When the renal stone disease develops to a serious scale and is accompanied by the formation of sufficiently large concrements, only the surgical removal of stones or their fragmentation remains. Removing concrements from the renal parenchyma by dissecting the tissues of the organ is called nephrolithotomy.
The procedure for removing stones is carried out by several methods. Percutaneous puncture( or percutaneous) nephrolithotomy is a technique that is performed using a special device - a nephroscope. This is a minimally invasive endoscopic operation, carried out through several small incisions above the area of the affected kidney. Sometimes nephrolithotomy is carried out through the open cut. Carrying out nephrolithotomy requires mandatory ideal kidney excretion, since without this it is impossible to isolate the renal artery.
Nephrolithotomy is performed in the presence of such indications:
Indications for nephrolithotomy and operation
- Large coracoid calculus;
- Deeply located stones
in the cup system of the kidneys;
- In the presence of excessive branching of coral stones with an arrangement in the cup structure of the second order;
- If it is impossible to remove the calculus through the pelvis;
- If there are stones larger than 2 cm;
- Sometimes nephrolithotomy is prescribed in renal colic;
- In case of uselessness of lithotripsy and other more gentle methods of removal of renal calculi.
procedure Before performing an operation to remove stones from the kidney tissues, the patient must undergo preoperative examination, including:
- General urine test;
- Urine culture with detection of sensitivity to antibiotic group preparations;
- Deployed clinical laboratory blood test;
- Blood biochemistry;
- Rhesus, group;
- Blood for HIV, hepatitis and syphilis;
- X-ray diagnostics of the chest cell area;
- Consultation of the therapist and anesthesiologist.
About a week before the surgery, it is important to stop taking medications: aspirin and Warfarin, tocopherol and Clopidogrel, Plavix and Diclofenac, Coumadin and Celebrex, Voltaren, Fraxiparin and the like. Usually, such medications are used for cardiovascular pathologies, so you can not stop taking them yourself, you need to consult a doctor.
It is important that urine tests are good, there is no infection. If an infectious process is found, then it is necessary to cure it, only then to conduct surgical intervention.
Technique for performing the
The patient is anesthetized, after she acts on the patient in the side make a cut( ≈., The patient is usually located on the abdomen.) The doctor determines the location of the kidney, if necessary, a long hose, similar to a tube, can be inserted into the kidney. Through it, a contrast is introduced into the organ, as in renal urographic diagnosis
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After completing the cut, the surgeon inserts into the organ a special tube through which in the future will be producedremoval of concrements. This tube introduces nephroscopic equipment, through which the crushing, removal of stones. Therapy is technically quite complex. In accordance with the arrangement of concrements, the type of incision chosen is polar, transverse, radial, etc.
If the stone is coral and too branched, sectional ones are carried out. After the extraction of the calculus, suturing with catgut sutures is performed, usually the nodal suture is applied to the kidney, since it is least likely to disturb renal hemodynamics.
One fragment of coral calculus from a cup with parenchyma suturing is performed by the surgeon in approximately 5 minutes, then proceeds to the next fragment. And so, until the entire concrement is removed. After that the parenchyma is sewn, then the cut on the side is sewn up. The patient is left in the emergency room before awakening, and then transferred to the department.
On video, performing nephrolithotomy:
Recovery period of
During the postoperative recovery, patients may experience discomfort in the area of the operated kidney, so in the early days patients are anesthetized. Also, a characteristic postoperative phenomenon is nausea caused by an anesthetic. But doctors do not provide for food restrictions. Normal food can be eaten when nausea passes. In the first days after the intervention, it is recommended to drink more, in order to wash the urinary ways in a natural way.
It is important already on the first evening after surgical removal of concrements in this way it is necessary to get up from the cot and start walking. Early mobility will avoid the formation of thrombi in the vascular channels of the legs.
The patient can go to the shower, but the bathtub is still banned. The specialist will determine the date of the examination to identify residual calculi, and to determine the closure of the nephrostomy.
The main contraindication for the operation:
- Tumor neoplasm on the way to the stone;
- Urinary tract infections;
- Cancerous tumors;
- Blood flow problems.
Percutaneous puncture nephrolithotomy is now increasingly used in patients with coral stones in the kidneys. This is a more gentle technique than conducting an open surgery. Therefore, complications after it, as a rule, do not arise.