The procedure for crushing stones in the kidneys over time. Features of ultrasound crushing kidney stones. Video about the symptoms of stones in the kidneys, tells the urologist

Preparation for the procedure

• general blood and urine tests;
• fluorography;
• analysis on blood sugar;
• blood chemistry;
• Ultrasound of urinary tract and kidneys, men - ultrasound of the prostate gland;
• review and excretory urography.

Survey data makes it possible to eliminate inflammatory processes in the body, assess the permeability and functions of the urinary system. To improve regeneration after lithotripsy, patients are prescribed by vitaminotherapy and means that improve blood circulation. Immediately before the procedure, it is recommended to receive laxative or enema to free the intestines.

Therapy after lithotripsy

After the operation, the kidney needs to be able to free themselves from stones fragments, otherwise they can migrate into a hard-to-reach place, stick up or increase.

To bring fragments to the patient, you need to take the following drugs:

• Spasmolytics. DROTAVERINA preparations and other antispasmodic remedies reduce the risk of renal colic.
• Wide spectrum antibiotics. After lithotripsy, the kidney can attack bacteria that are in the urinary tract. For the prevention of bacterial infections, it is recommended to take preparations from a row of cephalosporins and fluorochinols.
• Anti-inflammatory nasteroid funds. Preparations reduce pain in the dishevement of small fragments of stones, and in the event of damage to the urinary tract, the inflammatory process prevents the inflammatory process and prevents the obstruction of the urinary tract.

In addition, to accelerate the withdrawal of fragments of stones with patients, it is shown to drink as much liquid and beams of diuretic herbs - birch leaves, a hunter, a chest. Food in the first day after lithotripsy includes light meat broths, sweets, diluted juices (dishes with dense consistency, as well as solid milk and eggs). Subsequently, the diet can be introduced boiled, steam and wipe food, preferably without salt and spices.

The lithotripsy of kidney stones is a procedure at which the impact is carried out with the help of electromagnetic or ultrasonic waves. Crushing of kidney stones is carried out by contact or contactless method, depending on the testimony and condition of the patient. Lithotripsy: What it is, how it is carried out, and also what to do after the operation - read further.

Types and features of lithotripsy

What is lithotripsy? This is a way to crush a stone in the kidney or urinary tract so that they can be derived to the natural way (with urine) or with a minimally invasive intervention.

The contactless remote lithotripsy of kidney stones involves the non-invasive method of impact on the human body. In the process, the device is located above the concrete agent (stone). Crushing is carried out using shock waves, after which the particles of the stone are outlined with the urine naturally for a certain time after the procedure.

Contact crushing of kidney stones refers to minimally invasive types of procedures. Entering an endoscope is carried out through urethra on the ureter and bladder. There, with the help of a camcorder at the end of the tube, the doctor sees a stone and begins to have an effect with a laser or ultrasound.

Expressive lithotriphesia kidneys is rare. It belongs to a minimally invasive interventions under which the minimum incision is carried out. Endoscope is introduced on it, which is consequeled and all manipulations are carried out. After the fragmentation of the slices of stone, the doctor is covered through an incision, after which the seam is superimposed.

Any of the proposed procedures is carried out by high-tech equipment, thanks to which the risk of complications is minimal. But at the same time there is still there. Probably the emergence:

• Hematomas in the field of kidney location;
• "Tracks" created from the fragments of the concrections - it is able to cause a new blockage of the ureter or kidney colic;
• The aggravation of kidney inflammation, if there is a patient in a chronic form (pyelonephritis, glomerulonephritis).

The risk of developing such complications is minimal, especially if the process of preparation for the procedure, diagnostics for contraindications and rehabilitation period is correct.

Contact laser and ultrasound lithotripsy

This intervention is carried out under anesthesia, the type of which is determined individually. Can apply spinal anesthesia, intravenous or endotracheal anesthesia. For half an hour before the start of the procedure or during parliamentally (using injections), wide spectrum antibiotics are introduced.

The endoscope is introduced through physiological pathways, that is, urethra, bladder and ureter. This avoids operational intervention in the process of conducting the procedure and reduce the risks of the development of complications that often occur after the operational ways to remove stones.

