Types of lithotripsy, their advantages and disadvantages
Mar 23, 2018
Lithotripsy is a medical procedure that targets the physical destruction of stones in the organs of urination or digestion.This method of treatment is widely used to combat urolithiasis.But despite its undeniable advantage - a small traumatic procedure, lithotripsy is still not devoid of shortcomings.Contents: The essence of the lithotripsy procedure Remote lithotripsy Contact lithotripsy Transcutaneous( percutaneous) lithotripsy Contraindications to the
The essence of the lithotripsy procedure
At the heart of lithotripsy are the principles of impact on the stone by shock energy waves .A shock wave is an effect of high pressure.When a wave passes through soft tissues, it retains energy until it encounters a solid object - a stone.That is, passing through the human body, it does not damage the surrounding soft stone tissue.When facing a concrement, the shock wave breaks it into small fragments and thereby facilitates the removal of the stone from the urinary system.
Distinguish distant, contact, percutaneous( percutaneous) lithotripsy.
The principle of remote lithotripsy is based on the crushing of stones without direct contact with them.That is, the shock wave is formed from the outside. The aiming of the focus of the shock wave on the stone is carried out under the control of radiography or ultrasound.Thus, the wave acts only on the stone, without affecting the surrounding soft tissues.At the end of crushing, small particles of the stone leave the urine independently.For better separation of small stones, one should drink plenty of liquid after the procedure.
Remote lithotripsy is often performed in an outpatient setting and the patient will be able to leave the clinic soon after the procedure.The duration of the manipulation is about an hour .When using modern equipment, as a rule, local anesthesia is required before the procedure.
Advantages of the method:
- Effective crushing of small stones;
- Minimal trauma;
- A short rehabilitation period after the procedure.
- It does not allow to split sufficiently high-density stones, because of what there is a need for repeated manipulations;
- Not applicable for large stones;
- When fragmentation of kidney stones is more than 2 cm, the formed fragments can be large.Such fragments can clog the lumen of the ureter and cause attacks of renal colic in the patient.Especially dangerous is the phenomenon of the "stone path", when many small pebbles obstruct the outflow of urine in the ureter.
- There is damage to the shock wave of surrounding soft tissues around the calculus, which is manifested by hematuria( the appearance of blood in the urine), and in the long term by the formation of a parainal hematoma.
Lithotripter is used to conduct contact lithotripsy directly to the stone, a tool for destruction.The operation is performed under epidural or general anesthesia .With urolithiasis in a patient, the doctor enters the endoscope into the urethra, from there into the bladder, the ureter and, if necessary, penetrates the renal pelvis.
A lithotripter is inserted through the endoscope inside the organ.The endoscope removes the image that is displayed on the monitor.Moving the endoscope and watching the monitor, the doctor finds a stone - and close to it puts a lithotripter.The device divides the calculus into small particles, which are removed with special tools.After crushing the stone with contact lithotripsy, as a rule, a stent is installed to drain the kidney.
The duration of the procedure may vary, depending on the number of stones, the density and the configuration of the calculus.After the end of the procedure, the patient needs to stay in the hospital for another couple of days.
The following lithotripters are used for contact lithotripsy:
As can be understood from the name, ultrasonic lithotripsy involves the destruction of stones by ultrasonic waves.This method is used for the crushing of small stones.
Pneumatic crushing is carried out with the help of a powerful jet of air.Such a procedure will be ineffective in high-density concrements.In addition, pneumatic lithotripsy is not performed in the kidney area.
Laser lithotripsy is the most effective procedure.The use of a laser lithotripter makes it possible to break even dense, large stones.
Advantages of the method:
- The procedure is capable of destroying large stones;
- Even high-density stones can be broken;
- Soft fabrics around the stone are not damaged.
- Probability of ureter perforation by an endoscope;
- Need for longer rehabilitation.
For percutaneous lithotripsy in urolithiasis, a doctor makes a puncture in the lumbar region of the .Through the opening, the surgeon introduces an endoscope with a lithotripter.The endoscope under the control of radiography is promoted to the calyx-pelvis system of the kidney.Through the lumen of the endoscope, a lithotripter is introduced and the stone is crushed.
As the lithotripter is in close proximity to the kidney, it allows to crush large stones, with a complex configuration, including coral ones.Formed small fragments of calculus the doctor seizes with the help of surgical instruments.At the end of the operation, the nephrostomy is left with the drainage installed, which provides a complete drainage of urine from the kidney.One end of the drainage tube is in the kidney, the other end is outwardly and connects to the urine collecting device.As a rule, drainage is removed after 1-2 days.
Percutaneous lithotripsy is performed under anesthesia.After manipulation, the patient must remain in the hospital for several more days.
Advantages of percutaneous lithotripsy:
- The possibility of crushing large stone kidney stones, complex configuration;
- Maximum efficiency of the procedure without the need for a repeat procedure.
- Use of anesthesia;
- Traumaticity of the method;
- Probability of vascular injury when introducing an endoscope;
- Long-term rehabilitation period.
Contraindications to lithotripsy
If a patient has a pathology of the musculoskeletal system, obesity is very difficult to precisely aim with the help of equipment shock wave on the calculus.These pathological conditions can be enumerated to relative contraindications to remote fragmentation of stones.
To absolute contraindications, doctors refer to a clotting disorder, otherwise the procedure can lead to bleeding .In particular, if the patient is taking anticoagulants, this must be notified in advance by the doctor.In addition, the crushing of the stones is not carried out in violation of the heart rate, the presence of an implanted pacemaker.
Lithotripsy is not performed with acute pyelonephritis, chronic renal failure.The presence of these diseases creates an unfavorable background and it is difficult to predict the outcome of lithotripsy under such conditions.It is also recommended to abstain from the procedure for pregnant women.
Grigorova Valeria, medical reviewer