Aspects of Urinary Tract Calculus Surgery New technology is more accurate and thorough

Urinary tract calculus is a common urological disease. Patients may be asymptomatic. However, when the calculi no longer "keep their feet", they may block the urinary tract, causing renal colic, hematuria and infection. In severe cases, it may even affect the kidneys. Function.

In the case of acute renal colic, the first priority is to relieve the pain with drugs. If a urinary tract infection or renal function deteriorates, it is necessary to perform percutaneous renal drainage or place a ureteral stent. Properly control the pain and infection first, and then deal with the stones .

This time, Dr. Yan Zou, a specialist in urology, is invited to share with you the details of the new technology of stone-shocking.

Treatment options for urinary stones depend on their location, size, density, and the function and structure of the urinary system.

Not all stones need to be removed immediately, such as stones smaller than 5 mm.

However, once the stones cause symptoms, they need to be treated. The options include: medical expulsion therapy (MET), extracorporeal shock wave lithotripsy (ESWL) and surgery.

Management of ureteral stones

Smaller stones have a higher chance of being passed naturally, and MET uses alpha-1 receptor blockers to relax the ureteral muscles, thereby helping to pass stones.

The course of α-1 receptor inhibitor treatment is 4 to 6 weeks, during which the doctor will monitor and evaluate the progress of stone removal for the patient.

If stone removal is not possible, ESWL or surgical treatment should be considered.

ESWL uses the principle of shock waves to focus the shock waves emitted by the instrument on the back skin of the patient and transmit them to the stones, shattering the stones, and the crushed stones will be naturally discharged through the urine, with a success rate of 70% to 80%.

As long as the location is correct, ESWL has minimal effect on adjacent organs.

In rare cases, the shock wave may affect nearby organs, causing bleeding.

The procedure of ESWL is simple, no anesthesia is required, patients can be discharged from the hospital on the same day, and complications are rare.

Patients must drink plenty of water after the operation, or take alpha-1 receptor blockers to increase the chance of natural passage of stones.

If the patient fails to pass the stone naturally through ESWL, ureteroscopic lithotripsy (URSL) is required.

The doctor will push the slender ureteroscope through the urethra and bladder into the ureter under X-ray imaging, and then use laser or ultrasonic waves to crush the stones. The stones can be excreted with the urine, or the stones can be taken out with an instrument.

The doctor can watch the situation of the broken stone from the screen.

Although URSL is a day surgery, it is invasive and requires partial or general anesthesia. The success rate is 90%.

Uncommon complications included injury to adjacent organs during the procedure leading to infection or bleeding (<5%), or reoperation due to injury to the ureter (<0.1%).

Kidney stone management

The treatment of kidney stones also depends on factors such as the size and number of stones, including ESWL and URSL mentioned above, and percutaneous nephrolithotomy (PCNL).

The traditional URSL lens is rigid and inflexible, and the flexibility of movement is limited. It is difficult to deal with kidney stones with tricky angles. Now a flexible ureteroscope has been developed, which can be bent up to 270 degrees during operation by the doctor, allowing the endoscope to Go straight to any corner of the kidney, and cooperate with the high-energy laser to crush the stones, "zero dead angle" to deal with the kidney stones that cannot be touched by traditional methods, and greatly improve the removal (efficiency) of kidney stones.

The price of the flexible ureteroscope used in the past was as high as hundreds of thousands, and it was easily lost due to repeated use; It was in new and best condition the first time it was used.

PCNL breaks through the traditional reversal and then reverses

PCNL is another minimally invasive surgery for kidney stones. After the location of the stone is determined by X-rays, an instrument is used to penetrate the patient's skin and enter the kidney. Air pressure, ultrasound or laser are used to crush the stone. The wound is about the diameter of a ball pen.

At present, the latest positioning technology is ultrasound combined with navigation, which has higher accuracy and allows less experienced urologists to master it with ease, making this operation popular.

In traditional PCNL, the patient needs to lie prone (with the back facing the sky) during the operation, but the application of ultrasonic navigation and positioning technology subverts this tradition, allowing doctors to turn the patient to a supine (lying flat) position in a short time and perform the operation.

The biggest advantage of lying on the back is that it can ensure that the patient maintains good breathing and blood circulation, and reduces the risk of anesthesia.

In addition, the technology of lying flat helps doctors deal with larger and more complex stones, and can treat multiple stones at the same time; even if there are still residual stones, it only needs to cooperate with URSL (ECIRS, Endoscopic Combined Intra Renal Surgery) during the operation. ), the best results can be obtained.

In addition to positioning technology, the laser used in stone surgery has also made new breakthroughs. The second-generation laser used in recent years is an intensified laser that can crush stones more thoroughly at a higher speed. Even larger stones only need to open a small Small wounds effectively reduce trauma and the risk of pain and bleeding for patients.

All in all, the breakthroughs in the treatment of urolithiasis are not only due to the rapid development of medical technology, but also urology experts' persistent investment in the research and development of surgical methods with better results and higher safety.

Hong Kong Urological Association website: https://www.hkua.org

Hong Kong Society of Urology YouTube channel: https://bit.ly/3H87xcn

*The content of this article is for reference only and cannot replace clinical medical advice. If you have any questions, please consult your doctor.

(Information provided by Hong Kong Urological Association)