Operative treatment among methods of getting rid of kidney diseases occupies an important place. Cavity operations in recent years are often replaced by endoscopic ones. Often, patients are recommended such an intervention, as pyelolithotomy, which will be discussed below.
Pyelolithomy - what is it?
The operation of pyelolithotomy involves the removal of stones from the renal pelvis after it has been dissected. Basically, such intervention is carried out if it is impossible to perform ultrasound or laser crushing of stones - with large stones, with stones that sprout into all parts of the pelvis, etc. The operation can be carried out in different ways, depending on the indications.
Indications
The patient is assigned a similar operation for such indications:
- Large stones in the renal pelvis;
- Cor angulate concrements;
- Large stones in the ureter;
- Concrements of a peculiar shape that can not be shredded or removed in any other way.
The operation is indicated if other types of manipulations and minimally invasive procedures have not produced the proper result, as well as patients with abnormalities of pelvis structure, with strictures( constriction) of the ureters. It is necessary to remove stones operatively, if the condition of the urinary tract does not allow them to be removed after crushing in a natural way.
Types of
There are three main types of operation:
- Open. It is planned in the presence of stones of the largest size, including - coral nephrolithiasis, as well as in the absence of more sophisticated equipment in the clinic. During the intervention, a large incision is made to access the ureter and pelvis.
- Laparoscopic. It is carried out through punctures in the abdominal cavity, into which tools and medical equipment are introduced. It is usually recommended, if other methods of treatment of urolithiasis did not bring results, but you can do without cavitary surgery.
- Retroperitoneoscopic. It is an endoscopic intervention, for which it is not necessary to make cuts( through natural holes), it gives much less complications.
Preparation of
Before any type of intervention as preparation, a number of tests must be submitted and the following examinations should be performed:
- Urine boiling;
- General blood test;
- General analysis of urine;
- ECG;
- Review radiography of kidney and ureter;
- Excretory urography.
The patient should take X-ray pictures and urograms with him on the operation, they are in the operating room during the intervention.8 hours before surgery you can not eat, for 3 hours - drink water, smoke.
Progress of operation
Usually pyelolithotomy is performed under general anesthesia and lasts from 1 to 3 hours, depending on the type and complexity. Endoscopic operations are done through the urethra, introducing the necessary instruments and removing the calculi in parts.
In laparoscopic surgery, 2-3 punctures are performed through lateral access, with open pyelolithotomy the incision is made up to 10 cm long along the costal arch. Lateral( transluminal) access does not allow the abdominal cavity to be used, but a special operating table is needed to use it. Through the abdominal access with a cut in the peritoneum pyelolithotomy is done if the concrements are present in the lower part of the ureter.
After the deenergizing of consciousness and the execution of a layer cut, the physician identifies that part of the urinary system that will be operated on. Further, the kidney or ureter is cut, the stone is removed. Then complete suturing of the organs with absorbable material, or partial suturing with the installation of drainage. The latter option is used if there is a purulent process or hydronephrosis, and there is a need for a catheter for subsequent washing with antiseptics and antibiotics. After layer-by-layer suturing the patient's wounds are transferred to the intensive care unit.
On video, retroperitoneoscopic pyelolithotomy:
Contraindications
Do not do pyelolithotomy, if there are such contraindications:
- Diseases of the blood system, including - coagulopathy.
- Severe anemia.
- Decompensated stages of heart disease.
- Any critical body condition.
Temporary bans are acute infectious disease, the use of blood-thinning drugs, exacerbations of chronic pathologies, including in the urinary system. To eliminate such problems, the operation can be performed. But for emergency indications pyelolithotomy is done almost without restrictions.
Rehabilitation period
In the early rehabilitation period, the patient is prescribed analgesics, non-narcotic analgesics, and NSAIDs to reduce the pain syndrome. Depending on the type of operation a person can stay in the hospital for 6-14 days, which is necessary to monitor his condition and reduce the risk of complications.
Sutures are removed on day 10( with open and laparoscopic surgery).Walking is allowed from the second day after the intervention, but for the entire recovery period, physical exertion is strictly limited. Antibiotics are prescribed for 7-10 days, according to indications - heart drugs, medicines for hypertension.
The full rehabilitation period will be 2 months( after endoscopic surgery - a month), at this time a person takes a number of phytopreparations.
Possible complications of
During the execution of pyelolithotomy, damage to the ureter, rough extraction of the stone with damage to the tissue of the pelvis, bleeding from the injured vessels may occur, but they are rare.
Consequences of surgery in the rehabilitation and long-term period sometimes become:
- Bleeding from the urinary tract with rupture of sutures.
- Urine leakage from the wound due to rupture of the suture on the pelvis.
- Ureteral strictures due to improper execution and suturing of the ureteral-ureter segment.
- Pneumothorax and other pulmonary disorders( usually detected in the first days after pyelolithotomy).