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Treatment of lithiasis

The treatment of renal lithiasis depends largely on the size, location and number of stones in the urinary system. Fortunately, most of the small kidney stones (5 mm diameter or less) do not cause symptoms and infections and will disappear if the patient drinks great amounts of fluids every day. The consumption of two to three liters of water increases the production of urine, which eventually will eventually drag the kidney stones in the system. Once they have come out, you do not need any other treatment. The doctor will usually ask the patient to keep the stones that were removed for analysis.

In addition, renal colic i.e. the sudden pain in the sides that occurs when the small stones begin to move down the ureter, can usually be treated with rest and analgesics or pain relievers. Certain types of stones, like those formed by uric acid, can be dissolved with medical treatment. However, the majority are composed of calcium and do not respond to medical treatment.

Surgery may be required if a stone:

Does not drop

Is greater than 8 mm

Obstructs the flow of urine

Is accompanied by a concomitant infection

Damages the renal function

Keeps growing

Until recently, surgery to remove stones was very painful and required a long recovery period. Nowadays, the treatment of these stones has dramatically improved and there are many options thanks to the Endourology (minimally invasive surgery inside the urinary tract).

Ureteroscopy (URS)

Ureteroscopy is performed using ureteroscopes i.e. small flexible or semi-rigid telescopes that can be inserted through the urethra and the bladder until the ureter without any need to make incisions. Ureteroscopy was developed in the 1970s and began to be widely used in the 1980s. These instruments allow the doctor to view the ureteral stone directly. They have small working channels through which it is possible to switch devices to remove or fragment the stone.

 

It is usually performed under general anaesthesia and an endoprosthesis (double-J catheter) is left in the ureter for a few days after the procedure.

 

The risks of ureteroscopy include the drilling or development of a stricture (scar tissue), especially if the calculation was impacted in the ureteral wall. Most of the ureteroscopic procedures may be performed on an ambulatory basis in the USDS.

Percutaneous nephrolithotomy (PCNL)

This procedure is the treatment that is used for kidney stones larger than 2 cm and that are found in places that do not allow ESWL to work effectively. In this procedure, the surgeon makes a tiny cut in the area of the side and then uses an instrument called Nefrosis Amiloidea to locate the stone and remove it. For larger stones, it may be necessary to use an energy probe (ultrasonic, electro-hydraulic or hydraulic) to break the stone into smaller parts.

Diagnostic and therapeutic alternatives

Diagnostic and therapeutic alternatives available in LYX are:

1

Metabolic evaluation of the lithiasis

2

Flexible and rigid ureterorenoscopy assisted by Holmium laser

3

Retrograde intrarenal surgery (RIRS) assisted by Holmium laser

4

Percutaneous nephrolithotomy

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