(kidney stones), the attending physician may order the patient to undergo kidney stone lithotripsy. It is modern and efficient way, allowing to alleviate the patient's condition.

It is performed almost painlessly and allows the patient to forget about the pain that tormented him and live a full life.

What it is?

Lithotripsy is a method of removing calculi by aiming a beam of ultrasonic waves on them.

Distinguish two kinds:

1. Non-contact lithotripsy;
2. Contact removal method.

With the contactless method the apparatus is directed to the kidneys, an ultrasonic signal is sent through the skin, which accurately detects stones, and waves of a certain frequency begin to be supplied. Waves crush stones into small fragments or grind them into sand.

Subsequently, stones and sand are released naturally through the urinary tract.

How to remove sand from your kidneys folk remedies read in our article.

Contact method suggests the presence of small punctures in the skin for the introduction of instruments.

Indications for the procedure

Lithotripsy is performed if there is a series of indications:

• Stones in diameter should be from 0.5 to 2.5 cm. Larger calculi cannot be removed using this method;
• Lack of a positive result from other treatments;
• Frequent sharp pain in the lumbar region;
• The calculi have a high-density structure;
• The chemical properties of stones allow them to be destroyed by ultrasonic waves.

Removal of stones by guiding ultrasound do not carry out under the following restrictions:

• The presence of purulent formations or inflammation in the body;
• Obesity 3 and 4 degrees;
• Spine diseases;
• Low blood clotting;
• The menstrual cycle in women;
• Pregnancy;
• Benign and malignant tumors;
• Exacerbation of gastrointestinal diseases;
• Complications after previous lithotripsy operations;
• The presence of a pacemaker in the patient;
• Dilation of the aorta.

Varieties of lithotripsy

Remote

This way is the most painless... The patient does not have a skin incision. The operation is performed under local anesthesia.

The patient is placed on the operating table, using ultrasonic instrument find the location of the stones and use a special lithotripter device to induce ultrasonic waves. By types of energy, lithotripters are:

1. Piezoelectric;
2. Electromagnetic;
3. Electrohydraulic.

The calculus is crushed into fragments under the action of waves. Stones up to 2.5 cm are crushed. The forms cannot be removed in this way. Also, if the calculus is dense, then there is a high probability that the remote method will not help, then other methods are used.

The operation takes about an hour. The recovery period is 2-3 days, after that the patient can return to normal life.

Laser

Laser method refers to contact methods... The doctor inserts an endoscope through the urethra. A holmium laser is used. It evaporates calculi, as a result, there are no fragments and sand, everything is destroyed into dust.

The advantage of this method is the constant control of the doctor over the course of the operation. The tissues are not damaged, the effect goes directly to the stones. Concrements of any density and shape can be destroyed. Sometimes one procedure is enough. The recovery period takes several days. The operation is performed under local anesthesia.

Percutaneous nephrolithotripsy

Another name for the procedure is percutaneous lithotripsy... It is used to remove coral-shaped stones.

A puncture is made in the lumbar region, a nephroscope is inserted, an ultrasonic lithotripter is located on its head. Allows crushing stones big size, an obvious plus of the method.

After the completion of the operation, a drinking regimen, hot baths and exercises are prescribed to facilitate the rapid removal of fragments. Postoperative recovery on average takes 10 days... A course of antibiotics is prescribed in order to prevent negative consequences.

Cystolithotripsy

The patient is placed in a urological chair, the bladder is washed through. Cystolithotriptor is introduced. 300 ml of liquid is poured into the bladder, the location of the stone is determined, and it is captured with an instrument. The calculus is brought to the center of the bladder and destroyed. In the process of destruction, the liquid becomes cloudy, the bladder is periodically washed.

This method allows you to effectively remove stones. The recovery period takes from 8 to 14 days.

Contact ureterolithotripsy

The abbreviated name is KULT. The operation is performed under general anesthesia.

The patient is placed on his back with legs apart. Examine the urethra and. After detecting a calculus, a ureteroscope is inserted into the urethra, and the stone is destroyed with the help of ultrasound waves.

In some cases, thin forceps are used to grip the stone. If necessary, place a stent in the ureter, which is removed 2 weeks after surgery.

Extracorporeal shock wave

Refers to contactless methods... The patient is on a special table. The doctor uses X-rays to find the calculus. After detection, the irradiators are brought to the place and a shock wave is applied, which breaks the stones into small particles.

