Urolithiasis is one of the most popular diseases of our time. Pathology is found in 1-3% of able-bodied people. In the initial stages of the course of the disease, stones can be dissolved with the help of drugs, but in the later stages, the only way to get rid of kidney stones is surgery.
What are kidney stones?
Kidney stones are s alt deposits that can form as a result of malnutrition, metabolic problems, very hot climates, hypervitaminosis D and beriberi. The provocateurs of the development of pathology can be drugs that are part of the group of tetracyclines or glucocorticoids.
Kidney stones can cause pain, urinary problems and inflammation. To prevent complications caused by this pathology, it is required to start treating the disease. Given the symptoms of kidney stones,treatment by surgery, according to urologists, is the most effective.
Causes of urolithiasis
Do kidney stone surgery? Before contacting a doctor who can prescribe an operation, first of all, you should deal with the causes that provoke the formation of stones.
The most common causes of kidney stones include:
- Genetic predisposition. It is known that quite a lot of pathologies are transmitted from parents to children, including urolithiasis. The main place in this case is occupied by a predisposition to hypercalcemia - an excess percentage of calcium in the blood. Congenital problems with metabolic processes also play an important role.
- Kidney disease. Any condition that adversely affects the ability of the kidneys to filter can provoke the appearance of stones in them, in particular, inflammatory diseases (pyelonephritis) and congenital pathologies (renal deformity) affect.
- Diseases of other organs. The metabolism of the above substances may be disturbed in certain diseases, such as gout, inflammatory bowel disease.
- Food quality. Dietary problems play an important role in the formation of urolithiasis. Eating highly s alty and acidic foods can cause kidney problems.
- Dehydration. Insufficient water in the body provides an environment incapable of excreting harmful compounds.
- Climatic conditions. Hot climatic conditions, provoking a decrease in the concentration of fluid in the body, have a negative effect on the kidneys, often causing pain.
- Inactivity. Due to physical inactivity, metabolism deteriorates throughout the body.
With such pathologies, kidney stones are almost impossible to remove without surgery.
Indications for surgery
An operation to remove kidney stones is performed in case of a number of indications:
- Obstruction of the ureter. This pathology needs immediate treatment, so the use of conservative methods of therapy is not effective.
- The development of renal failure or the presence of this pathology in the acute stage. If you ignore the symptoms inherent in this disease, there is a high likelihood of complications, even death.
- The presence of pain that cannot be relieved with medication.
- Inflammation of a purulent type.
- Presence of kidney carbuncle. This term deciphers the area of purulent necrosis resulting from the impact of stones.
- The desire of the patient to perform surgery.
Varieties of operations
Before getting an answer to the question of how stones are removed from the kidneys by surgery, it is necessary to clarify that there are several types of surgical intervention:
- Lithotripsy. Crushing of stones is performed due to the influence of ultrasound through the skin, after which the stone is removed to the outside using the ureter or catheter.
- Endoscopic surgery. They are performed using an instrument such as an endoscope, its introduction is performed through the urethra, or ureter, and is brought to the site of the localization of the calculus. The stone is removed through the ureter.
- Open surgery. The kidney is cut and the stone is surgically removed.
- Resection. The operation is somewhat reminiscent of open surgery, but it involves partial removal of the organ.
Lithotripsy: the essence of the operation
If kidney stones were found, laser surgery (using a laser to actuate a shock ultrasonic wave generator) will help get rid of stones in a short time. Lithotripsy has been widely used in medicine since the 90s of the last century and has not lost its effectiveness to this day. When kidney stones are removed by this type of operation, the trauma and the likelihood of infection are significantly reduced, since the effect is performed through the skin without making incisions.
The essence of the technique lies in the effect of ultrasound on a variety of body environments. It quietly spreads in soft tissues without causing any harm. When ultrasound and dense s alt deposits collide, microcracks and cavities form in them, which provokes destruction.stone.
Indications and contraindications for lithotripsy
When carrying out this operation to remove kidney stones, it is possible to get rid of only stones with sizes up to 2 centimeters, and localization does not cause difficulties. If the urolithiasis has reached the fifth stage, then this method of treatment is not only useless, but even dangerous.
This kidney stone crushing operation is not recommended in the following situations:
- gestation period;
- injury to the musculoskeletal system, which makes it impossible to take the position on the couch required for the operation;
- patient's body weight is more than 130 kilograms, height is above 2 meters or below 1 meter;
- blood clotting problems.
Lithotripsy technique
How to get rid of kidney stones by surgery? Before this, you should familiarize yourself with the technology for performing lithotripsy. During the first operations, general anesthesia was used, but today, epidural type of anesthesia is preferred. The introduction of analgesics is performed in the lumbar spine. The effect of their use is noticeable after 10 minutes, and the duration does not exceed 60 minutes. In emergency situations or when there are prohibitions to perform an epidural type of anesthesia, analgesics are administered through a vein.
Surgical intervention is performed in a supine or stomach position, everything directly depends on the location of the calculus. In the firstcase, the patient's legs are raised and fixed. After the detection of kidney stones, the operation treatment begins with the introduction of a catheter into the ureter, thanks to the device, a contrast agent penetrates the kidney, it is necessary to improve visualization. During these manipulations, the patient does not feel any discomfort.
If the size of the calculus exceeds 1 cm, a needle is inserted into the renal pelvis. Through the puncture, the formed channel expands to the required diameter, which makes it possible to put a tube with a device for extracting sediment particles into it. Stones of smaller sizes are excreted together with urine.
