According to statistics, one in ten people sooner or later faces kidney problems. Urolithiasis (ICD), 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 in women, for the most part, severe forms of the disease develop. Nephrolithiasis is the formation of calculi in the kidneys themselves . Renal calculi are nothing but the deposition of various salts.
Causes of Stone Formation
The main predisposing factors to their appearance:
- poor nutrition;
- abuse of certain products;
- hardness of drinking water;
- a - and hypervitaminosis D;
- impaired metabolism;
- hot climate;
- lack of drinking regimen;
- heredity;
- infections of the kidneys and ureters;
- physical inactivity;
- taking certain medications (glucocorticoids, tetracyclines);
- condition after chemotherapy.
Stone formation mechanism
On average, the formation of any stones originates from the concentration of urine and changes in its chemical composition (its supersaturation with salts). Salts are surrounded by pathogenic cells, and they are coated. They are formed from a mixture of minerals and organic substances. First, sand appears, which, as the pathology progresses, is converted to stones. With proper treatment, such a transformation can be avoided.
Stone classification
Stones differ not only in size, but also in composition. They come in 4 types:
- oxalate;
- phosphate (70% of stones);
- urate (10%);
- struvite (20%).
A clean look is rare, most often mixed stones.
Why are doctors trying to determine the type of stone? The tactics and choice of treatment depend on this. By the location of the stones are single and bilateral. In shape: flat and round, with spikes, coral-shaped 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 are formed in different ways for everyone: sometimes for a month, for 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 urgent surgery. Among the symptoms are:
- sharp pains in the stomach, side and back above the belt;
- urine with blood (hematuria);
- vomiting and nausea;
- rapid and painful diuresis;
- temperature;
- urine contains protein and salts.
Treatment measures
Any stone treatment goes through 3 stages:
- Removing stones in an optimal way.
- The rehabilitation period after that.
- Relapse prevention
Each stage requires separate lighting.
Drug method
Treatment begins with medication, as the safest. The medicinal method is the removal of kidney stones without surgery. In this case, reinforced diuresis is used - drugs increase the amount of urine excreted with the simultaneous consumption of a large amount of fluid. This method is justified only when the size of the stones is less than 4 mm, then their passage through the urethra is free.
Perhaps the dissolution of stones due to herbal infusions. It is justified with organic stones and urate. 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 full guarantee of their 100% dissolution.
If the drugs were ineffective, the stones are large or there are a lot of them, complications develop, an operation is performed to remove the stone from the kidney. Many urologists speak out in favor of radical treatment, since this solves the problem completely.
Indications for kidney surgery
An operation is shown if:
- outflow of urine is not possible due to obstruction;
- attacks of renal colic became more frequent;
- severe pain is constant;
- frequent pyelonephritis;
- OZM - acute urinary retention - emergency;
- damage to the vessel in the kidney and subsequent bleeding;
- ureter obstruction;
- renal failure;
- kidney carbuncle - purulent necrosis of the tissue where the stone was located;
- purulent inflammation of the kidney;
- the patient’s desire to be operated on.
Methods of surgical intervention:
- Unilateral urolithiasis. In this case, the functions of the urinary system are preserved.
- Bilateral urolytiasis - performed simultaneously or in 2 stages with a break of 1-3 months.
Types of operation
In different cases, operations will vary.
Removal of kidney stones is carried out in 3 ways:
- open (abdominal surgery);
- laparoscopy;
- lithotripsy.
Open way
Open abdominal surgery to remove kidney stone involves grabbing large areas of tissue to access the kidney. Therefore, the subsequent healing process becomes long.
Indications for intervention:
- persistent relapses;
- large stones that cannot be removed by other means;
- purulent inflammation.
The name of the operation to remove kidney stones is pyelolithotomy. Intervention is performed under general anesthesia. A 10 cm incision is made on the patient’s side from the affected side, tissues are cut in layers. The kidney is cut, the stone is removed from the pelvis. The wound is sutured, the stitches are removed in a week. The consequences of abdominal surgery are adhesions and aching pain due to them. There may be swelling at the incision site, which also delays healing.
If the stone is in the ureter, abdominal surgery to remove the stone from the kidney is called ureteroscopy. The situation is the same. The incision is made over the area where the stone is stuck. The ureter is exposed, examined and the stuck stone is removed. Today, abdominal stone kidney removal surgery is extremely rare. They are applicable when other methods have failed. Most operations today are minimally invasive.
What is the name of the operation to remove kidney stones with partial removal of the kidney? This is a resection and it is a kind of open. This operation allows the kidney to be stored, which is always important with a single working kidney.
Indications for resection:
- monopolar multiple (multicavity) stones;
- frequent relapses;
- tissue necrosis;
- the last stage of urolithiasis.
Operation progress
The operation is performed under general anesthesia. The patient is laid healthy sideways on a roller. Tissues are dissected and spread in layers. The affected area is excised. The edges are stitched. A drainage tube is inserted, which is left for 7-10 days after surgery. If it remains dry and clean, then it is removed.
Laparoscopy
Several small incisions are made with a size of less than 12 mm in the abdominal cavity. Through them, a camera for viewing and a light source - a laparoscope is inserted. The image is fed to the monitor in the operating room.
Contraindications for laparoscopy:
- dense adhesions;
- complexity of anatomical access;
- stomach ulcer and duodenum;
- decompensation of the cardiovascular system;
- increased bleeding with a decrease in coagulability;
- acute inflammatory pathologies in the body;
- stones more than 2 cm;
- 2 half of pregnancy;
- obesity.
