Features of ultrasonic crushing of kidney stones. Traditional methods of treating kidney stones

Crushing kidney stones is a necessary manipulation for a wide range of patients suffering from urolithiasis. The process of formation and enlargement of stones is ongoing and is a consequence of persistent metabolic disorders.

Why remove kidney stones

It begins with collecting an anamnesis. The doctor should ask in detail about the diseases that the patient has or had, and check for the absence of contraindications.

In addition, a number of necessary laboratory tests are prescribed:

• General blood analysis. The doctor checks for an inflammatory process, hemoglobin levels (for hidden bleeding);
• . In the acute period of pyelonephritis (and even more so glomerulonephritis), lithotripsy is contraindicated;
• General fluorography;
• Blood sugar;
• A biochemical blood test allows you to assess the condition of the liver and kidneys. A coagulogram shows the doctor whether the body can cope with bleeding (this happens during lithotripsy);
• An ultrasound examination of the kidneys is performed, urinary tract as well as the prostate gland;
• Survey and excretory urography allows you to assess the patency and functional parameters of the urinary system;
• After 40, a preliminary consultation with a therapist (cardiologist) is required, with an interpretation of the electrocardiogram.

Preparation for lithotripsy includes vitamin therapy necessary to restore the kidney after manipulation, as well as drugs that improve microcirculation.

Before the procedure itself, it is necessary to empty the intestines, so laxatives and/or cleansing enemas are recommended. Currently, people are not admitted to the hospital for non-contact stone crushing methods. With the endoscopic method of stone removal, the doctor may recommend hospitalization for several days.

The process of crushing kidney stones

In most cases, a non-contact method is used. Before the procedure, sedatives and painkillers are prescribed.

Manipulation progress:

• The patient undresses (jewelry must be removed) and lies down on a special table;
• Ultrasonic guidance is performed, which allows you to determine the exact location of the stone (standing level). Based on the data obtained, an adequate position of the patient’s body is selected;
• A pillow of water is applied directly to the body;
• The device generates a series of waves that are felt by patients as tapping, and sometimes - slight pain in the area of ​​the body under the pillow;
• All this time the stone is visible on the ultrasound screen. The doctor sees how the stone is crushed under the influence of waves. As soon as the size of the fragments becomes small enough to pass painlessly through the urinary tract, the manipulation stops.

Stone expulsion therapy after lithotripsy

Immediately after the manipulation, the kidney is “littered” with fragments of stones. It is necessary to help the organ get rid of them. IN otherwise– fragments may begin to stick together or grow larger (depending on the type of stones). The following drugs are prescribed:

• No-spa, spasmalgon, drotaverine preparations. Antispasmodics reduce the risk of renal colic when stone fragments pass;
• Broad-spectrum antibiotics. A kidney provoked by manipulation can become a target for bacterial infection(ascending urinary tract infections). To prevent this scenario, fluoroquinolones or cephalosporins are prescribed prophylactically;
• Anti-inflammatory nonsteroidal drugs– nimesulide, diclofenac, etc. Reduce painful sensations when small stones pass. In addition, when the urinary tract is damaged by a fragment, the inflammatory response is reduced, which prevents blockage and the development of colic;
• To relax the sphincters and ureters, alpha-blockers, such as tamsulosin (Focusin), are prescribed.

Types of kidney stones diagnosed

The patient's condition and trace symptoms after crushing kidney stones

Immediately after the manipulation, an examination is performed. As a rule, the doctor leaves his contact information for communication and sends the patient home.

Here is a list of symptoms common after lithotripsy:

• Frequent urination. This is normal, goes away after some time, does not require any treatment;
• Traces of blood in the urine. This symptom should disappear 2-3 days after lithotripsy. It may be associated both with the manipulation itself and with trauma to the urinary tract from stone fragments. This most often occurs when oxalates (a type of stone) break down. If there is blood in the urine 3 days after the procedure, consult a doctor;
• Renal colic caused by the passage of fragments. IN in this case– antispasmodics help well, since the fragments are small;
• The temperature can rise to 380C. If it rises higher or lasts longer than 3 days, consult a doctor.

For the first two weeks after the procedure, visit your urologist every 3 days.

Non-contact forms of lithotripsy are the best that modern medicine can offer to patients with urolithiasis.

The indications for this procedure should not be neglected, since stones tend to enlarge, which leads to serious complications and, in some cases, to the death of the patient. As a rule, the formation of stones is associated with metabolic disorders. After lithotripsy, try to find out what you can do to prevent new stones from forming. Depending on the type of metabolic disorder, you may be recommended special diet

, physiotherapy, as well as elements of reflexology aimed at accelerating organ recovery and improving overall metabolism.