Under the influence of a laser or ultrasound, stones are crushed into the kidneys or urinary tract to the state of small particles. Harm to live cells Contact lithotripsy does not affect. Next, they are removed aspiration. Such cysticotripsy is not suitable for dense stones of the ureter.

In the process of the procedure, one of the energies that contribute to the crushing of the concrete is used: pneumatic, ultrasound, laser lithotripsy. Ultrasonic I. laser treatments Enjoy greater popularity due to the fact that they cause minimal side effects.

Remote crushing of stones

Remote lithotripsy to remove stones in a ureter and kidney is carried out after special preparation and additional inspection by the therapist. Before the patient's procedure, sedative and painkillers are introduced. The patient takes off his clothes and falls on the operating table. Using ultrasound, the doctor is determined by the location of the stone. The projection of the neoplasm is supplied with water pillow and a device that will produce a certain frequency waves.

In the process of crushing stones in the kidneys, remote lithotripsy implies the presence of certain minor sensation sensations, pinching, tapping or insignificant pain. When crushing from stone, the smallest particles are chipped. When it is fragmented to such a state, which can pass through the ureter, the procedure ends.

When remote shock-wave lithotripsy was performed, the patient gives drugs aimed at eliminating the kidney stones, as well as anesthetics-antispasmodics, diuretic, antibacterial agents. It helps not only withdraw a crushed concretion from the organ, but also prevent infection and inflammation of physiological paths. Further, the patient's condition is monitored over a few hours after ultrasonic lithotripsy was carried out. If there are no complications and side effects, send home for rehabilitation.

What happens after the procedure

Whether it is remote or laser lithotripsy, the sensations after the procedure can persist for some time. These are symptoms of the subsequent effect of manipulations, associated both directly with the intervention itself and the process of removing stones under the influence of medicines:

• Urination is expensive and passes with some soreness and thumbs;
• A few days after the procedure in the urine there may be blood in small quantities;
• Together with the urine, stones are displayed that can be visually distinguished;
• The symptoms of renal colic is manifested, but it quickly stopped with antispasmodics;
• The temperature is slightly rising to 37-37.5 degrees.

This is a typical symptoms manifested after the procedure of any of the above types and methods. Before discharge from the hospital, doctors warn about such manifestations, and also talk about how to behave during the period of rehabilitation.

Do I need a hospital?

Many are asked whether it is necessary to observe stationary for some period after the procedure. As mentioned earlier, non-invasive methods suggest observation of doctors in the hospital within a few hours. If the crushing of stones in the kidneys with a laser (contact lithotripsy) passed without complications, then the patient is derived from anesthesia and are observing how he feels, there are no bleeding or other side effects that can significantly affect human health. Maximum after a day, such patients are released home.

Contact lithotripsy (crushing stones in the kidneys ultrasound) is carried out without anesthesia. Therefore, the hospital observation lasts a maximum of 4 hours. If there are no complications or other prescriptions, then the patient is released home. In general, it all depends on the size of the fragmented stone, its position in the urinary system.

In the process of staying in the hospital, the patient gives antibacterial drugs, diuretic and painkillers. This will speed up the process of eliminating the kidney rate. Doctors prescribe a further course of treatment and recovery, as well as advice, which the patient is obliged to visit.

Postoperative rehabilitation

Postoperative rehabilitation will not take a long time if the contact or ultrasonic crushing of the kidney stones was carried out. The patient is appointed by the course of spasmolitics and analgesics. Antibiotics are prescribed to greater prevention. In this case, preferences are given to the preparations of a wide spectrum. Also recommended:

• Consume a certain amount of water - 1.5 liters;
• Drink teas that contribute to strengthening urination, for example, decoction of rosehip, birch kidneys, a field of field, lingonberry. In general, there are a lot of diuretic herbal fees sold in pharmacies;
• Choose a type of diet to prevent the formation of new stones.

Features of rehabilitation after the procedure relate to a greater extent nutrition, drinking and leisure with loads. The patient should consume half a liter of water at least every day. This will facilitate the removal of kidney stones. The diet is chosen as a whole that which allows preventing the formation of new stones and facilitate the state of a person in the recovery process, when only a contact or remote crushing of kidney stones was performed. The type of diet depends on the composition of the stone, that is, the category of products that contributed to its formation is sharply limited.

