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Endourology


Endoscopic Treatment for Urinary Lithiasis
What is urinary lithiasis?

Urinary lithiasis, better known as kidney or bladder stone disease, is the accumulation of the same urine, forming solid bodies of different sizes. They are called «kidney stones» if they occur in the kidneys, «ureteral stones» if they are in the ureter (urinary tract that connects the kidney with the bladder) or «bladder stones» if they are found in the bladder.

Why are the calculations formed?

The main reason is the accumulation of salts in the urine or the failure to process inhibitors in the urine.

Symptoms

Depending on the size of the stones, different symptoms can occur. If these are very small, they can be passed when urinating without major pain or problem. However, if they are larger, the following may occur:

Bleeding in the urine – Medically called hematuria, this occurs when the stone scrapes the airways inside.
Infections – Stones, regardless of size, can cause several constant infections. The risk of developing an infection increases when the same stone causes obstruction to the urine outlet and this remains retained in the kidney.

Intense pain

Technically known as renal colic, the pain is caused by the urinary tract becoming blocked by stones. This pain occurs in the lower back and runs to the lower abdomen and genitals. In addition, the pain is accompanied by vomiting, a swollen belly and excessive sweating.

How can I avoid it?

The diet should be modified to a healthier and more balanced one which includes fluids (plain water is the best recommendation) without containing high levels of sodium, salt and sugars.

How do I treat urolithiasis?

During the last 25 years the treatment of urinary stones has drastically evolved. The conventional surgery alternative, practically the only treatment option 25 years ago, is no longer used today. The development of new technology now makes it possible to treat lithiasis with less invasive and more effective methods. The objective of any of these methods is to perform the stone fragmentation “lithotripsy” and to extract or favor the removal of the stone fragments.

There are basically two methods of lithotripsy: extracorporeal lithotripsy or intracorporeal lithotripsy.

Extracoporeal Lithotripsy:

It consists of the fragmentation of the stone through the application of energy discharges (shock waves) formed from outside the body (extracorporeal) by an energy generator. These shock waves travel through the skin and various body structures until they hit the stone. The repeated impact of shocks or shock waves, favors the fragmentation of the stone, which is later eliminated in the form of sand or very small fragments through the urine without discomfort.

This is the least invasive treatment alternative, however it is also the treatment alternative that has the highest risk of failure. The possibility of success with this treatment option depends on an adequate selection in relation to the size of the stone, the consistency of the stone, the location of the stone.

Holmium laser:

The Holmium Laser is a multifunctional tool in minimally invasive endoscopic and laparoscopic procedures. This System is extremely effective in the fragmentation of stones of all types of composition and vaporizes any type of kidney stones. Its main characteristic is that there is no heat radiation outside the point of application, which prevents burns to healthy tissue. Treatment is done through endoscopy and the patient requires anesthesia during the procedure.

Ureteroscopy or ureteronephroscopy procedure:

The endoscope (ureteroscope or ureteronephroscope) is inserted, which is a fiberoptic tube with a rigid or flexible tip which is connected to a camera. Once the calculus has been visualized, they begin to fragment through the pulsation of the laser. Fragmentation can be monitored under vision to ensure that the stone has been completely destroyed. Some fragments can be extracted through the same endoscope using fine grasping and pulling instruments for the fragments.

Post-Endoscopy Care

Using an endoscopic instrument inside the urinary tract can cause inflammation of the urinary tract and this in turn makes it difficult for urine to flow freely from the kidney to the bladder. Therefore, it is frequently necessary to place an internal catheter (double-J ureteral catheter) after the endoscopic procedure, this catheter remains temporarily inside the urinary tract, and although it sometimes causes discomfort when urinating, it allows physical activities conventional without major restrictions.

As you can see, the treatment of urinary stones is now carried out through minimally invasive and low-risk procedures.
For any question, do not hesitate to contact us.

Copyright Dr. José Luis Canto Pérez 2021. All rights reserved.