Video about contact crushing of kidney stones

Urolithiasis is an unpleasant phenomenon that turns into a real disaster when excrement comes out, causing severe pain in the patient. Timely treatment can not only save a person from suffering, but also protect his life. A great way is crushing. Let's look at how kidney stones are crushed using ultrasound below.

If the kidney stones have reached a considerable size, the doctor may prescribe stone crushing, called lithotripsy. Due to the influence of a directed ultrasonic wave, vibration reactions occur. As a result, cracks form in the stones, leading to the stone being destroyed.

• Lithotripsy may be prescribed in the following cases:
• if the size of the formations in the kidneys has reached 1-2 cm;

when drug therapy has not produced results.

Crushing stones using this technique is allowed only in a laboratory. There is a possibility that bleeding from the urinary tract may begin, so doctors should always have resuscitation equipment nearby. Indications for the use of this method are stones of all types, localized in bladder

, kidneys or ureter and are unable to exit on their own due to their considerable size. Also, the lithotripsy procedure can be prescribed for renal colic, which often recurs.

Important! The presence of a stone must be proven.

Preparatory procedures

• To achieve guaranteed success, the patient should be prepared for the lithotripsy procedure. The patient must undergo examination, including:
• Ultrasound examination of the kidneys;
• excretory urography;
• fluorography;
• General analysis of urine and blood;

Important! Not all patients are necessarily prescribed a similar list of diagnostic procedures. The purpose of some is determined by age (for example, ECG).

The essence of lithotripsy

A lithotripsy session boils down to the following:

1. Through diagnostics, the exact location of the excrement is determined;
2. The ultrasound sensor is positioned so that it is exactly above the location of the stone;
3. The area is exposed to high-intensity rays for about a quarter of an hour.
4. Using a nephroscope inserted into the kidney area, small pieces of stone are removed.

If successful, the patient is discharged from the hospital after 3-4 days.

Main types of ultrasonic crushing procedure

There are several types of procedures that can be used to remove kidney stones using ultrasound.

1. Extracorporeal

This simple method is perfect for those whose stones have reached considerable sizes, up to 35 mm. The procedure is a shock wave that is aimed at a specific point on the stone. When the energy reaches its maximum, the calculus disintegrates into separate pieces. The whole procedure takes no more than 40 minutes. The magnitude of the shock waves depends on the formation itself, in particular, its size and structure. The success of this type of operation allows the patient to return home within 24 hours.

1. Remote

This type involves the destruction of the stone by focusing an acoustic wave at a separate point, without damaging the soft tissue. For this type of procedure, it is very important to accurately determine the location of the stone, as well as the distance between it and the radiation source.

1. Contact removal

With this method of lithotripsy, it is assumed that ultrasound will act at the point of contact of the genitourinary tract with the calculus. This method assumes that the fragments will be removed after the procedure using a nephroscope or urethroscope.

Important! After contact removal, a stent must be placed in the ureter, which will be removed by the doctor after 7 days, unless, of course, complications arise.

Removing stone formations using the contact method has a number of advantages, including:

• low likelihood of injury;
• high efficiency (80-100%);
• Several stones can be removed at the same time;
• One session is usually enough for complete healing;
• no need for preliminary anesthesia;
• After the operation, no traces will remain.

Lithotripsy technique

Before lithotripsy, the patient must cleanse the intestines. After this, he lies down on the table, having previously undressed. If there is such a need, the patient is given painkillers and sedatives before the procedure.

Important! If the patient has inflammation, then 14-15 days before the session he is prescribed antibacterial drugs.

The patient's position should be such that maximum accessibility to the stone is ensured.

After specifying the location of the stone, a special pillow filled with water is placed on this area.

After all these steps, the crushing procedure is performed. It is considered complete when the size of the crushed pieces is such that they can easily pass through the ureter.

The entire lithotripsy process is under the control of a specialist who carries it out through an image displayed on the monitor.

After the stone crushing procedure, the following reactions may occur:

• frequent urination, accompanied by painful sensations;
• the occurrence of hematuria;
• pain attack;
• temperature increase.

Upon completion of the ultrasound lithotripsy procedure, the patient may be prescribed hospital treatment(5-7 days), during which antibacterial therapy is carried out, antispasmodics and painkillers are prescribed.

However, it is advisable to combine lithotripsy with conservative treatment methods and, first of all, with proper nutrition.

Disadvantages of lithotripsy

Despite all the uniqueness this method, it does, however, have disadvantages.