The patient must strictly observe the day of the day, refuse harmful habitswhich greatly load the body. At the same time you need to adjust the level of loads to the level of the norm. It is also assumed to carry out gymnastics to strengthen the body, such as a qigong health system, which does not provide sharp movements that are contraindicated at the first time.

To speak short, then after surgery it is necessary to achieve certain purposes: overcome the consequences after intervention - prevention of inflammation, bleeding, control over regeneration processes; from the body as quickly as possible fragments of stones; Restore normal lifestyle, including load, food, rest elimination of bad habits. Only when performing these conditions, the ultrasonic or laser crushing of stones in the kidneys will benefit for a long time.

Today, they are responsible for the head of the regional urological department of the GKB of the city of Zhukovsky, Moscow Region, Candidate of Medical Sciences Andrei Rumyantsev.

Tell me, and the composition of the kidney stones is important? I heard that when crushing, carbonate stones crumble better?

Catherine, Pskov

When choosing a method of surgical treatment of urolithiasis, the magnitude of the stone, its position in the urinary ways, as well as the visibility of the stone with X-ray study - x-ray is x-ray or x-ray, that is, it is visible on an x-ray or not. The mineral composition of the stone in clinical practice matters only when choosing a prophylactic diet that excludes some products, or special drugs that contribute to the dissolution of stones that are not visible during an X-ray study.

To be continued?

Recently got rid of stone in the kidney. But they say, this is not a panacea and stones can appear again. Is that really true?

Alexey, Kaliningrad

Unfortunately, often gives relapses. Therefore, after surgery, try to stick to the diet, limiting meat and fish dishes in the diet, which contain many purines that contribute to the synthesis of uric acid in the body and, as a result, stone formation.

More drink - no less than 1-1.5 liters per day to dilute urine: in its saturated solution, the crystals of uric acid and salts of other elements are formed faster.

A good prophylactic effect gives the use of phytotherapeutic agents with a weak diuretic and antibacterial effect. And, of course, keep your health under control - once every 3-6 months hand over urine tests and take ultrasound kidneys, ureters and bladder ultrasound every six months.

Remove or wait?

I have . They say you need to get rid of them. But it does not worry me yet. So, maybe not worth it to smoke?

Vasily, Yoshkar-Ola

It all depends on the size of the stones and from the changes they caused in the urinary trait. It is no secret that the presence of stones in the bladder or ureter is the source of inflammation and can lead to chronic pyelonephritis, renal failure, right up to the death of the kidney, which may require further renal care (hemodialysis) and kidney transplantation.

So, if you have passed the appropriate examination and your attending physician decided that the operation you need is better to listen to his advice and not to delay with the solution of this issue.

The risk factors of urolithiasis are:

Look or delete?

I suffer from urolithiasis. And stand in front of the choice: to crush me my pebbles or remove? What is better to choose?

Olga, Nizhny Novgorod

To traditional operational methods (open surgery) today resorted in rare cases when the patient already has a violation of urine outflow, caused, for example, by narrowing the ureter (congenital or acquired), and is required plastic surgery upper urinary tract.

In other cases, doctors resort to three methods: remote lithotripsy (DLT), transurethral (through the urethra) of contact and percutaneous nephrolitholpaccia.

In the first case, the crushing of the stone (as a rule, of medium-sized - from 1 to 1.5 cm) is made with the help of a special remote lithotripsy apparatus, which, creating a special field, fragments the kidney stones without internal intervention in the human body.

Other two methods - with penetration in tissue and more often apply with larger and multiple stones. The essence of these methods is as follows: under the conductor or general anesthesia, the patient makes a puncture of the skin over the kidney and under the control of ultrasound and x-ray through a special tube inside the optical system either through the urethra dyeing on the ureter tool is supplied to the stone.

Then, with the help of special devices (ultrasound, laser, pneumatic, electrically pulse), the stone is crushed. Thanks to these techniques, you can immediately destroy all the stones and remove their fragments. At the same time, the patient returns to active life much faster than if traditional open surgery were used.