Laparoscopic stone removal is often replaced with endoscopic surgery.
Endoscopic surgery
Depending on the localization of the stone, the endoscope can be inserted into the urethra (urethra), the bladder, ureter, or directly into the kidney, i.e. through a natural opening. The lower the stone, the easier it is to remove it. General anesthesia is given or anesthesia is carried out intravenously with stones less than 2 cm.
Indications for endoscopic surgery to remove kidney stones:
- no result from lithotripsy;
- damage to kidney tissue after crushed stone.
The urethroscope has a tube with a mirror so that the surgeon can see and control the process of removed stones.
Punctures during minimally invasive surgery are minimal, and the load on the surrounding tissue is also small. The patient can move independently on 2-3 days after the operation and conducts hygiene procedures himself. There are practically no complications after laparoscopy .
Lithotripsy
Another type of laparoscopic surgery is lithotripsy. When it is used, special nozzles for ultrasound are used to crush stones. The bottom line is that ultrasound passes freely through the soft tissues without damaging them. When a wave meets a stone, it crumbles and crushes it.
Types of lithotripsy
There are 4 types of lithotripsy:
- If a stone is crushed by ultrasound using an endoscope, it is percutaneous or percutaneous nephrolithotomy (CNL).
- Laser lithotripsy is the most effective, with it the stone literally dissolves.
- Pneumatic method - a stone came out of the kidney, but can’t move on. Then a probe is inserted into the ureter and a series of shock air waves (UVL) is exposed through it. The stone collapses after a few seconds. Shards are removed with special tongs or loops. With a high density of stone, this method does not work.
- If UVL is used not through the probe, but through the skin, this is remote lithotripsy. There are no cuts and punctures here. Fragments are excreted in the urine. Many patients complain of pain during this manipulation. Visual inspection is always performed using ultrasound or X-rays. Ultrasound breaks the stone into sand, which is then cleaned with special aspirating tools. Immediately after the operation, the patient is placed in the intensive care unit for a day, then goes to the general ward. The drainage tubes in the wound are removed for 2 days.
Contraindications to lithotripsy:
- stones larger than 2 cm in diameter;
- in advanced cases, lithotripsy is not done;
- 3 trimester of pregnancy;
- spinal injuries that will not allow the patient to take the correct position during surgery;
- obesity - weight more than 130 kg;
- tall or too short growth - more than 2 m or less than 1;
- decreased blood coagulation.
The progress of lithotripsy surgery
Previously, general anesthesia was used for her. Today limited to epidural anesthesia through the lumbar spinal cord. The action begins in 10 minutes and lasts about an hour. Depending on the location of the stone, the patient lies on his back or abdomen. In the supine position, the legs are lifted and secured. After anesthesia, a catheter with a contrast agent is inserted into the ureter. No pain. If the stone is more than 1 cm, pierce the renal pelvis and expand the channel to the desired diameter to insert a tube with a tool for removing fragments.
When a catheter is inserted, saline is injected into it. It facilitates the movement of the ultrasonic wave. From ultrasound, the patient feels soft, painless tremors.
After 2 days, the doctor conducts 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 safe method. He even turns large stones into dust quickly. The procedure is absolutely painless. Laser surgery to remove kidney stones is an alternative to abdominal surgery. The only negative is the high cost. But then for the destruction of stones of any size, only 1 session is enough.
Possible complications
After kidney surgery to remove stones, there is always a different chance of complications:
- Relapses - they are possible because the stone is removed, and 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 stones not completely removed. 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 stone and accumulation of infiltrate in this place.
- Bleeding - more often with abdominal surgery.
- Exacerbation of renal failure. To prevent this, the patient before and after the operation is connected to an artificial kidney.
- Arrhythmias and hypertension.
- The possibility of a fragile suture when it is torn and urine begins to leak.
- Narrowing the lumen of the ureter.
- Urinoma is a urinary pseudocyst.
- Anuria - lack of urination.
- Complications of the operation to remove stone from the kidney also occur more often after ultrasonic destruction of the stones due to an incorrect assessment of the patient's condition.
Rehabilitation period
After kidney surgery to remove stones, you must avoid physical exertion, do not lift weights. Anti-inflammatory, antibacterial drugs should be taken until the tissues heal completely. It is necessary to observe the drinking regime and diet.
The operation of removing a kidney stone and a diet in compliance with the water regime are very closely interconnected, since urolithiasis tends to recur with improper nutrition. A month later, a follow-up inspection is required.
Relapse prevention
The fact of removing stones is not a guarantee of complete cure. Therefore, relapse prevention is so important. The disease does not go away, only the level of treatment changes - diet and healthy lifestyle. If you do not perform prophylaxis, stones will certainly appear again - it is proved by practice.
Recommendations after discharge
The main recommendation after surgery to remove a stone from the kidney is the introduction of an enhanced drinking regime. Water is the best purifier, it washes and rinses all the urinary tract from traffic jams. 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.
A diet after kidney surgery to remove stones is developed by a doctor individually for each patient, taking into account the chemical composition of the stones. For example, with oxalate calculi, it is necessary to exclude foods with a high content of oxalic acid from the diet - offal, sorrel, spinach, spicy cheese, broths, aspic, rhubarb, tomatoes, celery, etc.