1. Using this method to get rid of large entities(more than 20 mm) will be impossible.
2. If the density of the stones is high enough, more than one session will be required.
3. There is a risk that large enough pieces may become lodged in the ureter.
4. The sharp edges of the pieces emerging through the ureters can injure the mucous membrane, resulting in bleeding and renal clicking.
5. Such treatment does not exclude the possibility that new stones may form.

Another significant disadvantage of lithotripsy is the high cost of the procedure.

Contraindications

Despite the fact that the ultrasonic crushing procedure is quite safe, not everyone can use it. Thus, lithotripsy is contraindicated:

• during pregnancy;
• for bone abnormalities;
• patients with low levels of platelets in the blood;
• with aortic aneurysm;
• if there are large cysts in the kidneys;
• people with heart disease;
• for acute infectious diseases;
• patients with oncology.
• In cases of urinary tract abnormalities in which urine is retained in the kidneys.

Lithotripsy is a technique that is already quite well established.

Possible complications

The process of crushing kidney stones using ultrasound has a very low probability that complications may develop, especially when we are talking about modern equipment and highly qualified personnel. However, it is the duty of any doctor to warn the patient that complications may still arise and what they are. The most common complications include:

• development of hematoma in the kidney;
• the appearance of a “stone hematoma”, which can become the root cause of relapse;
• the occurrence of an acute infection in the kidneys.

Preventing kidney stones

Urolithiasis is an unpleasant disease that is much easier to prevent than to treat later. You can reduce the risk of developing this disease by:

• first get rid of extra pounds and harmful addictions, if any;
• take more frequent walks fresh air, try to lead an active lifestyle;
• organize your food balance by making your diet varied and balanced;
• observe drinking regime;
• If possible, visit sanatorium-resort complexes.

Ultrasound lithotripsy is just one method of treating kidney stones. However, it is he who has established himself as one of the most effective and affordable.

Anton palaznikov

Gastroenterologist, therapist

Work experience more than 7 years.

Professional skills: diagnosis and treatment of diseases of the gastrointestinal tract and biliary system.

Today, urolithiasis occurs in both adults and infants. Stones formed for a variety of reasons can begin to move down the urinary tract and provoke attacks of severe pain, called renal colic, or clog them and cause the development of life-threatening complications.

Therefore, timely treatment allows not only to protect the patient’s life, but also to deprive him of terrible torment. A the best way lithotripsy or crushing kidney stones with ultrasound is suitable for this.

What is ultrasound lithotripsy?

The method of crushing kidney stones with ultrasound is based on the targeted impact of a high-energy ultrasonic shock wave on the stone. As a result, tension and vibration arise in the stone, which leads to the appearance of cracks in it.

Lithotripsy is used to remove stones of any kind, localized in different parts of the urinary tract, if they are unable to pass out on their own or their number and size are so large that this threatens the patient with constant, prolonged attacks of renal colic.

Crushing kidney stones is possible only after receiving complete information about the patient’s health status, which allows not only to determine the correct sequence of manipulations, but also to avoid the development of serious complications. Therefore, patients are prescribed a number of examinations, including:

• Ultrasound examination of the kidneys;
• excretory urography;
• determining blood sugar levels and so on.

Important: not all patients are prescribed the same list of diagnostic procedures; for example, an ECG is usually indicated for people over 40 years of age.

How is the procedure performed?

Crushing of stones can be carried out contact-wise and remotely. In the first case, under general anesthesia with the help of endoscopic equipment, a device emitting ultrasonic waves is placed in the kidney, directly next to the stone. This leads to the destruction of stones to the smallest fragments, which are washed out of the organ with injected liquid or special suction. This operation is characterized by a low degree of trauma.

During external lithotripsy, the ultrasound wave emitter is located outside the patient's body. Due to the absence of the slightest punctures on the body, many prefer this type of stone crushing, but there is an opinion that, due to the great force of the shock wave, it can vibrate the kidneys and cause contusions. In any case, the sequence of actions for remote crushing of stones can be described as follows.

1. Immediately before the procedure, patients should clear their intestines of feces.
2. The patient undresses and lies down on a special table.
3. He is given painkillers or sedatives.
4. The doctor determines the exact level of the stone.
5. The patient is placed in a position that will allow direct exposure of the ultrasound waves to the stone.
6. A special pillow with water is installed in the projection of the calculus.
7. The stone is directly destroyed by successive ultrasonic impacts until the broken fragments are commensurate with the size of the ureter and urethral canal.

Attention! The doctor constantly monitors the procedure through the monitor and, as the stone is crushed, if necessary, can make changes to its course, for example, ask the patient to change his position.

