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, calculi 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 calculi are deposits of salts that can form as a result of malnutrition, metabolic problems, very hot climatic conditions, hypervitaminosis D and vitamin deficiency. Drugs that are part of the tetracycline or glucocorticoid group can become provocateurs of the development of pathology.
Kidney stones can cause pain, cause problems with urination and inflammation. To prevent complications caused by this pathology, it is required to begin treatment of the disease. Given the symptoms of kidney stones, treatment with surgery, according to urologists, is most effective.
Causes of urolithiasis
Do kidney stones do surgery? Before contacting a doctor who can prescribe an operation, first of all, you should deal with the causes of the formation of calculi.
The most common causes of urolithiasis include the following:
- Genetic predisposition. It is known that quite a few pathologies are transmitted from parents to children, this also includes urolithiasis. The main place in this case is the predisposition to hypercalcemia - an exceeded percentage of calcium in the blood. Not the least role is played by congenital problems with metabolic processes.
- Kidney disease. Any condition that negatively affects the ability of the kidneys to filter can provoke the occurrence of calculi in them, in particular, inflammatory diseases (pyelonephritis) and pathologies of a congenital nature (renal deformation).
- Diseases of other organs. The metabolism of the above substances may be impaired in certain diseases, such as gout, inflammatory bowel disease.
- The quality of food. Nutrition problems play an important role in the formation of urolithiasis. Eating highly salted and acidic foods can cause kidney problems.
- Dehydration. An insufficient amount of water in the body provides an environment that is not able to remove harmful compounds.
- Climatic conditions. Hot climatic conditions that provoke a decrease in fluid concentration in the body, have a negative effect on the kidneys, often painful sensations arise.
- Lack of exercise. Due to inactivity, metabolic degradation occurs throughout the body.
With such pathologies without surgery, kidney stones are almost impossible to remove.
Indications for the operation
An operation to remove kidney stones is performed if there are a number of indications:
- Uterine obstruction. This pathology needs immediate treatment, so the use of conservative methods of therapy is not effective.
- The development of renal failure or the finding of this pathology in the acute stage. If you ignore the symptoms inherent in this disease, there is a high probability of developing complications, up to a fatal outcome.
- The presence of painful sensations that cannot be eliminated with the help of medications.
- Purulent inflammation.
- Presence of carbuncle kidney. With this term, the area of purulent necrosis that is formed as a result of exposure to stones is deciphered.
- The desire of the patient to perform surgery.
Varieties of operations
Before getting an answer to the question of how kidney stones are removed by surgery, it is necessary to clarify that there are several types of surgical intervention:
- Lithotripsy. The stones are crushed due to the influence of ultrasound through the skin, after which the calculus is removed using the ureter or catheter.
- Endoscopic surgery. They are performed using a device such as an endoscope, its introduction is performed through the urethra, or ureter, and is brought to the localization site of the calculus. The stone is removed through the ureter.
- Open surgery. The kidney is cut and a stone is removed surgically.
- Resection. The operation is somewhat reminiscent of open surgery, but a partial organ removal is expected.
Carrying out lithotripsy: the essence of the operation
If kidney stones have been detected, a laser operation (using a laser to drive an ultrasonic shock wave generator) will help get rid of calculi in a short time. Lithotripsy is widespread in medicine since the 90s of the last century and to this day has not lost its effectiveness. When removing kidney stones, an operation of this type significantly reduces the morbidity and likelihood of infection, since exposure is performed through the skin without making incisions.
The essence of the technique is the effect of ultrasound on a variety of body environments. It calmly spreads in the soft tissues without causing any harm. When there is a collision of ultrasound and dense deposits of salts, microcracks and cavities form in them, which provokes the destruction of the stone.
Indications and contraindications for lithotripsy
When carrying out this operation to remove kidney stones, there is the opportunity to get rid of only stones with sizes up to 2 centimeters, and determining the localization does not cause difficulties. If urolithiasis has reached the fifth stage, then this method of treatment is not only useless, but even dangerous.
This operation to crush kidney stones is not recommended in such situations:
- the period of gestation;
- trauma to the musculoskeletal system, which does not make it possible to occupy the position on the couch, required for surgery;
- the patient’s body weight is more than 130 kilograms, height above 2 meters or below 1 meter
- clotting problems.
Lithotripsy technology
How to get rid of kidney stones? Before this, you should familiarize yourself with the technology of lithotripsy. At the first operations, general anesthesia was used, but today, an 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 in the presence of prohibitions to perform an epidural type of anesthesia, the administration of analgesics is carried out through a vein.
Surgery is performed in a supine or abdominal position, everything directly depends on the location of the calculus. In the first case, the patient's legs rise and fasten. After the discovery of kidney stones, the 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 in it to extract sediment particles. Small calculi are excreted together with urine.