The procedure lasts from 40 to 60 minutes. It is performed under anesthesia. The recovery phase takes 1-2 days. You should drink plenty of fluids so that the remnants of the stones come out faster, and take a course of pain medications.

Possible complications

Negative consequences can occur both during the operation and after:

1. In addition to distal lithotripsy, adjacent tissues can be destroyed, as a result, the kidneys can be damaged, and blood appears in the urine.
2. If the calculi are more than 2 cm, then there is a risk that the splinter will remain in the ureter, leading to severe pain.
3. If the operation lasts more than 2 hours, scars will not form.
4. In some cases, a single use of the contactless method is not enough, you need to repeat the procedure.

The laser method for removing calculi is minimal possible complications and a high degree of efficiency.

Common complications, typical for all types of stone removal are:

• Increased body temperature in the first days after surgery;
• Pain in the abdomen and kidneys;
• Blood may appear in the urine;
• Blood pressure surges;
• Nausea and vomiting.

During the operation complications are rare. They can occur if the patient is allergic to drugs used for anesthesia. There are also complications if the operation is performed by an unqualified doctor.

After the operation, the patient is in the hospital for at least 1-2 days, this is done in order to see if there will be complications if they are resolved promptly.

If you feel unwell after discharge, you should immediately contact a medical institution.

How are stone residues removed?

Fragments of stones left after the procedures are excreted naturally through the urethra. Recommended in this case drink more fluids.

There are situations when calculus particles get stuck, in this case, it is required to carry out the operation to remove them again.

Lithotripsy of kidney stones - effective method removal of calculi. Due to the variety of methods, it is possible to individually select exactly the method that will maximally help in solving the problem.

Learn more about extracorporeal lithotripsy from the video:

This procedure is a method of hardware fragmentation of renal calculi. A high-pressure, short-pulse shock wave is used. It is directed to the area of ​​the identified location of the formation. After the procedure, the crushed stones leave the genitourinary tract in a natural way.

What is kidney stone lithotripsy?

An alternative to surgical intervention technique for the removal of renal calculi. The method prevents most complications of urolithiasis. They are manifested by the development of purulent complications with the formation of renal failure, bleeding from the vessels of the kidney and persistent renal hypertension. The main danger of the prompt removal of calculi is the formation of a septic focus. This is fraught with subsequent purulent inflammation of the renal parenchyma and death.

Types of lithotripsy of kidney stones

Apparatus shock wave involves the impact on kidney stones of small and medium diameter by means of ultrasonic waves. The destruction of the formations is caused by a high-frequency shock wave directed to the required area. It is performed in several ways:

• The most commonly used one is remote.
• Contact transurethral method, which allows to increase the effectiveness of the procedure, but requires careful surgical preparation.
• The percutaneous method is the formation of access through the skin.

Remote lithotripsy

Remote or shock wave method is a non-contact method of crushing calculus that does not require penetration into the body. Lithotripters are represented by small high-precision devices. For the procedure, the patient first undergoes an ultrasound examination, which allows you to establish the height of the stone. The advantage of the method is low pain. There is also no need for a major traumatic abdominal operation.

Contact lithotripsy of kidney and ureteral stones

The endoscopic (contact) technique involves the use of a special instrument that provides access to the stone. It is carried out through the urinary tract. Then the action is carried out with ultrasound, pneumatic, electrohydraulic or laser energy. By means of a special pneumatic device, a large calculus is destroyed. Then the fragments are removed by the manipulator. As a result, after the procedure, the stone is completely removed.

Laser lithotripsy

The safest and most optimal method for removing calculi is laser lithotripsy. For its implementation, a laser and an endoscope are used. The endoscope is brought to the calculus through the ureter or urethra. Then the formation is subject to erasure with the complete absence of fragments requiring removal. The procedure is characterized by high precision, painlessness and efficiency. The high quality of the result is mediated by visual endoscopic control.

How is lithotripsy performed?

For crushing kidney stones, a special apparatus is used - a lithotripter. It has a built-in X-ray targeting sensor and an ultrasonic focusing element. The procedure is carried out without violating the integrity of the skin and penetration: a special fluid-filled pillow is applied to the projection of the identified location of the calculus. A shock wave is conducted through it by means of a generator, which acts as a point on the stone. The procedure is considered effective when it turns out to fragment the stone into parts passing through the opening of the ureteral and urethral canals.

