The problem of urolithiasis is very relevant in urology. The number of people suffering from nephrolithiasis is only increasing every year. If no therapeutic measures are taken, the disease quickly leads to various disorders of all body systems. The most effective way to get rid of nephrolithiasis is surgical intervention. One such treatment option is percutaneous nephrolithotripsy. The procedure is minimally invasive and shows high efficiency.
What is percutaneous nephrolithotripsy?
This method was first used as an alternative to open kidney stone removal in 1973. Percutaneous (percutaneous contact) nephrolithotripsy is a method of treating urolithiasis by crushing kidney stones in direct contact with them. The method makes it possible to remove large (more than 1 cm), single and multiple kidney stones, as well as to destroy staghornstone formations located in the internal space of the pelvicalyceal system of the bean-shaped organ.
The crushing of stones is carried out by exposing them to a shock wave. The fragments are removed through a nephroscope using a two- or three-blade gripper, a Dormia basket (lithoextractor) or other instruments: a needle, an Ellik evacuator.
Indications for surgery
Doctors among the surgical methods of treating urolithiasis most often prefer remote lithotripsy. However, in some cases, this procedure is ineffective and significantly inferior to other methods. Based on the results of examinations, the doctor chooses the best way to remove kidney stones.
Percutaneous nephrolithotripsy is prescribed for the following indications:
- Single or multiple large stones (more than 20 mm).
- Koral-like calculi in the cavity of the pyelocaliceal system of the kidney.
- Infected, oxalate, cystine stones.
- Obstructive complications.
- Contraindications to external lithotripsy or too rapid recurrence of the disease after applying this method.
- Failure of other treatments.
Contraindications
Percutaneous nephrolithotripsy is primarily a surgical procedure that has a number of features that prevent the use of this method. Contraindications for the procedure are:
- All trimesters of pregnancy.
- Hemocoagulation disorders.
- Changes in the renal structure, in which access to stones is difficult.
- Ureteral stricture.
- Cardiovascular disease.
- Presence of malignant neoplasms.
In case of infections and acute inflammatory processes, the operation is postponed. Surgical intervention can be performed only two weeks after the end of antibiotic therapy. Also, the procedure is not carried out during menstruation.
Types of operation
Percutaneous nephrolithotripsy is performed in various ways. Their choice depends on the type and number of kidney stones.
- For calculi larger than 1.5 cm, contact crushing is performed. Through the instrumental channel of a special device designed to diagnose the renal pelvis (nephroscope), a lithotriptor umbrella is brought to the stone - a tool for destroying the stone and crushing is performed with simultaneous aspiration (suction) of small fragments. Litholapaxy can be performed using an ultrasonic or pneumatic lithotripter.
- With staghorn and multiple stones, a combination of contact and remote lithotripsy is used. Initially, with the help of rigid instruments, the maximum allowable volume of coral-like calculus is removed, including its pelvic fragment. The remaining cup parts of the stone are crushed by remote lithotripsy. Often, remote lithotripsy is replaced by fibronephroscopy. The fiberscope displays an accurate image thatimproves the quality of the operation and reduces the risk of complications.
- To remove stones up to 15 mm in size, percutaneous nephrolithotripsy with lithoextraction is used - this is crushing the stone with subsequent extraction of fragments using special devices designed to capture stones.
The urologist in each case applies exactly the method of treatment that will help the patient get rid of the stone with minimal trauma to the patient and the kidney.
Preparation for surgery
The urologist prescribes the operation after consultation with the therapist, nephrologist and anesthesiologist. Initially, it is necessary to identify all contraindications so that there are no complications during and after surgical manipulation, for example, Quincke's edema. Due to an allergy to the components of anesthesia, swelling of the throat may occur, and the patient may suffocate. Preparation for the procedure of percutaneous nephrolithotripsy consists in passing a set of examinations.
- Blood tests: CBC, biochemical analysis, determination of the Rh factor, coagulogram, antibodies to HIV, markers of hepatitis B, C.
- Urine tests: general analysis and bacterial culture.
- Analysis of feces for worm eggs.
- Immunoglobulin IgE.
- Ultrasound kidney scan.
- Excretory urography.
- Fluorography, ECG with decoding.