However, the choice of the method of removal of stones is a doctor's business.

Recognize urolithiasis in the following features:

The method of treating the ICD largely depends on the characteristics of the concrement, as well as on the overall condition of the body, the presence of concomitant pathology, gender and age.

Ultrasonic or laser crushing of kidney stones belongs to the most common methods for removing the accretions. Their education is a very dangerous phenomenon. The results of the latest studies argue that the frequency of this pathology among adult and the children has increased.

In men, the ICD occurs 3 times more often than women, but still the tendency towards the development of urolithiasis in older people is preserved. This disease is dangerous not only to the formation of late and irreversible consequences (kidney wrinkling), but is the main cause of the painful spasm of urinary tract. Renal colic is evolving after blockage or blistering ureter. It is characterized by the development of pain in the lumbar region against the background of complete well-being, men have pain often move in groin and scrotum. Without adequate treatment, pathology threatens the life of the patient.

Methods of treatment of urolithiasis

The conservative and operational methods of treatment of the ICD are distinguished. The optimal reference tactics is generated by the attending physician.

The treatment method largely depends on the characteristics of the concrement (size, form, location, composition), as well as on the overall condition of the body, concomitant pathology, gender and age.

In the arsenal of modern medicine non-invasive or minimally invasive. Such methods include ultrasound, laser and surgical lithotripsy.

Ultrasonic destruction of kidney stones is widespread. This is the most popular treatment method. Attracts the minimum number of complications in it, the ability to remove stones without surgery, accessibility for the population, rapid rehabilitation terms.

Laser lithotripsy has become a revolutionary treatment method. It combines the therapy with a laser and endoscopic technique. The endoscope is introduced through the urethra and is supplied to the stone. Under the influence of Laser, uroliths are destroyed. Conductors as it were melted and painlessly removed with urine. But the cost of laser lithotripsy is several times more, so the method is not applied so wide.

Crushing stones in the kidneys with ultrasound

Shock-wave removal of concrections is one of the leading methods for the treatment of nephrolithiasis. By type of drum waves generation, it is divided into piezoelectric, electro-hydraulic, electromagnetic crushing.

The electromagnetic lithotripsy is based on the ability to split the stone by focusing the wave of an optical lens. The disadvantage of the apparatus with such a type of wave generation is high cost and the briefness of its components.

Electro-hydraulic lithotripsy allows you to break the stones of medium and large sizes. The device has the best efficiency. Its disadvantages include rapid wear of parts and expensive consumables, so in modern medicine it gradually loses its meaning.

Piezoelectric lithotripsy is used to remove the accretions from the urinary tract - so crushing the stones of small sizes (up to 15 mm in diameter). The device of this type works due to the focusing of the pulse reflector, emanating from the set of plates from special ceramics. The disadvantage of the device is a small service life.

Methods of lithotripsy stones in the kidneys

There are specific indications for each method of treatment. You can crush stones in the kidneys in 3 ways:

• remotely - the size of no more than 20 mm in the kidneys and 15 mm in the ureter, the density is not more than 1000 Hu;
• transurethral - no more than 25 mm size, the density is not important;
• percussionally (through the skin section) - the size of the stones is more than 25 mm, the density is not important.

Remote lithotripsy - the effect of the directional beam of the Uz-wave through muscle tissue. Crushing stones in kidneys Ultrasound - a painful process, it is carried out under common or local (spinal anesthesia) anesthesia. The procedure takes no more than an hour. Under visual control (ultrasound or x-ray), the arrangement of the concrete, a special device (lithotripter) is located above the stone localization area and generates ultrasound waves with a gradual increase in frequency and a decrease in the time intervals between the waves.

For 1 session produce up to 2000 shots, sometimes more. It all depends on the individual features of the concrement in concrete case. During the entire session, the attending physician is watching the condition of the concrement and selects lithotripsy tactics. After completion of the procedure, the patient establishes a special catheter to quickly remove small fragments of kidney stones.

In each hospital, patients are conducted differently. Most doctors prefer to leave patients under observation for another 1-2 day. On the first day after the intervention, an increase in temperature, pain during urination, an attack of the kidney colic, urine painting in red. These phenomena take place independently, but it is recommended to clearly perform instructions of the attending physician to minimize complications.