How long does the kidney hurt after lithotripsy?

An examination is carried out immediately after the manipulation. Here is a list of symptoms after lithotripsy:

• Frequent urination and soreness in the lumbar region.
• Trace hematuria, caused both by the manipulation itself and by traumatization of the urinary tract by fragments of stones. This symptom disappears 2-3 days after the procedure. Most often it is observed with the destruction of oxalate types of stone.
• Renal colic due to the passage of fragments.
• Temperature rise up to 38C.

The first two weeks after the manipulation, it is required to visit the urologist every 3 days. If the described symptoms persist for more than a week, an examination is required.

Treatment after lithotripsy

• A common method of therapy for patients with KSD is endoscopic administration in the pre- and postoperative periods of the drug "Pyobacteriophage" in a dosage of 0.3 ml per 1 kg of body weight, three times a day, for 5-7 days.
• Also, to eliminate secondary infection of the urinary system, "Immunovenin" is used. A dose of 50 ml is injected intravenously at 30-40 drops per minute. For the course of treatment, 2 infusions are used, one per day.

These methods will help you recover from surgery.

Extracorporeal lithotripsy of kidney stones is a method of crushing kidney stones without damaging skin... This procedure allows them to move out of the urinary tract. Let's consider the features of this procedure, its indications, contraindications.

What is lithotripsy?

Remote lithotripsy (DLT) is one of the non-surgical treatments for urolithiasis in humans. The essence of such fragmentation of kidney stones is that they are crushed without direct contact.

The required effect is achieved by applying a shock wave. In turn, contact lithotripsy involves direct crushing of stones using a laser beam, compressed air, and ultrasound.

A special shock wave generator is used for crushing or crushing. It creates shock waves that repeat at a specific frequency.

Waves during EBRT gather in one place, which makes it possible to grind stones to the state of sand. Then he goes out on his own with a blood stream.

To determine the point where the shock waves should converge (focus), the method of ultrasound diagnostics is used. This makes it possible to significantly increase the effectiveness of ESWL.

This operation refers to closed-type interventions, with the exception of crushing the so-called coral stones. The patient must be monitored by a specialist and, if necessary, can stay in the hospital for several days.

Types of lithotripsy

In modern conditions, the following types of lithotripsy are performed:

• Extracorporeal.
• Remote.

Extracorporeal lithotripsy - grinding kidney stones in this way is performed using a high-energy shock wave. The stone is deformed from this.

To achieve the desired effect, crushing is carried out for about 1 hour. Extracorporeal lithotripsy is not done during pregnancy, if the patient's weight deviates, especially in the case of pelvic stones.

In contact lithotripsy, the stone is destroyed using a laser beam or ultrasound. With the help of a urethroscope, fragments are removed from the genitourinary tract. After lithotripsy, a stent is placed in the area of ​​the ureters.

A few days later he is removed. This procedure is done only with the use of anesthesia (most often general). The patient can get rid of the stone in just a few sessions.

Remote lithotripsy is performed, as already indicated, using ultrasound, which is focused on the area of ​​the kidney stone. Usually, crushing is used in cases where they are small (that is, they do not exceed 25 mm in diameter).

It can sometimes be used as an emergency treatment for renal colic. With stone sizes up to 5 mm, lithotripsy is usually not prescribed.

The specified method of fragmentation must be carried out subject to the development of frequent and pronounced inflammatory phenomena in the urinary tract. Lithotripsy is safe and can be prescribed for children.

Features of the

For ESWL, the patient is given anesthesia (most often intravenous). Sometimes the doctor may apply general anesthesia (it all depends on the patient's health, age and other factors).

Next, a device is applied to the abdomen (usually it is installed on the lumbar region, where the kidney calculus is most likely to be located). The duration of the wave impact on the calculi can be different: it depends on the number and their size.

During one wave session, the number of strokes reaches 5000. During the procedure, the doctor changes the intensity of the wave radiation, which makes it possible to effectively control the process of removing the stone.

Laser lithotripsy has its undeniable advantages, which is why it is a kind of gold standard in modern urology. And all because such removal uses only innovative technologies. At the same time, it is possible to quickly and effectively treat the ICD. In addition, the laser type of lithotripsy is also the most gentle and almost painless procedure in modern urology.