It is also necessary to obtain the conclusion of specialized specialists: an endocrinologist (the presence or absence of diabetes mellitus), a phlebologist (identification of varicose veins). Best before datesuch conclusions 1 month.
Execution technique
Surgical manipulation aimed at treating nephrolithiasis by crushing stones with their subsequent removal is most often performed according to planned indications. The operation percutaneous nephrolithotripsy is performed under general anesthesia and consists of two stages.
- Formation of access to kidney stones. Access is a significant stage of the procedure that affects the final result and the successful outcome of the operation. Proper access makes it possible to remove the largest amount of coral stones. A calculus of any size located in the pelvis is removed completely without auxiliary interventions. The puncture of the kidney wall is done under X-ray and ultrasound control. For insurance, a string is installed in the ureter, which serves as a guideline when expanding the nephrostomy passage. The string is removed at the end of the operation.
- Removal of a kidney stone. A tube is installed in the kidney and rigid instruments (nephroscope, ultrasonic bougie or laser fiber, forceps) are introduced through it, with the help of which fragments of the calculus are crushed and evacuated from the pyelocaliceal system of the kidney. After that, the kidney is scrupulously examined. After making sure that the stone is completely removed, a nephrostomy drain or ureteral stand is inserted into the passage. The tubes are removed 3-4 days after the operation.
Complications
Percutaneous nephrolithotripsy is considered a gentle and relatively safe method of treating urolithiasis. Butsince the procedure is invasive, there is always a risk of complications.
- Bleeding. The kidney consists of nephrons, which are the structural and functional unit of the organ. A nephron is a bundle of blood capillaries. If the instrument is handled carelessly, bleeding develops.
- Injury to nearby organs. The probability of a breach occurring is very low, but still exists.
- Ultrasonic lithotripter burn.
- Rupture of the calyx of the kidney under the influence of the shock wave of the electrohydraulic lithotripter.
- Perforation of hollow structures that carry urine.
A frequent complication of percutaneous nephrolithotripsy with lithoextraction is rupture of the wall of the pelvis when the stone is “pushed out” into the renal parenchyma. As well as the loss of a calculus in the muscles during its extraction.
Consequences
Pyelonephritis often develops after surgery. This is due to infection during the procedure or in the early rehabilitation period. Untreated infectious and inflammatory pathologies contribute to the formation of the disease.
Percutaneous nephrolithotripsy is a treatment method. No one can guarantee that kidney stones will not reappear. It is possible to reduce or even exclude such a probability only if you follow a diet, daily routine, you need to avoid factors that contribute to the formation of urolithiasis. It is also worth considering that if fragments of calculi were not completely removed, then a relapse is guaranteed later.
Forecast
Postatistics in 95% of the prognosis for recovery is favorable. Patients no longer experience the discomfort associated with kidney stones. But do not forget that the effectiveness of therapy depends on compliance with all medical recommendations.
Removal of stones from a kidney does not mean the removal of an organ, therefore, a person is not en titled to a disability. The natural question is how many days a person is considered able-bodied after percutaneous nephrolithotripsy and when you can go to work. With a successful operation without complications, the patient can return to normal life and work in a week.
Rehab
After the operation, the patient is observed in a medical facility for several days. He is prescribed a course of antibiotics to prevent the inflammatory process, make dressings. The patient gives urine and blood every day for analysis to track the dynamics of the recovery process.
Many are interested in: with percutaneous nephrolithotripsy, how long do they give a sick leave? The duration of stay in the hospital is a week, provided that no complications have arisen. A sick leave certificate can be obtained on the day of discharge, indicating the number of days in the hospital.
Reviews from patients and doctors
Urolithiasis and its treatment have been studied for a long time. Crushing stones is considered the most effective method of therapy. Medical reviews of percutaneous nephrolithotripsy are only positive. Urologists note that the use of modern equipment increaseseffectiveness of the operation and significantly reduces the risk of negative consequences. With the help of flexible nephoscopes, access is made to the most difficult places in the kidney, this is especially true for staghorn stone formations.
Most of the patients who underwent surgery speak positively about it. Women consider the absence of an ugly scar and a short rehabilitation period to be the main advantage.
