Features of bilateral surgery
Stones in both ureters at the same time are an emergency situation: the outflow of urine from both kidneys is disrupted, and creatinine increases rapidly. Tactics depend on the condition: in case of anuria or infection, the kidneys are first drained with stents or nephrostomies, then lithotripsy is performed. If the condition is stable, both stones are crushed in one operation: the ureteroscope is sequentially inserted into the left and right ureter, the stones are destroyed with a laser, and stents are installed. Bilateral surgery saves anesthesia and treatment time, but requires an experienced endourologist and monitoring of renal function in the postoperative period.
When is contact lithotripsy needed?
- ureteral stones of any size, especially the middle and lower third, where ESWL is less effective;
- stones that do not pass on their own within 2–4 weeks or cause repeated renal colic;
- dense stones (more than 1,000 HU), which are difficult to crush remotely;
- stone with impaired urine outflow, kidney enlargement, infection - after drainage;
- ineffectiveness of one or two ESWL sessions;
- kidney stones up to 2 cm, if ESWL is not possible, using flexible ureterorenoscopy (RIRS).
How is the operation performed?
Under spinal or general anesthesia, an endoscope is inserted through the urethra into the bladder, then a thin ureteroscope with a diameter of 2–3 mm is inserted into the mouth of the ureter. Under the control of a video camera and, if necessary, x-rays, the doctor brings the instrument close to the stone. A holmium laser destroys stone of any density into dust or small fragments; a pneumatic lithotripter crushes with probe blows - the method is faster for large stones in the lower third. Large fragments are removed using a Dormia basket.
If the stone is in the renal pelvis or the upper third of the ureter, a flexible ureterorenoscope is used - it passes through the bends of the ureter and reaches any renal calyx (RIRS, retrograde intrarenal surgery). At the end, if there is swelling of the mucous membrane, an internal stent is installed for 1-3 weeks to ensure the outflow of urine. The operation takes 30–60 minutes, with RIRS – up to 90.
Preparation
The key study is MSCT without contrast: it accurately shows the size, density and position of the stone, which determines the choice of instrument. An ultrasound of the kidneys, a general and biochemical blood test, a coagulogram, a general analysis and urine culture are also needed - in case of infection, antibiotic therapy or drainage of the kidney is first carried out, otherwise the operation is dangerous due to sepsis. An ECG and consultation with an anesthesiologist are required. Hospitalization on the day of surgery, 8 hours on an empty stomach.
After surgery and stent
After contact lithotripsy, the patient spends 1 day in the hospital. If a stent is installed, within 1-3 weeks you may experience increased urinary frequency, discomfort in the lower back when urinating, and some blood - these are expected sensations from the stent, which are relieved by alpha blockers and antispasmodics. The stent is removed on an outpatient basis in a few minutes during cystoscopy. You can return to work in 3–5 days. Fragments of the stone are sent for analysis of the composition - according to this, the urologist prescribes a diet and prevention that reduces the risk of new stones by half.
Contact lithotripsy or ESWL
Extracorporeal lithotripsy (ESWL) is the most gentle method without anesthesia, but its effectiveness for ureteral stones, especially the lower third and dense ones, is 60–75%, and repeated sessions are often needed. Contact ureterolithotripsy solves the problem in one go in 95–98% of cases at the cost of anesthesia and one day of hospitalization. For kidney stones larger than 2 cm, percutaneous nephrolithotripsy is chosen. The final choice is made by the urologist based on MSCT data.
Crushing of ureteral stones in Tashkent
In the clinics below, contact ureterolithotripsy is performed with a holmium laser and a pneumatic lithotripter, including a flexible ureterorenoscope for kidney stones; there is MSCT, hospital and round-the-clock care for renal colic. The price list indicates one-way and two-way operations; anesthesia, stent and bed days are paid according to the price list. Sign up for a consultation with the results of an ultrasound or MSCT.