During such an operation, an endoscope is inserted through the urethral canal, bladder and ureteral cavity directly to the calculus. After that, a laser beam is directed to it.

This method of crushing allows you to grind the calculus into dust. This means that it disappears in the kidneys without a trace.

After laser lithotripsy, no debris remains in the kidneys and urinary tract. This dust is then completely removed from the kidney and urinary tract naturally.

The advantages of such crushing are as follows:

• laser removal is most suitable if there are calculi of a complex chemical nature;
• in just 1 procedure, you can achieve complete expulsion of the stone from the kidney;
• the patient does not feel pain during destruction;
• in the indicated localization, it is possible to completely achieve the expulsion of the calculi;
• laser removal is almost completely suitable for small stones;
• due to the fact that the holmium laser is used during the procedure, it does not affect the surrounding tissues.

In most cases, this procedure is effective. Often, it is possible to say that it was successful immediately after the end of the procedure (when the radiography shows that the impact method of removal reduces the shadow). Nevertheless, it may take some time to assess the state of the body after such a procedure.

In some cases, the doctor prescribes repeated lithotripsy for his patient. If several sessions are ineffective or ineffective, then percutaneous lithotripsy is used.

How to Prepare?

As with any procedure, you need to prepare for the destruction of a kidney stone. An initial consultation is recommended before her.

During the initial consultation, the doctor collects and carefully examines the history. Before crushing, an X-ray should be done, in some cases - an MRI.

Before crushing, it is necessary to pass the following tests:

• general clinical analysis of urine (it is imperative to determine the number of platelets);
• general examination of urine, always with bacterial culture;
• biochemical blood test (carried out according to the standard procedure);
• blood coagulogram;
• chest fluorography should be done no more than a year before the removal of stones in this way;
• all patients who have reached the age of forty should have an electrocardiogram.

A week before the wave destruction, you need to stop using all drugs containing acetylsalicylic acid.

Are there any complications after lithotripsy?

Although lithotripsy is highly effective, it, like any other procedure, can lead to complications. First of all, during the intensive passage of stones, acute pyelonephritis, blockage of the upper urinary tract, and even renal colic can develop.

All patients need to be aware of the possibility of developing such dangerous complications in order to respond in time to their occurrence. If renal colic appears, an ambulance should be called immediately.

Blockage of the ureter is quite dangerous condition... It is also called a stone path. " It manifests itself in the form of lower back pain like renal colic.

In some cases, it is necessary to urgently remove the stone using a urotroscope. The consequence of pyelonephritis is urosepsis with hemorrhage in the renal tissue.

Other complications of the removal procedure:

• hematuria (usually should go away in a few days);
• severe spasmodic pain (relieved by analgesics);
• internal bleeding (refers to an emergency);
• damage to the urethra.

When very severe pain, blood in the urine, a strong urge to urinate, even if the bladder has recently been emptied, you must immediately call an ambulance.

When shouldn't lithotripsy be done?

This procedure is not carried out in the case of the presence of such diseases and phenomena:

• prostatitis;
• pneumonia;
• menses;
• complications after lithotripsy;
• stones of urate origin;
• poor blood clotting;
• aneurysms;
• obesity, increased gas production;
• vertebral deformities;
• tuberculous process of renal cavities;
• various exacerbations and disorders in the gastrointestinal tract;
• the presence in the heart of an artificial pacemaker, atrial fibrillation;
• failure of the heart and lungs;
• impaired renal function;
• a sharp narrowing of the ureter (if it is narrowed below the localization of the calculus, in such cases there is a risk of urinary tract obstruction and other adverse complications);
• pregnancy (regardless of the period).

So, stone lithotripsy is an effective and safe procedure to get rid of calculi. This is one of the most effective ways treatment of urolithiasis and its complications.

Before carrying out this procedure, you need to prepare and first of all do required analyzes... In some cases, lithotripsy may be contraindicated, and this is due to the state of the body.

Patients report an improvement in their condition after lithotripsy. Complications after this method of crushing are rare. If, nevertheless, after removal, unpleasant symptoms are felt, then an urgent need to call a doctor for emergency care.

