The problem of urolithiasis is very relevant in urology. The number of patients with nephrolithiasis is increasing every year. If no therapeutic measures are taken, then the disease quickly leads to various disorders of all body systems. Surgery is considered the most effective way to get rid of nephrolithiasis. One option for this treatment is percutaneous nephrolithotripsy. The procedure is minimally invasive and shows high efficiency.
What is percutaneous nephrolithotripsy?
For the first time, this method was used as an alternative to open removal of kidney stones in 1973. Percutaneous (percutaneous contact) nephrolithotripsy is a method of treating urolithiasis by crushing kidney stones with direct contact with them. The method makes it possible to remove large (more than 1 cm), single and multiple kidney stones, as well as destroy coral-like stone formations located in the inner space of the pyelocaliceal system of the bean-shaped organ.
Grinding stones is carried out by exposure to a shock wave. The removal of fragments occurs through a nephroscope using a two- or three-blade capture, a Dormia basket (lithoextractor) or other tools: a needle, an Ellik tow truck.
Indications for surgery
Doctors among surgical methods for 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 the 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).
- Coral-shaped calculi in the cavity of the pyelocaliceal system of the kidney.
- Infected, oxalate, cystine stones.
- Obstructive complications.
- Contraindications to remote lithotripsy or too rapid recurrence of the disease after using this method.
- Ineffectiveness of other treatment methods.
Contraindications
Percutaneous nephrolithotripsy is primarily a surgical procedure that has a number of features that impede the use of this method. Contraindications to the procedure are:
- All trimesters of pregnancy.
- Blood coagulation disorders.
- Changes in the renal structure, in which access to calculi is difficult.
- Ureteral stricture.
- Cardiovascular diseases.
- The presence of malignant neoplasms.
With infections and acute inflammatory processes, the operation is transferred. Surgical intervention can be performed only two weeks after the end of antibiotic therapy. Also, the procedure is not performed during menstruation.
Types of operation
Percutaneous nephrolithotripsy is performed in various ways. Their choice depends on the type and number of kidney stones.
- When calculi, having a size of more than 1.5 cm, perform contact crushing. Through the instrumental channel of a special device designed to diagnose the renal pelvis (nephroscope), a lithotripter umbrella, a tool for destroying the stone, is brought to the stone and crushed with aspiration (suction) of small fragments. Litholapaxy can be performed using ultrasound or pneumatic lithotripter.
- With coral and multiple stones, a combination of contact and distance lithotripsy is used. Initially, with the help of rigid tools, the maximum permissible volume of the coral calculus, including its pelvis fragment, is removed. The remaining calyx parts of the stone are crushed by remote lithotripsy. Often, remote lithotripsy is replaced by fibronephroscopy. The fiberscope displays an accurate image on the screen, which improves 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 a crushing of a stone followed by extraction of fragments using special devices designed to capture stones.
In each case, the urologist applies the method of treatment that will help the patient get rid of the stone with minimal injury to the patient and kidney.
Preparation for surgery
The urologist prescribes the operation after consultation with the therapist, nephrologist and anesthetist. Initially, it is necessary to identify all contraindications, so that during and after surgical manipulation there are no complications, for example, Quincke edema. An allergy to the components of anesthesia may cause throat swelling and the patient may suffocate. Preparation for the percutaneous nephrolithotripsy procedure consists in passing a complex of examinations.
- Blood tests: OAK, 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 scan of the kidneys.
- Excretory urography.
- Fluorography, ECG with decoding.
It is also necessary to obtain the opinion of specialized specialists: an endocrinologist (the presence or absence of diabetes mellitus), a phlebologist (detection of varicose veins). The shelf life of such findings is 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. Percutaneous nephrolithotripsy is performed under general anesthesia and consists of two stages.
- Formation of access to kidney stones. Access is a significant step in the procedure that affects the end result and a successful outcome of the operation. Proper access makes it possible to remove the largest amount of coral stones. The calculus of any size, located in the pelvis, is removed completely without auxiliary interventions. A 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 for the expansion of 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, ultrasound bougie or laser fiber, forceps) are inserted through it, with the help of which crushing and evacuation of calculus fragments from the pyelocaliceal system of the kidney is performed. After which the kidney is carefully examined. After making sure that the stone is completely extracted, a nephrostomy drainage or ureteric stand is inserted into the passage. The tubes are removed 3-4 days after surgery.
Complications
Percutaneous nephrolithotripsy is considered a gentle and relatively safe method of treating urolithiasis. But since the procedure is invasive, there is always a risk of complications.
- Bleeding. The kidney consists of nephrons, representing the structural and functional unit of the organ. Nephron is a glomerulus of blood capillaries. Inaccurate manipulation of the instrument develops bleeding.
- Injury to nearby organs. The likelihood of a breach of integrity is very low, but still exists.
- Ultrasonic lithotripter burn.
- Rupture of a kidney cup under the influence of a shock wave of an electro-hydraulic lithotripter.
- Perforation of hollow urine excretory structures.
A frequent complication of percutaneous nephrolithotripsy with lithoextraction is the rupture of the pelvis wall when the stone is “pushed” into the renal parenchyma. As well as the loss of calculus in the muscles when it is removed.
Effects
Often after surgery, pyelonephritis develops. This is due to infection during the procedure or in the early rehabilitation period. The untreated infectious and inflammatory pathologies contribute to the formation of the disease.
Percutaneous nephrolithotripsy is a treatment method. No one can guarantee that the stones will not appear in the kidneys again. To reduce or even exclude such a probability is possible only if you follow a diet, daily routine, factors that contribute to the formation of urolithiasis must be avoided. It is also worth considering that if fragments of calculi were not completely removed, then subsequently relapse is guaranteed.
Forecast
According to statistics, a 95% prognosis for recovery is favorable. Patients no longer experience the inconvenience of having kidney stones. But do not forget that the effectiveness of therapy depends on compliance with all medical recommendations.
Removal of kidney stones does not imply organ removal; therefore, a person is not disabled. The question naturally arises of 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 his usual life and work in a week.
Rehabilitation
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, do dressings. Every day the patient gives urine and blood for analysis to track the dynamics of the healing process.
Many are interested in: with percutaneous nephrolithotripsy, how much do sick leave give? The length of hospital stay is a week, provided that no complications arose. A sick leave certificate can be obtained on the day of discharge indicating the number of days spent in the hospital.
Reviews of patients and doctors
Urolithiasis and its treatment has been studied for a long time. Crushing stones is considered the most effective method of therapy. Medical reviews about percutaneous nephrolithotripsy are only positive. Urologists note that the use of modern equipment increases the efficiency 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 of the kidney, especially in case of coral stone formation.
Most patients who have had surgery respond positively to it. Women consider the absence of an ugly scar and a short rehabilitation period to be their main advantage.