What is Urolithiasis?
Urolithiasis, best known as suffering from kidney, urether or bladder stones, is the accumulation of the same urine, forming different size solid bodies. They are called “kidney stones” if these are present in the kidneys, “ureteral stones” if they are located in the ureter (urinary tract that connects the kidney to the bladder) or “bladder stone” in case of being in the bladder.
Why are stones formed?
The principal 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, the symptoms may vary. If they are very small, they can be expelled when urinating without mayor pain or problem. Nevertheless, if their size is bigger the following may occur:
- Blood in the urine- medically called hematuria, this occurs when the stone rasps the tract in the inside.
- Infections- the stones, regardless of the size, may cause many and constant infections. The risk of developing an infection increases when the same stone obstructs the urine flow and it remains retained in the kidney.
- Strong pain- technically known as renal colic, the pain is caused when the urinary tract is blocked by the stones. This pain occurs in the lower back and goes to the lower abdomen and genitals. Moreover, the pain is accompanied by vomit, swollen stomach and excessive sweating.
How can I avoid it?
The diet has to be modified to a healthier and more balanced one, which includes liquids (natural water is the best recommendation) without high levels of sodium, salt or sugars.
How is Urolithiasis treated?
For the last 25 years the Urolithiasis treatment has drastically evolved. The alternative of conventional surgery, practically the unique treatment option 25 years ago, is nowadays not used any more.
The development of new technology allows treating Urolithiasis with less invasive and more effective methods. The objective of any of these methods is the fragmentation of the stone “lithotripsy”, the extraction of the same or the elimination of stone fragments.
Basically there are two lithotripsy methods available: extracorporeal shock wave lithotripsy or intracorporeal lithotripsy:
Extracorporeal Shock Wave Lithotripsy:
It consists in the stone fragmentation through the application of power discharges (shock waves) from outside the body (extracorporeal) by a power generator. These shock waves travel through the skin and the different body structures until the stone is reached. The repeated shock wave impacts, favor the stone fragmentation, which is later expelled as sand or very tiny fragments through the urine without the presence of pain.
It is considered the less invasive treatment alternative, but is also the treatment option with more incidence of failure. The possibility of success with this treatment option depends on an adequate selection in relation to the size, consistence and location of the stone.
Intracorporeal Lithotripsy:
This treatment alternative allows the stone fragmentation by applying power discharge directly to the stone. In order to perform this, it is necessary to do an endoscopic procedure (introduce a very fine instrument) directly to the spot inside the urinary tract where the stone is located (kidney, ureter or bladder).
Although with this treatment it is necessary to introduce instrumentation inside the organism, the procedure is much more effective than the extracorporeal method, basically because the power discharge is applied under visual control and directly on the stone surface. Likewise it allows an exact control of the moment in which the entire fragmentation takes place and additionally allows the extraction of some of these fragments, permitting a posterior chemical analysis (important for the planning of a posterior preventive treatment).
Depending on the location of the stone in the urinary tract, the necessary endoscopic procedure to access under vision of the same may be: cystoscopy (stone in bladder), ureteroscopy (stone in ureter), retrograde or antegrade nephroscopy (stone in kidney). The development of new technology allows fine flexible tipped endoscopic instruments (flexible ureteroscopes) to be used in order to perform lithotripsy procedures, both in ureter and kidney, the most common places for stones to be located.
Once the endoscopic procedure has been performed and having visual control of the stone, a source of energy is required in order to apply it directly to the stone through the endoscope. The lithotripsy, endoscopic fragmentation or intracorporeal fragmentation alternatives are: Holmium Laser, pneumatic waves or ultrasound.
Holmium Laser:
The Holmium Laser is a multifunctional tool in minimally invasive endoscopic and laparoscopic procedures. This system is extremely effective in stone fragmentation of all types of composition and it vaporizes any kind of stone. Its main feature is that there is no heat radiation outside the application point, avoiding healthy tissue to be burned. The treatment is done through endoscopy and the patient requires being under anesthesia during the procedure.
Ureteroscopy and ureteronephroscopy procedure:
The endoscope is introduced (ureteroscope or ureteronephroscope), which is an optic fiber tube with a rigid or flexible tip connected to a camera. Once the stone is visualized, the fragmentation process starts through the laser pulse. The fragmentation can be controlled under vision to ensure the stone has been completely destroyed. Some fragments can be removed through the same endoscope using fine grip and traction instruments.
Post-Endoscopy care
Using an endoscopic instrument inside the urinary tract may cause swelling in the same, which makes it difficult for the urine to travel from the kidney to the bladder. Therefore, it is frequently necessary to place an internal catheter (double J ureteral catheter), this catheter remains temporarily in the urinary tract and even though it sometimes causes discomfort while urinating it allows to do conventional physical activities without mayor restrictions. In some cases, minor bleeding may occur in the urine generally limited to no more than 5 days.
The patient may go back home some hours after the procedure, it is advisable that a companion drives back home or to stay no more than one night in the hospital. The physician will prescribe antibiotic and anti-inflammatories, and if the patient requires it pain medication. During the next weeks, the patient is required to drink many liquids, from 8 to 10 glasses of water a day, this in order to help expel any fragment that may have stayed behind and more over to prevent the problem to be repeated.
One month after the procedure, you will be required to perform a metabolic study, which consists in the evaluation of 24 hour urine and in various blood factors that may intervene in urinary stone formation. This test will be complemented with the chemical and crystallographic study from the stone formation of the extracted fragments. The intention of this study is to help prevent the recurrent formation of urinary stones.
As you can realize, the urinary stone treatment is now performed through minimally invasive and low risk procedures.
If you have any doubt, do not hesitate in contacting us.