The basis of therapy for urolithiasis is the crushing of kidney stones by conservative or instrumental means. Patients of urology departments are interested in how stones are removed from the kidneys and whether it hurts.
Lithotripsy of kidney stones is a method that helps break up salt deposits with minimal losses for the patient.

Indications for lithotripsy

The indication for lithotripsy is the presence of stones in the urinary tract. Movable calculi and sand with a diameter smaller than the orifice of the ureter (less than 5 mm) are removed on their own. However, it is not uncommon for the size of the stone to exceed the width of the outlet. The stone completely blocks the outflow of urine.

As a result, hydronephrosis of the kidney develops, followed by impairment of organ functions. This pathology is accompanied by severe painful sensations, since vasospasm begins - renal colic.
To relieve the patient of urolithiasis, relieve pain and remove stones, they are crushed into pieces and then removed.

Contraindications for crushing kidney stones

Despite the popularity of the lithotripsy method and the minimal risks of complications, it cannot be used in the following cases:

Stone crushing procedure

Those who have experienced renal colic at least once in their life think about how kidney stones are crushed using lithotripsy. You can find out what it is and how it is done at an appointment with a nephrologist. As the most progressive method of removing stones, it is presented in three types, differing in technical performance:

• Remote wave (ESWT).
• Contact. Includes options for endoscopic intervention.
• Percutaneous (percutaneous).

According to the methods of exposure, lithotripsy is divided into laser, electrohydraulic, piezoelectric and electromagnetic.
The treatment option depends on how many conglomerates have formed in the organ, on their physical and chemical properties, size, location, concomitant diseases of the patient.
Prepare the patient for the procedure in advance. No food is allowed the day before the operation. The preoperative examination includes:

• blood tests: general, biochemical, for HIV, syphilis, sugar, group and Rh factor;
• general urine analysis.

This is necessary to exclude possible contraindications and to avoid complications. If the patient is taking blood thinners, then they are canceled 5 days before the procedure. Bacterial infections genitourinary system are treated in advance.

The procedure is performed using an endoscope inserted into the urethra, then into the ureter, and, if necessary, even into the patient's renal pelvis. Thanks to this, the doctor sees directly everything that happens in the area of ​​work. This reduces the risk of tissue damage.
For crushing stones by a contact method, a laser based on a holmium element is used. Due to its properties, the beam penetrates into the calculus by a maximum of 0.5 cm, which prevents damage to nearby tissues. Under the influence of a laser, the stone is evaporated and falls apart into small grains of sand, which are easily expelled with urine.
The operation takes 60 minutes. The patient recovers within 2-3 days, and then is discharged home, continuing to be registered with a nephrologist. After the procedure, there may be traces of blood in the urine. After a few days, all symptoms disappear.

Patient reviews for laser stone removal are mostly favorable. Of the advantages, painlessness, atraumaticity, and absence of complications are noted. The contact laser method is a good opportunity to solve the problem in one session. The downside is that the procedure is not cheap.
Laser contact lithotripsy is done if the remote method does not help, the patient has large stones with a high density or an abnormal structure of the skeletal system, which makes it difficult to direct the ultrasound waves.

Contact method

The method is carried out using atraumatic endoscopic intervention. It is divided into three types:

• Ultrasonic. In this case, the stone is divided into fragments of 1 mm in size, and then they are removed using an aspirator. They are used mainly for loose formations.
• Pneumatic. Using a shock wave, the deposits are split and removed with loops and forceps. Thus, the ureter is cleared of "stone paths" and other urinary tract except the kidney.
• Laser. It is performed under constant visual supervision of a physician. Most preferred method.

Contact retrograde lithotripsy is not recommended for persons with upper ureteral stenosis, urethral strictures, and abnormalities of the urinary system. In addition, after plastic surgery on the urinary canal, it is difficult to perform manipulations. During purulent-septic and acute inflammatory diseases of the genitourinary sphere, this non-invasive intervention also cannot be used.

Remote ultrasonic crushing

The essence of the method of extracorporeal remote shock wave lithotripsy is in splitting deposits with a shock wave of a short pulse, which is formed using a special apparatus - a lithotripter.
The patient is placed on the table, the area around the kidney is smeared with a special gel, then a water pillow is brought in. The waves focus on the object and begin to impact. Anesthesia is not required, but local anesthesia can be done at the patient's request.
The stones fall apart under the destructive influence of impulses. All manipulations are carried out under ultrasound control. Having achieved crushing of deposits into small particles (less than 5 mm), the procedure is completed. It lasts about an hour. After that, the patient can independently leave the hospital and be monitored on an outpatient basis.

