Nephrolithiasis, (urolithiasis) is dangerous not only for its chronic progressive course, but also for serious complications associated with an infectious and inflammatory lesion renal tissue, the release of stones and a violation of the normal outflow of urine. Removal of kidney stones is one of the main ways to treat pathology. Today it is carried out various methods depending on a number of factors. To choose modern technology that will effectively and safely remove salt formations, you need to consult a doctor and undergo a comprehensive examination.

Attention to the patient

Before the question of which procedure should be used to remove a kidney stone from a particular patient with KSD is decided, a number of factors are taken into account:

• size, localization and number of stones;
• their chemical structure;
• anatomical features of the structure of the ureters;
• absence/presence of obstruction at all levels of the urinary tract;
• age, general condition and well-being of the patient;
• severity of pathological symptoms of nephrolithiasis;
• possible comorbidities.

The decision on how to remove stones from the kidneys is made taking into account all the information received by the doctor during the conversation with the patient, examination, as well as laboratory and instrumental examinations. The most efficient and safe way fight the disease.

Exist different methods. Conventionally, they can be divided into non-invasive and invasive.

Non-invasive techniques

Non-invasive treatment is preferable as it allows kidney stones to be removed without surgery. However, this type of therapy is used only in the case of small stones - up to 4 mm, since formations of a larger diameter can injure the urinary tract.

The appointment of diuretics and an increase in the amount of fluid consumed by a person. This simple method is used to wash the kidneys with water and remove the formed pebbles and sand from the body. Every day it is recommended to drink up to 2-2.5 liters of non-mineral water, unsweetened fruit drink from cranberries, lingonberries. The selection of the dosage and duration of taking diuretic drugs is carried out individually by a nephrologist. Purpose medicines.

Phytolysin, Urolesan, Kanefron, Cyston, Fitolita - the action of which is aimed at dissolving kidney stones and their natural excretion with urine. In addition to the direct effect on already formed stones, these drugs:

• prevent the crystallization of mineral components in the urine;
• relieve inflammation;
• prevent the formation of edema;
• increase daily diuresis.

Extracorporeal shock wave lithotripsy. A non-invasive therapy in which kidney stones are broken up by high-energy shock waves and removed from the kidneys naturally. Suitable for crushing calculi, the size of which does not exceed 2 cm.

Note! Non-drug treatment Phosphate and urate kidney stones are better exposed. At the same time, oxalate calculi, which are found in medical practice most often removed surgically.

Surgical treatment

And how to deal with kidney stones, if their diameter significantly exceeds the "permissible" 4-5 mm and is several centimeters? In this case it is required. Surgical removal stones is shown at:

• severe pain in the lower back, which causes the pressure of the stone on the kidney tissue;
• violations of the physiological outflow of urine;
• development CKD symptoms and disorders of the renal blood flow;
• the appearance of hematuria (blood in the urine) associated with damage to the moving calculi of the urinary tract;
• the development of infectious and inflammatory complications of the KSD.

Percutaneous access involves the removal of stones through a small incision in the lower back using a special endoscopic instrument - a nephroscope. Such a method surgical intervention allows you to perform both nephrolithotomy (removal of the calculus entirely) and nephrolithotripsy (extraction of the stone after its preliminary crushing).

Benefits of this kidney stone treatment method:

• extensive experience in medical practice - percutaneous calculus removal is considered the "gold standard" of therapy;
• high efficiency (95%) even with big size stones;
• for complete cure one procedure is enough;
• reliability and efficiency - this type of surgical intervention is most often used in urology.

Transurethral stone removal

During transurethral nephrolithotripsy, a kidney stone is removed using special endoscopic equipment inserted into the urinary tract through the urethra - a ureteronephroscope. This minimally invasive technique is carried out under the general or local anesthesia, and consists of several stages:

1. Conducting a ureteronephroscope to the location of the calculus.
2. Bringing instruments for stone removal through a special channel in endoscopic equipment.
3. Removal of the calculus: if the diameter of the formation is small, a nephrolithotomy is performed, with a significant size of the calculus, the doctor crushes it into smaller pieces, and then removes it with the help of tools.

Benefits of transurethral stone removal:

• the method actively fights small and medium-sized calculi;
• successfully used to treat patients with chronic cardiovascular diseases, as it does not require the abolition of blood-thinning agents (unlike other types of surgery);
• carried out on an outpatient basis;
• does not require violation of the integrity of the skin and mucous membranes.

Laparoscopic and open surgery

At present, large abdominal operations were almost completely superseded by minimally invasive endourological methods of treatment. Laparoscopy and interventions through open surgical access are performed with:

• gigantic size of the stone;
• malformations of the urinary tract, not allowing for endoscopic surgery.

Despite being 100% effective, radical invasive surgery is dangerous long recovery patient and high risk development of complications after removal of the calculus. Today it is extremely rare.

Kidney stones can be compared to a time bomb. Long time they do not declare themselves, but one day they will lead to serious complications. Therefore, it is important to remove them in a timely manner - the main method of treatment. urolithiasis.

After surgery and a short recovery period, patients with nephrolithiasis are advised to eat right, observe drinking regimen, be physically active, treat in a timely manner infectious diseases bodies urinary system. These activities will normalize the disturbed metabolism and prevent the possibility of the development of new stones.

Modern urology is constantly trying to solve the problem: "how to remove stones from the kidneys in a minimally traumatic way?" and thanks to this, new methods of treating urolithiasis appear every year. To date, there are two fundamentally different approaches to removal - conservative (medication), instrumental and surgical (classical and minimally invasive).

