PERCUTANARY (PERCUTANEOUS) NEPHROLITHOTRIPSY IN THE VITAMED MEDICAL CLINIC

PERCUTANARY (PERCUTANEOUS) NEPHROLITHOTRIPSY IN THE VITAMED MEDICAL CLINIC

Urologist, endourologist at the VITAMED MEDICAL clinic Rakhmatillaev Shokhrukhbek Yusupzhonovich will introduce you to an article on the topic of percutaneous (percutaneous) nephrolithotripsy.

Percutaneous nephrolithotripsy is one of the most effective and safe methods for removing kidney stones (stones), which are the main manifestation of urolithiasis. The essence of the method is to remove urinary tract stones, in which the stone is removed from the kidney through a “tube” inserted into the kidney through a small hole in the back.

Crushing of stones is carried out by contact method - by exposing them to a shock wave (laser, ultrasound, pneumatic). Removal of the resulting fragments is carried out antegradely - using endoscopic instruments.

Who is indicated for percutaneous nephrolithotripsy?

Today, percutaneous nephrolithotripsy is performed for:

·         contraindications to DLT (external lithotripsy or extracorporeal shockwave therapy);

·         lack of effect from extracorporeal lithotripsy (if previous ELT sessions were unsuccessful);

·         the need to eliminate obstructive complications of extracorporeal lithotripsy;

·         “infected” and “impacted” kidney and ureteral stones;

·         large (more than 2 cm), coral-shaped and multiple kidney stones;

·         as a combination therapy, for example, the patient first undergoes an EBRT session, and then percutaneous nephrolithotripsy.

·         narrowing of the ureteropelvic segment (this condition prevents the spontaneous passage of stones);

·         large upper ureteral stones.

Contraindications

The following contraindications for percutaneous nephrolithotripsy have been identified:

·         pregnancy;

·         severe coagulopathy (blood clotting disorder);

·         acute inflammation of the kidneys or urinary tract – nephritis, urethritis, cystitis;

·         conditions in which access to the kidney is difficult - obesity, splenomegaly, interposition (improper location) of the colon.

In each specific case, the question of the type of intervention is decided by the urologist individually, taking into account the characteristics of the disease.

Preparing for surgery

Before surgery, each patient is consulted by an anesthesiologist to identify contraindications to medications used during anesthesia and allergic reactions to medications. In addition, a list of medications that the patient uses is determined, since some medications can cause complications during surgery. For example, if a patient is taking anticoagulants, which can cause massive bleeding during lithotripsy, they must be discontinued 5-7 days before surgery. In addition to the anesthesiologist, a therapist and a urologist talk with the patient. The patient must report all existing diseases.

Before the operation, a thorough bowel preparation is carried out, and broad-spectrum antimicrobial drugs are prescribed to prevent infectious complications in the postoperative period.

The patient must undergo a clinical examination, including blood tests (general and biochemical), coagulogram, and urine tests. Instrumental examination methods include ultrasound of the kidneys and, if necessary, CT or MRI of the kidneys. Antibacterial therapy is prescribed.

How is percutaneous nephrolithotripsy performed?

The operation is performed under general, spinal or epidural anesthesia. Under ultrasound control, the operating surgeon performs a puncture of the renal pelvis, makes a small incision in the lumbar region and inserts an endoscope through it. Through an endoscope, the doctor examines the pelvic system, finds stones and crushes them under visual control. Small fragments are removed by constantly washing the pelvis; large fragments are removed using forceps. The operation lasts 1-3 hours. After the procedure is completed, a drainage is left in the kidney to prevent complications; it is removed after 2-4 days.

Postoperative period

The incision heals completely in 5-7 days, and the patient can be discharged from the hospital on the 3-5th day after surgery. In the early postoperative period, the patient may experience slight pain in the incision area. Transient hematuria, which resolves on its own within 12-24 hours after surgery, is considered normal.

The patient is not recommended to undergo heavy physical activity for 1.5-2 weeks after surgery.

You can always ask the clinic specialists any questions you may have.and VITAMED MEDICAL by sending a request by email or contacting us by phone:

info@vitamed.uz

(+998 71) 129-81-81

(+998 71) 129-82-82

Additional information:

www.vitamed.uz

Telegram channel - https://telegram.me/vitameduz

Ambulance – 1063, (+998 71) 129-00-03

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