Whether the kidney stone is blocked in the urethra or remains wisely in the kidney but exceeds 1 cm, it must be removed. There are three techniques of lithotripsy.
In the first intention, on a calculus not exceeding 1.5 cm, they opt for extracorporeal lithotripsy. Performable externally or on an outpatient basis, effective at 70-80%, this method consists of fragmenting the calculation by shock waves applied to the exterior of the body. Natural routes then expel the stone.
The flexible ureteroscopy (one passes by the natural ways) and percutaneous nephrolithotomy (one passes through the skin) make it possible to remove more important stones.
Laser lithotripsy is a surgical technique used to remove kidney stones using wave types, ultrasonic, electrohydraulic, or shock. The holmium laser, in particular, is among the most advanced techniques and allows the treatment of urethroscopy or endoscopy, using a laser beam of thermal energy that eliminates obstructive tissue.
Laser lithotripsy is used to fragment all types of kidney stones, be it cystine, calcium oxalate monohydrate, or brushite (calcium phosphate). In fact, it offers:
- Great effectiveness in fragmenting any calculation
- Maximum control of the surgeon during treatment, since the laser introduces minimal propulsion or movement into the calculation
- Optimal use of fibers of different caliber and of great flexibility, which can be used with any endoscope
Laser lithotripsy is a minimally invasive technique. Access to kidney stones occurs through a puncture in the skin at the lumbar level or through the urethra to the bladder or ureter, depending on where the stone is located. It is introduced is a fiber-optic tube with a rigid and flexible tip, connected to a camera. Once the calculations are identified, they are fragmented with laser pulsation. The energy contained in the laser allows you to act quickly on the calculation.
Before performing laser lithotripsy, the patient must communicate to the doctor:
- If you are or could be pregnant
- The medications you are taking
In addition, the doctor may request, in the days preceding the intervention, to stop taking acetylsalicylic acid, anti-inflammatories, or drugs that make blood clotting difficult. On the day of the procedure, the patient must:
- Do not drink or eat for several hours before the surgery
- Take the medications indicated by your doctor accompanied only by a small sip of water
The insertion of an endoscopic instrument into the urinary tract can cause it to swell, which in turn can hinder the passage of urine from the kidney to the bladder. As a result, a catheter should be placed temporarily within the urinary tract. Although it is slightly annoying, it is useful for carrying out normal urination. In addition to the discomfort of the urethral catheter, in some cases, there may be slight bleeding in the urine, which does not last for more than five days. It is always recommended that the patient be accompanied, even if it is an outpatient intervention, and that he be taken home. Once at home, rest and taking antibiotics and anti-inflammatories are indicated. On the following day of the operation, the patient can already return to daily activities. However, you need to drink lots of fluids in the following weeks, 8-10 glasses a day, to help remove debris. A month after the procedure, the patient will have to undergo a metabolic examination, with an evaluation of urine and blood for 24 hours, in order to study the factors that can intervene in the formation of the stones. To this is added a chemical examination to analyze the exact components of the calculation.
Extracorporeal lithotripsy is a non-invasive procedure for the treatment of kidney stones with shock waves. Its goal is to shatter the stones into small pieces. It is a safe procedure, in use since the 1980s, which is preferred to surgery in the treatment of large kidney stones.
The procedure is often used to treat people with stones in both the kidney and ureter. It can be less painful and risky than other procedures and is more effective for treating less dense stones and, therefore, easier to crush.
Treatment of this type is more likely to be recommended if:
- The calculation was not expelled naturally
- Intense pain is felt
- An infection has developed
- Kidney function is at risk
Extracorporeal shock wave lithotripsy usually takes half an hour to perform, without the need for any hospital stay. The patient is asked to lie down on an examination table on a pillow in a prone or supine position, depending on where the kidney stone is located. The procedure involves the use of high energy shock waves aimed at the kidney stones that pass through the body with the aim of crushing them. The stones, once crushed, leave the body through the urinary tract.
Preparation for extracorporeal lithotripsy
Although the procedure does not involve any surgical manipulation, the intensity of the shock waves could cause pain and, therefore, a sedative or anesthetic will be administered in the pre-intervention phase in order to perform the operation.
After the operation, the patient will be given an hour or two to recover and will be asked to drink a lot of liquid in order to help the stones get out of the body. It is important to rest for a few days after the procedure, avoiding driving, or drinking alcohol. The doctor will schedule a follow-up checkup to check that the kidney stone fragments have come out of the body. If there are others to be removed, it may be to check for new kidney stones. It is advised to repeat the procedure. Finally, further regular checks are likely to be needed.
There are a number of alternative treatments for kidney stones that may be more suitable depending on the size and location of the stones:
- Smaller stones can be treated with a type of medication called alpha-blockers, which relax the muscles of the ureter.
- Surgery with a ureteroscope is also a treatment option for smaller stones. The procedure involves inserting a thin probe with a camera mounted through the ureter and using special tools to shatter the calculation.
- In the presence of larger stones and if it is not possible to perform lithotripsy, a type of intervention known as percutaneous nephrolithotomy may be recommended. This procedure is sometimes recommended, even if extracorporeal shock wave lithotripsy has not been successful.