After manipulations, dull pain in the lumbar region may disturb. Over time, their intensity decreases. Small pieces of stones formed after crushing are expelled with urine within a few weeks. During this period, hematuria (the presence of blood in the urine) and colicky pains accompanying the release of stones can be observed.
Although distance lithotripsy is considered a low-traumatic method, damage cannot be completely ruled out. Waves have a destructive effect not only on stones, but also on organ tissue. The resulting injury corresponds to a contusion of the kidney, after which it recovers for 5-7 days.
Of the complications that arise after the operation, the most unpleasant is the so-called stone path, formed from fragments of calculi. Therefore, to prevent the retention of stones in the ureter, an endobiliary stent is placed - a special tube made of plastic.
In addition, the procedure often does not help the first time. Some patients require re-intervention. This is a significant disadvantage of this treatment option, since its cost is about 50 thousand rubles. Not everyone can afford a second course. However, in some clinics it is carried out under the compulsory medical insurance policy.
The contactless method of crushing is preferred if the stones are loose and fragile. For dense salt formations, other treatment options are used.

Percutaneous stone removal

If the stones are coral or especially large and dense, the remote method is used in conjunction with the percutaneous method. During non-contact crushing, they are destroyed, and then the residual calculi are removed using laparoscopic surgery.
The percutaneous method involves penetration to the kidney using special surgical equipment. Percutaneous lithotripsy is performed in a hospital under general anesthesia.

The technique of execution consists in the fact that a nephroscope is passed to the kidney through an incision in the lower back of 2–3 centimeters. It has a camera with which the doctor sees all the conglomerates. Then the sensor is moved close to them along the nephroscopic canal and the stones are crushed with a laser. Large debris are removed with a litho-extractor, and small particles are removed on their own within a few days. The patient is discharged for 3-4 days.
Percutaneous lithotripsy is preferred because of the low risk of complications, good tolerance, and high efficiency. This operation can be done by adults and children. In the percutaneous method, one disadvantage is the use of general anesthesia.
After lithotripsy, complications sometimes arise in the form of:

• pain;
• renal colic;
• tachycardia;
• increase or decrease in blood pressure;
• pyelonephritis;
• kidney hematomas;
• anuria (lack of urine during the day);
• "Stone path".

If any of the listed conditions appear in the postoperative period, you need to inform the doctor. He will prescribe the appropriate treatment.

Conservative stone removal methods

If it was possible to establish the type of salt deposits, and they are amenable to drug treatment, doctors prescribe urolithics. Pharmaceuticals and phytotherapeutic agents are used depending on the chemical composition of the stone.

In addition to medications, the nephrologist selects a suitable diet for the patient with ICD, containing the maximum amount of nutrients. The table lists drugs that help remove each type of stone and dietary patterns.

A type sediments	Drugs	Phyto-therapeutic agents (infusions and decoctions)	Diet food
Permitted	Is prohibited
Urata	Allopurinol, Hypothiazide, Cistenal, Uranit U, Benzobromarone, Blemaren	Corn stigma, Celery rhizome, Steel root, Birch leaves, Dill seeds, Parsley, lingonberry fruit	Sour drinks, sorrel, lemons	Protein food, vegetable oil
Oxalates	Asparkam, Vitamins B6 and B1, Cyston, Prolit-Super, Urolesan	Blue cornflower, Knotweed, Curly silkworm, Field horsetail	Meat, cereals, dried fruits	Potatoes, milk, cheeses, yoghurts, coffee, sour fruits, berries, canned vegetables
Phosphates and calcifications	Phytolysin, Kanephron N	Rosehip, Knotweed, Dushnik	Pasta, lean meat and fish	Milk, fruits, vegetables

Postoperative rehabilitation

After removing the stones, you need to support the kidneys, reduce the load on the urinary system. For this, a diet is prescribed. On the first and second day after the procedure, food consists of juices, jelly, low-fat broths. On the following days, meals are allowed on an extended surgical diet. The diet is supplemented with vegetable purees. Food is taken 5-6 times a day. In the future, the doctor prescribes a special diet, selected depending on the types of stones.