Conservative removal of a stone in the renal pelvis can be ascending and descending. The essence of the top-down method of stone dissolution is to take medicines inside (parenteral), and ascending, in topical application special medications. It should be noted that downward litholysis () can only be prescribed for uric acid urolithiasis. For these purposes, Eisenberg's mixture is used. It is prepared by mixing 40 g citric acid, 60 g sodium citrate, 600 ml sugar syrup, 6 g of orange root tincture and potassium citrate 70 g. 5 ml is used, 3 times a day, for 6 months.

Besides medicine, high efficiency show the following drugs: Uralit-U, Blemaren, Soruran, Alkalit, Solymok, Magurlit. In parallel with the use of these medicines, it is necessary to constantly monitor the pH of the urine, which should be 7.0–6.5. The imbalance leads to the formation and precipitation of calcium phosphates, which form a protective shell on the stone, making it difficult to dissolve. Radiologically, such a process is visualized as a rounded calculus with a well-defined core in the middle. The control of urine pH is carried out by the patient himself with the help of special litmus papers with a scale.

When urine always has an alkaline reaction, therefore, ammonium chloride and citrate, methionine (0.5 g - 3 times a day), ammonium phosphate (1 g - 4 times a day) are used to dissolve them. When o apply magnesium salt 150 mg 2-3 times a day.

Recently, ascending dissolution of stones using a double-lumen urinary catheter Dormian is often used. The essence of this method is that lithotripsy fluid enters the renal pelvis on one side of the tube, and flows out on the other. For these purposes, special solutions containing chelates (trilon B, oxalate) are used. The latter are able to give other elements instead of calcium ions, which leads to the destruction of the stone. The solution must be at a certain temperature (37–38 degrees).

Instrumental Methods

Among instrumental methods needs to be highlighted. Its essence lies in the fact that a special sighting device is aimed at the formation area, followed by ultrasound radiation. Such waves are in contact with the calculus at a certain frequency. Both during the procedure and after it, a slow destruction of the formation occurs. Crushed fragments descend into the ureter and out with the flow of urine.

Indications for this treatment method:

• the presence of a size up to 25 mm with obligatory patency of the lower urinary tract;
• multiple kidney stones up to 30 mm;
• coral-like stones up to 40 mm and without dysfunction of the organ.

General contraindications:

• large weight of the patient;
• the impossibility of precise guidance of the shock wave on the calculus;
• obstruction of the urinary tract;
• severe deformity of the spine;
• blood clotting disorder;
• pregnancy;
• acute pathologies of the cardiovascular system;
• aneurysm of the aorta or renal arteries;
• thrombophlebitis of the lower extremities;
• malignant tumors of the abdominal cavity;
• ulcers in the digestive tract;
• diabetes;
• active tuberculosis;
• diseases of the central nervous system.

Local contraindications:

• inflammatory process in the urinary organs;
• a large amount of blood in the urine;
• renal venous insufficiency;
• leukocytes in the urine (about 100 or more);
• severe bacteriuria;
• the presence of a stone in the ureter at the same level for more than 4 weeks;
• the calculus completely covers the lumen of the urinary tract;
• renal polycystic;
• tuberculosis of the urinary system;
• malignant tumor in the pelvic area;
• azotemia.

Surgical methods

Surgical interventions are considered highly effective, but at the same time they have clear indications for carrying out. These include:

1. Frequent bouts of colic that affect a person's ability to work.
2. Persistent violation of the outflow of urine, leading to swelling of the kidney.
3. Frequent diseases with pyelonephritis, which leads to the development of renal failure.
4. Purulent inflammation of the kidney (abscess, carbuncle, festering cyst).
5. A calculus in one kidney or ureter that interferes with the flow of urine.

Among the classical surgical interventions, it is necessary to single out organ-preserving and radical methods. Total removal of the organ (nephrectomy) is used as a necessary measure and also has its indications: calculous pyonephrosis, hydronephrotic transformation of the kidney in the extreme stage, apostematous pyelonephritis. These indications are the main ones, since there are many times more of them and it all depends on general condition sick.

Among organ-preserving surgical interventions, it is necessary to distinguish two main types - nephrotomy and resection. The essence of these methods is that after opening the organ, the calculus is removed from further recovery its integrity and, if necessary, its drainage. It should be noted that before and after the surgical intervention, a supporting drug therapy.

It is necessary to add that after organ-preserving procedures in many cases it is required reoperation. This is associated with recurrence of nephrolithiasis and secondary blockage of the urinary tract.

One of modern methods treatment of calculi, especially staghorn calculi, is considered percutaneous (percutaneous) nephrolithotripsy. It's minimally invasive surgical intervention is carried out by the formation of a puncture fistula of the pyelocaliceal system and the removal of a calculus through its channel under endoscopic control. The most commonly used is ultrasonic lithotripsy. To perform such a manipulation, rigid nephroscopes, various loops, clamps, an ultrasound generator and a special tip that generates waves are used.

The procedure begins after the nephrostomy is performed, and after a few days the nephrostomy tube is removed, followed by the introduction of a small tube into its lumen. optical system. After that, crushing of the calculus begins under the control of this optical system. Larger stones are removed using loops and clamps, or they are crushed and then washed out. The nephrostomy tube is left in place for several days after the operation.

Kidney stones can be removed with medication, instrumental and surgically, but most effective methodology considered minimally invasive surgery.