What is lithotripsy? Types description

What is lithotripsy?

Description

Lithotripsy is the destruction of stones in various parts of the urinary tract (kidneys, ureters, bladder, urethra) using various types of energy impact.

There are the following types of lithotripsy (stone crushing):

  • remote lithotripsy
  • transurethral contact lithotripsy
  • percutaneous (or chrysanthemum) lithotripsy

The possibilities of using this or that method depend on the location, size, and density of the calculus (stone). In many cases, the wishes of the patient are also taken into account.

Remote lithotripsy (DLT)

A method in which crushing of a kidney (or ureter) stone is achieved by focusing a shock wave on it from the outside. By the types of energy used, the following types of lithotripters are distinguished: 

  • Piezoelectric
  • Electro-hydraulic 
  • Electro-magnetic.

Focusing the shock wave on the stone is carried out using ultrasound or under X-ray. In most cases, operations are performed under general anesthesia (anesthesia).

Shock wave lithotripsy (SWL) can destroy small kidney stones (up to 2 cm), as well as ureteral stones. 

Being the least invasive method, SWL has a number of significant limitations:

  • The density of the stone  (stones of high density – more than 1000 units on the Hounsfield scale – often cannot be effectively destroyed. We have to resort to repeated sessions of lithotripsy or use other methods).
  • The size of the stone  (crushing of kidney stones larger than 2 centimeters is often associated with a violation of the passage of stone fragments through the ureter, which is manifested by repeated renal colic, as well as the most formidable complication – a “stone path”, when many small stone fragments get stuck and accumulate in the ureter. often so-called residual (residual) stones remain in the kidney, which further lead to a relapse of stone formation).
  • When performing remote lithotripsy, shock wave damage to healthy tissues around the stone  is always noted  – the parenchyma of the kidney, the wall of the ureter. In this case, hematuria (visual impurity of blood in the urine) occurs, which is observed in more than 90% of cases after SWL.

Transurethral Contact lithotripsy – laser stone crushing

A method of surgical treatment, in which stones are crushed with the help of special thin instruments – ureteroscopes, which deliver a destructive impulse directly to the stone. These operations are always performed under general anesthesia (anesthesia).

According to the types of energy used,  contact lithotripsy is distinguished into: 

  • pneumatic 
  • laser
  • ultrasonic
  • transurethral

Endoscopic visual control allows you to crush a stone in any part of the urinary tract and completely remove the stone fragments out. For crushing stones in the cups and pelvis, special flexible instruments are used.

For this method, there are much fewer restrictions than for extracorporeal lithotripsy:

  • The density of the stone does not matter: even very dense stones can be destroyed with the help of a powerful laser.
  • There is no damage to healthy tissue around the stone.

In the vast majority of cases, contact lithotripsy can completely crush a bladder, ureter or kidney stone in one operation. The use of endoscopic techniques also ensures a quick return to daily activities: the period of stay in the urology department of the clinic is usually 1-2 days.  

Read also: What is BBL Surgery? Cost, Procedure and FAQs

Percutaneous lithotripsy 

Surgical endoscopic method for the treatment of large and coral kidney stones, in which access to the stone is made through a puncture in the lumbar region. Operations are performed under general anesthesia (anesthesia). This method is more invasive than distance and contact lithotripsy, however, it allows you to completely destroy and evacuate large (more than 2 cm) and even coral-shaped stones (performing the entire renal calyceal system).

This method of treatment in our clinic is available free of charge under the High-Tech Medical Assistance (HMP) program.

  • In the urology department, the method of endoscopic transurethral laser lithotripsy (crushing of urinary stones) has been introduced into practice using the unique flexible Olympus and Karl Storz endoscopes.
  • Such operations allow completely (“into dust”) to crush multiple, large (up to 2-3 cm) and super-dense stones in any part of the ureter and kidney. This intervention is carried out completely endoscopically, without disturbing the skin and is one of the most high-tech and minimally invasive methods of treating urolithiasis.

The use of flexible small-diameter endoscopes minimizes the risk of damage to the urinary tract and promotes a speedy recovery – discharge for outpatient treatment is possible already on the second day after the operation with full preservation of working capacity. 

In difficult clinical cases, when large stones (more than 2.5 cm) and coral calculi are detected, percutaneous nephrolithotripsy (PNL) is used. Access to the kidney during this operation is made through a puncture in the lumbar region. This method is currently the world’s “gold standard” for surgical treatment of coral nephrolithiasis and successfully replaces open surgery. 

Performing PNL at the urology department of the N.N. NI Pirogov is possible under the program of high-tech medical care (free of charge). 

Operations are carried out using the latest equipment from the world’s best manufacturers: Olympus, Karl Storz, Richard Wolf.

Along with high-tech operations – transurethral laser lithotripsy and percutaneous lithotripsy, the urology department also performs traditional endoscopic operations for ureteral stones of any localization. These minimally invasive surgeries are performed, among other things, within the framework of compulsory medical insurance (free of charge). 

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