The consequences of advanced urolithiasis (ICD) are very dangerous — up to the loss of a kidney and death. Therefore, it is necessary to be treated on time. Moreover, today it is often possible to get rid of the stone without surgery. Or minimally invasive.
aif.ru told about this urologist, oncologist, doctor of the highest qualification category, senior researcher of the A.V. Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of Russia, Candidate of Medical Sciences Alexander Pranovich.
Leave no stone unturned
Many people are convinced that over the years, sand accumulates in the kidneys, so they are supposed to be cleaned periodically. In fact, there is no sand in our body, but a microsuspension of various particles may be present in the urine, from which stones then grow. These microparticles cannot be determined by any visualization methods — they are too small. Yes, and you don’t need to do this, because you don’t specifically need to remove them from the body — they already come out with urine.
However, under certain conditions, stones form from these particles in the kidneys. When they reach a size of more than 2 mm, then doctors will already be able to see them. However, not any imaging method is suitable for this: after all, stones located in the kidney can also be seen by ultrasound, and those located in the lower urinary tract can only be seen by computed tomography (CT).
In general, it is CT of the kidneys and ureters that is the gold standard in the diagnosis of urolithiasis (UCD). Because this study helps not only to see the stone itself, to determine its exact size, but also to suggest the chemical composition based on its density. The scientific developments of the Department of Urology of the Center for Surgery are aimed at exploring the possibilities of deep machine learning in determining the detailed chemical composition of the stone. Before taking any therapeutic measures, it is necessary to conduct a thorough diagnosis, otherwise the risk of dangerous complications will be too great.
From small to large
Stones up to 7 mm after consultation with a doctor and in accordance with Russian clinical guidelines, you can try to remove them from the body without surgery, using lithokinetic therapy. Herbal medicines (diuretic herbs, kidney preparations and teas), drugs from the alpha-1 blockers and non-steroidal anti-inflammatory drugs, as well as plant-based drugs are used for it. When the stone passes through the urinary tract, renal colic may occur. Renal colic is an attack of intense pain that occurs due to a sharp violation of the outflow of urine from the kidney. For uncomplicated renal colic, the following are recommended:
— non-steroidal anti-inflammatory drugs. NSAIDs have analgesic, antipyretic and decongestant properties — due to this complex action, they can facilitate and accelerate the passage of the stone;
— selective alpha-1 blockers. They relax the smooth muscles of the narrowest part of the ureters — near their entrance to the bladder, making it easier for the stone to leave the body;
— antispasmodics. Relieve muscle spasms.
In addition to taking medication, a patient with renal colic is advised to follow certain rules:
— drink more to increase the outflow of urine;
— actively move (then the stone is also activated);
— take a hot bath (it will relax and anesthetize).
Even small stones can be expelled only under the guidance of a doctor. Indeed, in the process of lithokinetic therapy, there are complications. The pain itself is not a reason to stop efforts — the stone simply will not come out painlessly. But if the sensations experienced by the patient are unbearable and if painkillers do not stop them, or if the temperature has risen against this background (above 37.7 degrees), then it is urgent to stop amateur activities and call an ambulance. In addition, lithokinetic therapy requires great care if the patient has only one kidney.
Modern «stone quarries»
In stationary conditions, stones can be removed surgically.
Urology is one of the most high-tech areas in medicine. The proportion of endoscopic operations (performed through the natural urinary tract using endoscopes and laser devices) is about 90% of all interventions in urology. And about 7% more account for minimally invasive surgery (for example, percutaneous surgery, which is performed through punctures in the lower back). With the help of a laser surgical complex, surgeons crush stones (including large ones, over 1.5-2 cm in diameter, and staghorn ones) in all parts of the urinary tract and in the kidneys.
If the density of the stone is low (this will be shown by CT), there is a chance to crush it remotely, by shock waves, without damaging the skin. This is subject to such a device as a remote lithotripter.
What is metaphylaxis
All stones after the operation are subject to mandatory examination by infrared spectroscopy (such an analysis determines the composition of stones with maximum accuracy). There are many types of stones. The most common are phosphate and oxalate. Less commonly, uric acid stones (they are the only ones that can be completely dissolved thanks to drugs, the rest are only partially dissolved). But not only treatment depends on the composition of the stones, but also the prevention of KSD, as well as metaphylaxis (aimed at preventing the recurrence of the disease after treatment).
According to statistics, the recurrence of kidney stones within 5 years after surgery occurs in 40-50% of cases, and within 10 years — in 70-80% of cases. To reduce the risk of recurrence, it is important for a patient with KSD to examine at least one stone that has come out (or extracted) from it. For example, according to the composition of the calculus, a special therapeutic and prophylactic diet is selected. In addition, in order to determine the personalized methods of metaphylaxis, it is necessary to find out the causes of stone formation. To do this, it is necessary to investigate the congenital prerequisites for the formation of stones or to correct the acquired causes (for example, to cure urinary tract infections).
In Moscow, on the basis of the A.V. Vishnevsky Center for Surgery, free schools for patients with KSD are held every last Thursday of the month. At these «lessons» doctors talk about the disease, methods of treatment, the composition of stones, answer questions from patients. Also, in addition to training, you can get a free kidney examination.