During surgical interventions, antibacterial and antimycotic agents are prescribed to prevent infections. To help the kidneys recover faster, antioxidants and circulatory medications are taken.
Modern options for removing kidney stones are designed to get rid of a momentary problem, but do not prevent the formation of conglomerates in the future. Therefore, it is important for patients with RCH to follow a special diet, adhere to the correct drinking regimen, and maintain healthy image life and periodically undergo examinations.

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Lithotripsy for urolithiasis

Lithotripsy (stone destruction) is a method of treatment of urolithiasis, which implies remote (without direct intervention in the body) or contact destruction of stones using different types energy. Minimally invasive operations to remove kidney stones are carried out by breaking stones into small fragments, which are removed directly during the operation and / or excreted from the body naturally.

Extracorporeal lithotripsy (SWL) or extracorporeal shock wave lithotripsy (ESWL) are synonymous with the same treatment. The main point of the procedure is the destruction (disintegration) of a stone in the kidney or ureter by the action of a shock wave, which is generated in the therapeutic head of the device using different methods of generating a discharge (electromagnetic, electrohydraulic, piezoelectric lithotripters).

Pulses focused on the stone using an ultrasound sensor and / or X-ray guidance gradually destroy the internal structure of the calculus, due to which it breaks up into smaller fragments. The stones are destroyed to the state of sand and small fragments, followed by an independent discharge with urine through the urinary tract.

Types of lithotripsy according to the method of impact on the stone

Remote lithotripsy. A method of treating urolithiasis using special complex and high-tech devices - lithotripters. Lithotripters generate a shock wave, which, by focusing on the stone using ultrasound or X-rays, leads to its destruction. A painless and low-traumatic operation is most often performed under intravenous anesthesia and is well tolerated by patients.

Contact lithotripsy (CULT - contact ureterolithotripsy). In this endoscopic operation, ureteroscopes are used - special instruments that are brought directly to the calculus located in the ureter or in the kidney through the natural urinary tract. After the calculus is visualized, it is destroyed using laser, ultrasonic or pneumatic energy. Spinal anesthesia is the gold standard for these procedures. When using this method of treatment, the probability of complete destruction of the calculus reaches almost 100%. Sometimes the operation is completed by inserting a ureteral catheter-stent, which is removed after 2-4 weeks.

Percutaneous (percutaneous) nephrolithotomy (PNLT). The operation involves the creation of a puncture in the lumbar region for the introduction of the endoscope directly into the kidney, followed by the destruction of stones and extraction of their fragments. This kind surgical treatment used for coral stones and stones large sizes... Percutaneous nephrolithotripsy is performed under general or spinal anesthesia.

The above-described minimally invasive operations can be performed in our clinic as an alternative to surgical intervention. Operations are performed by qualified specialists using modern medical equipment. You can find out how much it costs to remove stones from the kidneys and ureters by one of the treatment methods from the price list or by phone.

Indications for surgery

Indications for extracorporeal lithotripsy: stones ranging in size from 5 to 20 mm, located in the calyx of the kidneys, in the pelvis or in the ureter.

For larger stones, other methods of treatment are used.

Indications for contact lithotripsy: stones in the ureter, up to 20 mm in size.

Indications for percutaneous nephrolithotripsy: kidney stones larger than 20 mm, coral stones.

The expediency of using a particular method of treatment is determined by the attending physician in consultation after examining the patient and familiarizing himself with the results of his analyzes and examinations.

Contraindications to lithotripsy

General contraindications for lithotripsy:

• acute pyelonephritis;
• acute renal failure or progression of chronic renal failure;
• low blood clotting (hypocoagulation);
• spinal deformities;
• obesity;
• cardiovascular diseases in the acute stage;
• pregnancy;
• aneurysm of the renal artery and aorta;
• acute gastrointestinal diseases;
• atrial fibrillation;
• menstruation;
• kidney tumors.

The choice of a particular method of treatment depends on the individual characteristics of the course of the patient's disease.

Contraindications to extracorporeal lithotripsy:

• narrowing of the ureter below the calculus;
• violation of the excretory function of the kidney;
• acute pyelonephritis or urinary tract infection in the acute stage;
• the size of the calculus is more than 20 mm or its high density.

Contraindications to contact lithotripsy:

• an infection of the urinary system in the acute stage;
• stricture of the ureter.