Saline solution is poured into the catheter located in the ureter. It is necessary to facilitate the movement of the ultrasonic wave and protect neighboring tissues from negative influences. The tool is placed in the area of the exact projection of the calculus. During its action, the patient feels mild painful shocks. Sometimes, to destroy the stone, you have to perform several approaches. Occasionally, during the procedure, the patient may feel pain, in this case, do not worry, the main thing is to report the sensations to the attending physician.
After the operation, kidney stones will not bother the patient for a long time. At the same time, if lithotripsy was not invasive, after the anesthesia ceases to act, the patient is placed in the ward. Here he needs to go to the toilet in a jar in order to monitor the process of the release of stones from the body. There may be blood in the urine, this is quite acceptable, since it is formed due tosand injury to the epithelium of the ureter. Remaining s alt may separate for a couple of days after surgery.
Endoscopic surgery
When a kidney stone is found, the operation is performed only after obtaining the consent of the patient, while in case of impossibility of lithotripsy, doctors recommend endoscopic intervention.
Taking into account the location of the calculus, the endoscope is inserted into the urethra, ureter or kidney. The lower the stones are localized, the easier it is to perform surgery. The operation is performed under general anesthesia, it is possible to use intravenous anesthesia to remove calculi with a diameter of up to 2 centimeters.
With kidney stones, this type of operation is performed if there are such contraindications:
- low efficiency from lithotripsy;
- localization of the calculus in the area of the ureter;
- formation of residual formations after the influence of ultrasound.
This surgical intervention, despite its external simplicity, requires a high level of professionalism and high-quality modern devices from the doctor. A ureteroscope is placed in the patient's urethra. This machine includes a tube and a mirror that allows the doctor to look for stones. Once the tube reaches the stones, they are removed.
The most modern type of endoscopic intervention is the removal of stones from the kidneys with a laser. The beam travels along a special fiber inserted intoureteroscope.
In some situations, it may be necessary to install a stent - a catheter that prevents compression of the ureter. It is set for a period of a couple of weeks. Stone removal is performed using an endoscope and without a single incision.
Open surgery
When stones are found in the kidneys, abdominal surgery has been performed less and less lately. But there are a number of indications when such an operation is simply indispensable:
- regular relapses;
- stones are large and cannot be removed by any other method;
- inflammatory processes of purulent type.
Open surgery is performed under general anesthesia. During surgery, the body cavity is involved, excision is made through all tissue layers. A positive moment is the presence of a calculus in the renal pelvis, this helps to reduce the invasiveness of surgery. In addition, you can open the ureter and remove the calculus from there.
Laparoscopy is one of the modern methods of such surgery. In this case, the stone is removed through a small incision. A camera is inserted into it to transfer the picture to the big screen. Removal of stones using laparoscopy is performed only if there are special indications.
Removal of a portion of the kidney
When kidney stones are found, this type of operation is performed only with very large stones. This surgical interventionthe ability to save the internal organ, which is especially important in the presence of only one functioning kidney.
Resection is performed in the following situations:
- numerous calculi localized at one pole of the organ;
- regular relapses of the disease;
- necrotic lesions;
- last stages of urolithiasis.
At the same time, if the patient is in serious condition and doctors suggest that surgery may aggravate it, the operation is refused.
Resection is performed under general anesthesia. The patient is placed on a he althy side, under which a roller is placed. The surgeon makes an incision, and then the underlying layers of tissue are moved apart. A clamp is applied to the area of the kidney with the ureter to prevent bleeding, since this is where the maximum concentration of vessels is located.
Next, the affected area is excised. The edges are stitched. A drainage tube is removed from the kidney, and the wound is sutured. The drainage tube should be in the kidney for 7-10 days after surgery. After the specified period and in the absence of complications, it is removed.
Possible Complications
If the kidney stones could not be removed without surgery, the doctor prescribes surgery. Unfortunately, the operation can cause a number of complications:
- Relapse. Urolithiasis is quite often distinguished by the recurrence of stones in the kidneys. Operationalintervention only contributes to the fight against the consequences, but does not get rid of the cause of the formation of stones. That is why it is very important to diagnose the cause of the development of urolithiasis and take measures to eliminate it.
- False relapses. This is the name of the remaining not removed fragments of calculi. Such an outcome of surgical intervention is quite rare due to the improvement of surgical techniques and constant monitoring of the patient after the procedure.
- Infection. Even in the case of such a minimally invasive surgical intervention as endoscopic, there is a possibility of penetration of infectious agents into the internal organs. To prevent infection, a course of antibacterial drugs is prescribed even if the patient feels well.
- Acute form of pyelonephritis is an inflammatory process in the renal pelvis. Pathology develops as a result of the displacement of calculi, the prolonged presence of their fragments in the kidneys and the accumulation of fluid near them.
- Bleeding. Most often it develops during an open type of surgical intervention. To prevent the development of such a complication, the kidney is irrigated with a solution of antibacterial agents.
- Exacerbation and progression of kidney failure. To prevent such a complication, hemodialysis is used (connection to an artificial kidney machine) before and after surgery.
- Heart rhythm problems, high blood pressure. This complication usually develops inthe result of ultrasonic destruction of stones due to an incorrect assessment of the general condition of the patient.
Features of the postoperative period after open surgery
After open surgery, the recovery period is about 3 weeks. During this period, wounds heal and all body functions are restored. The patient is dressed every day, while treating the wound in parallel. In the first few days after the operation, a slight increase in temperature may be observed.
To assess the quality of kidney function, a nurse should help the patient calculate the amount of fluid drunk and excreted from the body. In the postoperative period, it is mandatory to take antibacterial, anti-inflammatory and analgesic medications.
During this period, the doctor must fully control the patient's condition, the time for discharge and removal of sutures is determined individually.
Surgery is an effective way to get rid of kidney stones.
