When urolithiasis is characterized by the formation of stones in the kidneys, ureters and bladder. There are a lot of reasons for its occurrence. This and metabolic disorders, and violation of urine outflow due to various comorbidities. And the stones - this is a characteristic consequence of urolithiasis. But be that as it may, the treatment of this disease begins exactly when the already formed concretions begin to annoy the patient to a great extent.
The formation of stones in the ureter
The formation of stones occurs, as a rule, in the kidneys. They enter the ureters from the renal pelvis along with the urine outflow. In the presence of stones in the ureters, the main symptom is renal colic. Small stones from the ureter enter the bladder and are eliminated from the body naturally or with the use of conservative therapy. It should be noted that the lower the stone is located in the ureter, the more likely it is to leave it alone.
Urotic stones can be removed from the ureter, by dissolving them in substances that reduce the acidity of urine - using the so-called litholytic therapy.
Stones with a diameter of more than six millimeters cannot be independently brought out of the ureter. In such cases, resorted to their removal using various surgical methods.
Large ureteral stones with a diameter of more than five millimeters must be removed even when they do not cause any physical discomfort. Especially if they are located in the middle or upper parts of the internal organ. This is due to several important points.
First, the presence of a stone in the ureter always leads to the appearance of renal colic, characterized by acute cramps and pain. Secondly, stones in the ureters are the main obstacle to the normal flow of urine. Even if this does not show complete blockage of the ureter, the presence of calculus is the cause of increased pressure and unnatural expansion of the urinary tract. What can lead to hydronephrosis - the expansion of the renal pelvis. And this is a direct path to the destruction of the parenchyma of the kidney.
Also, the violation of the outflow of urine and the slowdown of its removal from the body is fraught with another dangerous disease - pyelonephritis, which is characterized by the presence of an infectious-inflammatory process in the urinary system.
Methods of examination and diagnosis, indications for the removal of stones
In order to know exactly what size stones formed in the ureter, as well as to check for possible violations of the excretory function, the urologist will prescribe a complete clinical examination of the patient, including:
- Ultrasound, which is possible to determine the size of the calculus;
- radiograph of the kidneys;
- intravenous urography, in which you can determine the presence of violations of the outflow of urine;
- general urine analysis;
- urine bakposev and urinary sediment microscopy;
- complete blood count and blood biochemistry.
In addition, in some cases, if there are medical indications, scintigraphy, urine biochemical analysis, computed tomography, antegrade or retrograde pyelography may be prescribed.
Based on the results of the examination, as well as the presence of certain symptoms, the doctor prescribes certain therapies. Urgent indications for the removal of ureteral stones are:
- persistent renal colic;
- bilateral localization of stones;
- the appearance of an infectious-inflammatory process on the background of urolithiasis, leading to urosepsis and pyonephrosis;
- persistent chronic pain with proper conservative therapy;
- violation of urine outflow, leading to renal failure.
Methods for removing adrenal stones
The main methods of removing stones from the adrenal glands include:
- contact ureteroscopic lithotripsy;
- remote shockwave lithotripsy;
- endoscopic retroperitoneal ureterolithotomy;
- percutaneous nephroureterolithotomy with or without crushing;
- open operation;
- ureterolitic extraction.
Before the method of stone crushing was invented, which happened in the early eighties of the twentieth century, the method of open surgery was considered the main method of removing stones in the ureter.
To date, this method is used in the most severe cases when the use of crushing methods is contraindicated.
The choice of one or another method of removal of calculus is influenced by its size, level of location in the ureter, as well as the density and chemical composition of the stone.
Ureterolite extraction method
This method is often used when it is necessary to remove the stone from the middle or lower part of the ureter. It is used when the size of the stone is less than six millimeters, when you can get rid of it without first crushing.
Such an operation is performed under spinal anesthesia and takes a period of time from ten minutes to one and a half hours, depending on the location and size of the calculus. The duration of the operation also affects the individual features of the structure of the ureter.
Initially, the lumen of the ureter is filled with a special contrast agent, which allows to confirm the presence of a stone in the ureter, as well as to check the condition of the urinary tract, which do not fall into the field of view of the endoscope. After that, a string is inserted into the cup-lochanous region of the kidneys, which contributes to the subsequent installation of the ureteral stent.
Then ureteroscopy is performed, with the help of which various pathological formations in the lumen of the ureter are detected - tumors, strictures or concrements. This procedure is performed using a ureteroscope - an optical instrument consisting of a lighting lamp, an eyepiece and a flexible tube with a distal head. In the cavity of the tube are optical fibers, suction and instrumental channels. Such a device is equipped with video equipment that allows you to project on the screen everything that happens during the operation.
After the place of localization of the calculus has been reached, special extractors are brought to it using the working channel: endoscopic forceps, a loop of Zeiss or a basket of Dormia, used to grip the stone.
Under radiographic and visual control, the calculus is carefully removed from the ureter. If the lumen of the ureter is too narrow, it is possible to crush the stone in place so as not to damage the mucous membrane.
This procedure ends with the drainage of the kidney with an external or internal ureteral stent. The terms for which the drainage is established are individual and depend on the time of the operation, the condition of the urinary tract, the duration of the calculus, and the general condition of the patient. Usually, the urethral catheter and external ureteral stent are removed a day after surgery.
The presence of an internal stent allows the patient to be discharged the next day after the operation, however, it requires repeated hospitalization after three to four weeks for its removal.
Contraindications and possible complications of ureterolitic extraction
It is strictly forbidden to conduct such a procedure if the patient has the following conditions:
- prostatic hyperplasia, since this disease leads to a narrowing of the urinary canal, which is an obstacle to the passage of the endoscope;
- acute infectious-inflammatory processes of the urinary system (urethritis, pyelonephritis, cystitis), as a result of ureterolitic extraction, the infection can spread not only through the urinary tract, but throughout the body;
- urethral strictures constricting the urinary canal, which prevents the passage of endoscopic equipment;
- large calculus.
In the presence of the above symptoms, it is recommended to conduct open surgery - pyelolithotomy or ureterolithotomy.
After ureterolitic extraction, there may be some serious complications in the patient. Among them, the appearance of bleeding of varying intensity, caused by damage to the vessels of the urinary tract, obturation of the urinary tract, occurring against the background of large stones, when it is stuck in the narrowest place when it moves out and its further extraction is impossible due to the likely damage to the urinary tract, damage to the ureter .
Other types of complications can also occur: infections of the urinary organs, acute urinary retention, strictures and urinary canal scars, and others.
Ureterolithoe extraction is one of the types of endoscopic intervention used to remove ureteral stones. This procedure applies to minimally invasive methods of treatment of complex forms of urolithiasis. Before carrying out such an operation, the doctor must send the patient to a comprehensive examination, which allows to detect the presence of possible contraindications.