Consequences of the procedure

• antispasmodics;
• antibiotics;
• diuretic teas;
• NSAIDs;
• α-blockers.

Advice: patients should strictly follow all the doctor’s recommendations and take all medications prescribed by him, fully observing the dosage and timing of use, as this will allow the stone fragments to be removed from the body as quickly and painlessly as possible, as well as to avoid the development of complications.

Today they are answered by the head of the regional urological department of the City Clinical Hospital of Zhukovsky, Moscow Region, Candidate of Medical Sciences Andrey Rumyantsev.

Tell me, does the composition of kidney stones matter? Have you heard that when crushed, carbonate stones crumble best?

Ekaterina, Pskov

When choosing a method surgical treatment urolithiasis, the size of the stone, its position in urinary tract, as well as the visibility of the stone during an x-ray examination - is it x-ray negative or x-ray positive, that is, is it visible on an x-ray or not. The mineral composition of a stone in clinical practice is important only when choosing a preventive diet that excludes certain foods, or special medications that help dissolve stones that are not visible on x-rays.

To be continued?

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

Alexey, Kaliningrad

-Unfortunately, it often relapses. Therefore, after surgery, try to stick to your diet, limiting your diet to meat and fish dishes, which contain a lot of purines, which promote the synthesis of uric acid in the body and, as a result, stone formation.

Drink more - at least 1-1.5 liters per day to dilute the urine: in a saturated solution, crystals of uric acid and salts of other elements form faster.

Not bad preventive effect allows the use of phytotherapeutic agents that have a weak diuretic and antibacterial effect. And, of course, keep your health under control - take urine tests every 3-6 months and do an ultrasound of the kidneys, ureters and bladder every six months.

Against the background of urolithiasis, they often develop inflammatory diseases urinary system. In their acute stage(unless it is an emergency), stones cannot be removed. First, it is necessary to conduct a bacteriological study (culture) of urine to determine the amount and sensitivity of the patient’s microbial flora to antibacterial drugs and cure the inflammation. And only then can modern surgical methods of treating urolithiasis be used as planned.

Remove or wait?

I have . They say we need to get rid of them. But it doesn't bother me yet. So, maybe it’s not worth flogging the fever?

Vasily, Yoshkar-Ola

It all depends on the size of the stones and the changes they cause in the urinary tract. It is no secret that the presence of stones in the bladder or ureter is a source of inflammation and can lead to chronic pyelonephritis, renal failure, even kidney death, which may subsequently require renal replacement therapy (hemodialysis) and a kidney transplant.

So, if you have undergone the appropriate examination and your attending physician has decided that you need surgery, it is better to listen to his advice and not delay resolving this issue.

Risk factors for urolithiasis are:

>> genetic predisposition;
>> chronic diseases of the gastrointestinal tract and genitourinary system;
>> osteoporosis and other bone diseases;
>> dysfunction of the parathyroid glands;
>> abuse of foods that increase the acidity of urine (spicy, sour, salty), as well as an abundance of protein in food, a monotonous diet;
>> drinking hard water with a high salt content.

Chop or delete?

I suffer from urolithiasis. And I am faced with a choice: should I crush my stones or remove them? Which is better to choose?

Olga, Nizhny Novgorod

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

In other cases, doctors resort to three methods: extracorporeal lithotripsy (ESLT), transurethral (through the urethra) contact and percutaneous nephrolitholapaxy.

In the first case, crushing of a stone (usually medium in size - from 1 to 1.5 cm) is carried out using a special remote lithotripsy apparatus, which, by creating a special field, fragments kidney stones without internal intervention in the human body.

The other two methods involve tissue penetration and are more often used for larger and multiple stones. The essence of these methods is as follows: under the conductor or general anesthesia The patient is punctured in the skin above the kidney and, under ultrasound and X-ray control, an optical system is inserted inside through a special tube, or an instrument is brought into the stone through the urethra along the ureter.

Then, using special devices (ultrasonic, laser, pneumatic, electric pulse), the stone is crushed. Thanks to these techniques, you can immediately destroy all the stones and remove their fragments. In this case, the patient returns to active life much faster than if traditional open surgery were used.

However, the choice of stone removal method is a matter for the doctor.

Urolithiasis can be recognized by the following signs:

>> pain and a feeling of heaviness in the lower back, just above and to the side of the sacrum;
>> pain in the lower abdomen, as well as in the groin, in the genital area;
>> blood in the urine;
>> pain when urinating, frequent urination, cloudy urine;
>> swelling;
>> increase in body temperature.