrasound or x-rays. The ultrasound breaks the stone into sand, which is then removed with special aspirating instruments. Immediately after the operation, the patient is placed in the intensive care unit for a day, then goes togeneral ward. Drainage tubes in the wound are removed on day 2.
Contraindications for lithotripsy:
- stones larger than 2 cm in diameter;
- in advanced cases, lithotripsy is not done;
- 3rd trimester of pregnancy;
- injuries to the spine that will prevent the patient from taking the correct position during surgery;
- obesity - weight over 130 kg;
- too tall or too short - over 2m or under 1;
- reduced blood clotting.
Progress of lithotripsy operation
Used to use general anesthesia for her. Today they are limited to epidural anesthesia through the lumbar spinal cord. The action starts in 10 minutes and lasts about an hour. Depending on the location of the stone, the patient lies on his back or stomach. In the supine position, the legs are raised and fixed. After anesthesia, a catheter with a contrast agent is inserted into the ureter. No pain. If the stone is larger than 1 cm, puncture the renal pelvis and widen the canal to the desired diameter to insert a tube with a tool to remove the fragments.
When the catheter is inserted, saline is injected into it. It facilitates the course of the ultrasonic wave. From ultrasound, the patient feels soft, painless shocks.
After 2 days, the doctor performs a control ultrasound of the kidneys. If there are no complications, the patient is discharged home.
Laser lithotripsy
Laser crushing of stones is the most modern and safest method. He turns even large stones quickly into dust. The procedure is absolutely painless. Surgery to remove kidney stones with a laser alternative to abdominal surgery. The only negative is the high cost. But on the other hand, only 1 session is enough to destroy stones of any size.
Possible Complications
After kidney stone surgery, there is always a different likelihood of complications:
- Relapses - they are possible because the stone is removed, not the cause of the disease. Therefore, it is so important to find out the cause of the formation of stones.
- False relapses - symptoms give the remnants of not completely removed stones. Today, this complication is rare.
- Infection - the possibility of it is always present. Antibacterial therapy is prescribed.
- Acute pyelonephritis is an inflammation of the renal pelvis. It can develop after tissue irritation with a stone and accumulation of infiltration in this place.
- Bleeding - more often with abdominal operations.
- Exacerbation of renal failure. To prevent this, the patient is connected to an artificial kidney before and after the operation.
- Arrhythmias and hypertension.
- Possibility of a weak seam when it breaks and urine starts to leak.
- Narrowing of the lumen of the ureter.
- Urinoma - urinary pseudocyst.
- Anuria - lack of urination.
- Complications of the operation to remove a kidney stone also occur more often after ultrasonic destruction of stones due to an incorrect assessment of the patient's condition.
Rehabilitation period
After kidney surgery to remove stones, physical exertion should be avoided, do not liftgravity. Anti-inflammatory, antibacterial drugs should be taken until the tissues are completely healed. It is necessary to comply with the drinking regime and diet.
The operation to remove a kidney stone and a diet in compliance with the water regime are very closely interconnected, since urolithiasis tends to recur with malnutrition. A follow-up examination is required in a month.
Relapse Prevention
The very fact of stone removal is not a guarantee of a complete cure. This is why relapse prevention is so important. The disease does not go away, only the level of treatment changes - diet and he althy lifestyle. If you do not perform prevention, the stones will definitely appear again - proven by practice.
Recommendations after discharge
The main recommendation after the operation to remove a stone from the kidney is the introduction of an enhanced drinking regimen. Water is the best purifier, it washes and rinses all urinary tracts from blockages. Periodic herbal medicine is also desirable, which perfectly prevents postoperative complications and becomes a barrier to the formation of new stones. Regular urinalysis is required to check its chemical composition.
The diet after kidney surgery to remove stones is developed by the doctor individually for each patient, taking into account the chemical composition of the existing stones. For example, with oxalate stones, it is necessary to exclude foods high in oxalic acid from the diet - offal, sorrel, spinach, spicy cheese, broths, jelly, rhubarb, tomatoes, celery, etc.
