Kidney stones - a solid particle in the kidneys, bladder
Urinary bladder - structure and function
or the ureter. They may differ in chemical composition. They can be formed from the calcium salts of oxalic acid (oxalates), uric acid (urate), cysteine (cystine stones). Occasionally mixed stones are formed, for example, magnesium phosphate, ammonium, and calcium.
Kidney stones - is an ancient disease of mankind, which is still one of the most common reasons for visits to doctors. Approximately one out of eight representatives of the white European race is suffering from kidney stones.
After the first attack of kidney stones for the next ten years, about 50% of patients undergoing repeated attacks. The risk of developing this disease in men and patients in the family history of kidney stones, three times higher than the rest of the population. The difference between the sexes is related to differences in diet, lifestyle and sexual characteristic features. It is proved that men with urine produces more salts of oxalic acid, and women - more citrate. This explains some of the differences in the formation of kidney stones. Those most at risk of developing kidney stones susceptible people in the developed Western states, many of which in the diet of animal protein.
Symptoms
Symptoms include hematuria urolithiasis (blood in the urine), obstruction of urinary tract infections, urinary tract. It may be a weak flank pain or severe paroxysmal pain, which does not help alleviate common pain relievers. Sometimes there are no symptoms at all.
The manifestations of kidney stones can cause urgent urination, frequent urination, hematuria and / or a disorder of the gastrointestinal tract. When a patient consumes enough fluids, dehydration occurs, the urine becomes saturated, and the rate of formation of kidney stones
Kidney stones: identify and treat
increases.
Treatment
With the development of remote shock wave lithotripsy, as well as with the emergence of small caliber endoscopes and safest ways to percutaneous access to the upper urinary tract, the opportunity to fully examine the urinary tract and get them the full image. In addition, this technology is minimally invasive. Methods of treatment of urolithiasis are constantly improving, as many patients with severe disease can only help better technology. Disease severity depends on the kind and size of the stones, their location as well as the patient's anatomy.
Remote shock-wave lithotripsy
Remote shock-wave lithotripsy - a minimally invasive method of treatment, developed in 1980, after years of research conducted by the company Dornier, Inc. and the University of Munich. This technology is the use of shock waves generated outside the patient's body apparatus called lithotripter. Using ultrasound or fluoroscopy guidance of the shock wave is produced which destroys the stones in the urinary tract. Fragmentation occurs due to the tensile force, which removes material from the surface of the stone, and further grinding stone used with the multiple shock waves. The number of waves necessary for quality grinding stone depends on its chemical composition and size, as well as the focus of the shock wave, the energy density and the interaction with the liquid medium. Easily broken stones formed of calcium oxalate dihydrate, uric acid
Uric acid - a normal level?
And mixed stones. It is difficult to grind the stones of calcium oxalate monohydrate, cystine and calcium phosphate. Also, the use of shock-wave lithotripsy depends on the size, location and anatomical structure of stones. The method is less effective in the case where it is necessary to split large rocks, and also applied to a patient with overweight, since these factors make it difficult to focus on the central point of the stone. After careful grinding stone, the remaining small fragments themselves out through the urinary tract.
Urethroscopy
The method is used with rigid ureteroscopy 1980s and initially was considered a method of getting rid of stones in the distal ureter
. With the advent of semi-rigid ureteroscopy smaller, flexible ureterorenoscopy then became possible to carry out a standard endoscopic examination of the entire system mochesobiratelnoy
. Rigid and flexible urethroscopes used for the diagnosis and treatment of urolithiasis, for the study of macroscopic hematuria and positive urine cytology, fulguration epithelial tumors and remove the obstruction and blockage of the ureter, pelvic joints, as well as for cleaning of clogged kidney cups
. Indications for the use of ureteroscopy method - is inefficient remote shock wave lithotripsy, the stones in the lower pole renal cup, obesity
. Small stones in the lower ureter (less than 7 mm in diameter) can be removed with forceps like "basket" or tweezers through hard cystoscopy, which is connected to a working or protective conductor
. The stones of larger size, located in the ureter and kidney inside can be removed using intracorporeal electrohydraulic lithotripsy or holmium laser lithotripsy
. In this case the first stone is crushed and then discharged or removed
.
Percutaneous nephrolithotomy
Endoscopic intracorporeal or removal of stones through the catheter into the collecting system of the kidney through the skin is called percutaneous nephrolithotomy
. This technology was invented in 1975, and Johansson Fernstrom
. It can be used to remove most of the stones are in the kidney and the upper ureter (e.g., stones in the lower renal pole cups in cup diverticulum renal and staghorn calculus)
. But this method is commonly used to remove large stones more than two centimeters in diameter, from which it is difficult to get rid of with the help of remote shock wave lithotripsy or ureteroscopy
. In addition, it may be a palliative intervention after a failed remote shock wave lithotripsy or ureteroscopy
. Percutaneous nephrolithotomy procedure is performed under general anesthesia
. The patient is in the prone position, reclining or side
. After the skin surface is introduced nephroscope and extend this hole using a graduated plastic or balloon dilator
. Through the resulting hole is placed an empty plastic conduit for input rigid or flexible nephroscope
. Small stones of less than one centimeter can be removed manually through a wire with a clamp
. To remove larger stones held intracorporeal lithotripsy using ultrasonic, electrohydraulic or laser lithotripsy
.
Open lithotomy
In the 21st century, only 1-5% of all stones need to be removed by open surgery
. In most cases, instead of open surgery is performed Remote shock-wave lithotripsy, percutaneous nephrolithotomy and ureteroscopy
. These methods do not cause such serious postoperative complications, as an open lithotomy, contribute to more rapid recovery of strength, thereby reducing the period of hospitalization and improve the performance of the treatment
. In the past, indication for open lithotomy were obese, but the advent of longer nephroscope percutaneous procedures has become possible even for people with any weight
. Most often open lithotomy make those patients for whom the distance shock-wave lithotripsy and percutaneous nephrolithotomy been ineffective, and patients having various anatomical abnormalities
. Removing branched or large stones may require open surgery
. In some cases, the stones which can be removed by carrying out multiple remote shock wave lithotripsy or percutaneous nephrolithotomy, better recovered by open surgery
. Finally, open lithotomy may be imposed in cases where a patient requires full or partial nephrectomy to remove a non-functioning kidney repair in violation of patency or narrowing UPJ or other urological surgery is not nature
.
First-line therapy for the treatment of urolithiasis includes a minimally invasive surgical procedures to remove stones, which causes obstruction of the urinary tract symptoms, and which themselves can not come out within the allowable time period. The treatment method depends on the intended type, size and location of the stones, and the anatomy of the kidneys and renal function. Minimally invasive procedures, which include methods of remote shock wave lithotripsy, percutaneous nephrolithotomy and ureteroscopy, have fewer complications, require long-term hospitalization, and lower cost. Open lithotomy is rare, but in some cases it is indicated in patients. The less invasive method that is used in the treatment of kidney stones, the more successful passes recovery and return the patient to a normal life.