Contraindications to percutaneous nephrolithotripsy:

• patient somatic status

Preparing for surgery

Before carrying out lithotripsy, a comprehensive laboratory and instrumental examination is necessary:

• clinical blood and urine tests, biochemical blood test, coagulogram, urine culture, blood test for hepatitis B and C, syphilis, HIV, blood group determination;
• CT scan of the retroperitoneal space with contrast enhancement, ultrasound of the kidneys, ureters, prostate (in men), ECG, chest x-ray;
• esophagogastroduodenoscopy and duplex scanning of veins lower limbs(if necessary);
• treatment of concomitant diseases during their exacerbation;
• drainage of the upper urinary tract (if necessary);
• antibacterial prophylaxis of urinary tract infections.

Stages of the operation

An external lithotripsy session lasts about 1 hour. In case of poor fragmentation of the calculus, repeated crushing sessions may be required. A combination with other types of treatment is possible, in particular with contact lithotripsy. In the presence of large pieces of calculus, a ureteral catheter-stent may be placed in the patient. The duration of standing of the ureteral stent on average varies from 2 to 4 weeks.

Contact lithotripsy (laser, ultrasound, pneumatic) lasts from 30 to 60 minutes. The probability of complete destruction of calculus (especially when they are located in the lower parts of the ureter) reaches 100%. With this method of treatment, the destruction of the calculus is performed under visual control, which allows the doctor to fragment the stone to a finely dispersed mass and remove large fragments.

Percutaneous nephrolitomy is intended to remove large coral or kidney stones. The duration of the operation can be up to several hours. After the completion of the operation, a nephrostomy drainage is installed in the lumbar region for several days.

What is included in the cost of an operation to remove kidney stones

The cost of operations to destroy stones in the kidney and / or ureter depends directly on the chosen method of surgical treatment, the type of anesthesia, the length of hospital stay and the need for preoperative instrumental and laboratory examination.

Having found out the price of the operation to remove stones in our clinic, be sure that the price will not change after the end of the treatment. We have no hidden surcharges, the rates include consultation and examination of a urologist, anesthesiologist, instrumental and laboratory diagnostics, and anesthesia.

Rehabilitation

The duration of rehabilitation after stone removal depends on the method of lithotripsy and the characteristics of the patient's somatic condition. Crushed stones during passage can cause renal colic or lead to exacerbation of calculous pyelonephritis.

After remote lithotripsy, patients are usually discharged on days 2–3. After discharge from the hospital, dispensary observation by a urologist is required for 2 weeks. On the 10-14th day, it is necessary to perform an ultrasound scan or X-ray, to pass clinical (biochemical) blood and urine tests.

After contact lithotripsy, blood in the urine, mild burning sensation and pain during urination or in the lumbar region may be observed for several days. In the absence of pronounced pain the patient is discharged on the 2-3rd day.

The rehabilitation period for percutaneous lithotripsy takes longer. The length of hospital stay is on average 5 to 7 days or more. The nephrostomy drain is usually removed 2 to 4 days after surgery.

To increase the effectiveness of treatment and prevent the development of recurrences of urolithiasis, patients who have undergone lithotripsy need to take a responsible attitude to the rehabilitation period and strictly follow the doctor's recommendations.

Appointments in the postoperative period:

• diet food (exclusion of too salty and spicy foods);
• increased drinking regime (more than 3.0 liters / day);
• antibiotic therapy;
• the use of vitamins;
• physical activity;
• phyto-, laser-, vibration therapy, etc.

Undoubtedly, Moscow opens up a lot of opportunities for treatment, incl. carrying out lithotripsy. But the price of the operation, queues, quality of service, responsiveness of staff, efficiency and other criteria may not meet your requirements.

The effectiveness of the treatment of urolithiasis in the FNKTs FMBA is guaranteed. The clinic employs highly qualified specialists, the staff has candidates of science. A modern department, comfortable wards and operating rooms are equipped with high-tech equipment from world-famous manufacturers. The Department of Urology has all types of modern equipment (cystoscopes, ureteroscopes, nephroscopes; lithotripters: laser, ultrasonic, pneumatic and remote) for minimally invasive endoscopic removal of calculi of any localization of any parts of the urinary system. Prices for lithotripsy of kidney / ureter stones by laser, ultrasound and other methods are affordable.