Despite the fact that the percentage of favorable outcomes is high, problems still fail to avoid. The main complications arising from remote lithotripsy include such:

• kidney contusion;
• hemorrhage in the body;
• aggravation or occurrence of pyelonephritis;
• the formation of "stone tracks" is a dangerous phenomenon leading to acute urination delay;
• residual stones - can serve as reasons for recurrence.

Transuretral or contact lithotripsy is carried out using an endoscope introduced through urethra. Thus, the doctor visualizes the concretion and acts as an ultrasound directly onto a stone. Using a suction, remnants of nephrolite from the kidneys are removed. This type of lithotripsy is painful and is carried out only under general anesthesia.

Preference is given to this method of treatment, if after 2-3 sessions of shock-wave therapy there is no desired effect or there are contraindications to it: the localization of the stone in the scope of the ureter, the development of renal colic, urination disorders. After intervention, the patient is in the hospital about a week. Postoperative therapy includes painkillers, anti-inflammatory and antibacterial drugs.

Perkatnaya nephrolitotripsy is an endoscopic operation performed with large-sized concretions in the kidney, most often. The method, being invasive, is carried out under general anesthesia. The essence of surgical intervention is as follows: Through a small skin incision is carried out with a nephroscope stone under visual control. When the concretion is extracted, a drainage tube for removing urine and blood is installed in the wound. Drainage is cleaned a few days later. The patient is written out 5-7 days after surgery.

Contraindications

Despite the widespread use in the urological practice of various lithotripsy methods, they have contraindications. They are divided into technical (obesity, complex location of the stone, the inability to place the sensor is strictly at the localization zone of stone) and medical.

Basic medical contraindications:

• menstruation;
• blood coagulation disorders;
• urological pathology (tuberculosis, cysts, renal neoplasms, chronic renal failure, narrowing of urethra and ureters, the location of the stone in the ureter (more than 3 months);
• purulent and inflammatory processes (pyelonephritis, cystitis, pneumonia, otitis);
• cardiovascular pathology (the presence of a pacemaker, aortic aneurysm, decompensated heart failure, myocardial infarction);
• damage to the gastrointestinal tract (during the exacerbation period);
• pregnancy.

If there are contraindications, we consider alternative methods of treatment: conservative patient management, crushing stones in kidney with a laser or open surgical intervention.

Preparation and conducting procedure

For the correct I. effective treatment It is necessary to undergo a comprehensive examination. The main stages of diagnostics include such methods:

• general and biochemical blood test;
• coagulogram;
• blood glucose;
• general urine analysis;
• blood Group and Rh Factor
• determination of hepatitis B and C markers, HIV infection;
• vasserman reaction (analysis on syphilitic infection);
• fluorography (not older than 6 months);
• ECG (for patients from 40 years old, up to 40 years old - with suspected cardiovascular pathology);
• urography;
• Ultrasound kidneys, urinary tract, prostate gland;
• inspection of the gynecologist for women;
• study of the prostate gland in men older than 45 years.

A few days before the procedure, sedatives are prescribed. A week before the operation cancel antiagregants (aspirin, clopidogrel). Immediately before intervention, the intestinal cleansing is carried out in the patient.

The patient enters the prepared operating system, undresses and falls on a special couch. The optimal position of the patient is selected. Depending on the method of lithotripsy, the necessary anesthesia is performed. When the ultrasound or x-ray apparatus is detected at remote therapy or visually (with contact, percutaneous crushing), a bundle of Uz-wave per stone is directed. The procedure is carried out before the destruction of the concrete or achieve the maximum permissible amount of ultrasound strikes. After lithotripsy, the patient is translated into the ward for further observation.

Conclusion

Any pathology, whether nephrolithiasis or choledocholiticiasis requires comprehensive approach To treatment. For successful therapy of urolithiasis and reducing recurrences, lithotripsy is combined not only with conservative methods, but also with a change in food preferences, the right drinking mode, physical activity, refusal from bad habits. The key to happiness and health is always in the hands of the person himself.