A saline solution is poured into a 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 located in the area of the exact projection of the calculus. During its action, the patient feels soft painful tremors. Sometimes, in order to destroy a stone, it is necessary to perform several approaches. Occasionally, during the procedure, the patient may feel pain, in this case, do not worry, most importantly, inform the attending physician about the sensations.
After surgery, kidney stones will not worry the patient for a long time. Moreover, if lithotripsy was not invasive, after the anesthesia ceases to act, the patient is placed in a ward. Here he needs to go to the toilet in a jar to monitor the process of exit of calculi from the body. Blood may be present in urine, which is quite acceptable, since it is formed due to sand trauma to the ureteric epithelium. Residues of salt can be separated within a couple of days after surgery.
Endoscopic surgery
If a kidney stone is found, an operation is performed only after obtaining the consent of the patient, while in case of impossibility of lithotripsy, doctors recommend exactly endoscopic intervention.
Given 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 stones with a diameter of up to 2 centimeters.
With kidney stones, an operation of this type is performed if there are such contraindications:
- low efficiency from lithotripsy;
- localization of calculus in the area of the ureter;
- the formation of residual formations after the influence of ultrasound.
This surgical intervention, despite the external simplicity, requires a high level of professionalism and high-quality modern devices from the doctor. An urethroscope is installed in the patient's urinary tract. This device includes a tube and a mirror, allowing the doctor to identify stones. After the tube reaches the stones, they are removed.
The most modern type of endoscopic surgery is the removal of calculi from the kidneys using a laser. The beam moves along a special fiber introduced into the urethroscope.
In some situations, a stent may be required - this is a catheter that prevents the ureter from being compressed. It is set for a period of a couple of weeks. The removal of stones is performed using an endoscope and without a single incision.
Open surgery
If stones are found in the kidney, abdominal surgery has recently been performed less and less. But there are a number of indications when such an operation is simply indispensable:
- regular relapses;
- stones are large and cannot be removed using another method;
- inflammatory processes of a purulent type.
An open operation is performed under general anesthesia. During surgery, the body cavity is involved, excision is performed through all tissue layers. The presence of calculus in the renal pelvis is recognized as a positive moment, this helps to reduce the invasiveness of surgical intervention. In addition, you can open the ureter and remove the calculus from there.
Among the modern methods of conducting such an surgical intervention is laparoscopy. In this case, the calculus is removed through a small incision. A camera is introduced into it to transfer a picture to a large screen. Removal of calculi using laparoscopy is performed only if there are special indications.
Kidney Removal
If kidney stones are found, an operation of this type is performed only with very large calculi. This surgical intervention makes it possible to preserve the internal organ, which is especially important in the presence of only one functioning kidney.
Resection is performed in such situations:
- numerous calculi localized at one pole of the organ;
- regular relapse of the disease;
- lesions of the necrotic type;
- the last stages of urolithiasis.
At the same time, if the patient is in serious condition and doctors suggest that surgery may aggravate it, they refuse the operation.
Resection is performed under general anesthesia. The patient is placed on a healthy side, under which a roller is placed. The surgeon performs 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 it is there that the maximum concentration of blood vessels is located.
Next, the affected area is excised. The edges are stapled. A drainage tube is removed from the kidney, and the wound is sutured. The drainage pipe 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 kidney stones could not be removed without surgery, the doctor prescribes surgery. Unfortunately, surgery can cause a number of complications:
- Relapse. Urolithiasis is often distinguished by the repeated occurrence of calculi in the kidneys. Surgery 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 urolithiasis and take measures aimed at eliminating it.
- False relapses. So they call the remaining not deleted fragments of calculi. A similar outcome of surgical intervention is quite rare due to the improvement of surgical procedures and constant monitoring of the patient after the procedure.
- Infection Even in the case of a minimally invasive surgical intervention such as endoscopic, there is a possibility of the penetration of infectious agents into the internal organs. To prevent infection, a course of antibacterial drugs is prescribed, even if the patient is feeling well.
- The acute form of pyelonephritis is an inflammatory process in the renal pelvis. Pathology develops as a result of the displacement of calculi, the long-term presence of their fragments in the kidneys and the accumulation of fluid near them.
- Bleeding. Most often develops when conducting an open type of surgical intervention. To prevent the development of such a complication, the kidney is irrigated with a solution with antibacterial agents.
- Exacerbation and progression of renal failure. To prevent such a complication, hemodialysis (connecting an artificial kidney to the device) is used before and after surgery.
- Heart rhythm problems, increased blood pressure. Such a complication most often develops as a result of the 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. Every day, the patient undergoes dressings, while treating the wound. In the first few days after surgery, a slight increase in temperature may be observed.
To assess the quality of kidney function, the nurse should help the patient calculate the amount of fluid drunk and excreted from the body. In the postoperative period, antibacterial, anti-inflammatory and analgesic medications are necessarily taken.
During this period, the doctor must fully monitor the patient's condition, the time of discharge and removal of sutures is determined individually.
Surgery is an effective way to get rid of kidney stones.