Contents
Ureterolithotomy is a surgical treatment for urolithiasis. This is urolithiasis, in which calculi form in the organs of the urinary system. They damage the mucous membranes of organs, provoke pain, discomfort, bleeding and problems with urination. Stones can form in the bladder itself, causing cystitis (inflammation), or get there from the kidneys. Surgeons use ureterolithotomy to remove stones. What do you need to know about the procedure, how exactly is it performed, and what risks should the patient be aware of?
General characteristics of the intervention
Laparoscopic ureterolithotomy is an invasive surgical procedure aimed at removing a stone from the lumen of the ureter. The operation is indicated for complications of urolithiasis. The formed calculus can reach a critical size and block the lumen of the ureter. This will complicate the outflow of urine and the process of urination itself, which will be accompanied by severe pain. Also, ureterolithotomy is indicated for renal colic and the ineffectiveness of other methods of dealing with urolithiasis.
The method is indicated only for urolithiasis. There are other surgical and non-surgical techniques to treat nephrolithiasis (kidney stones).
When is ureterolithotomy indicated?
In modern realities, ureterolithotomy is quite rare. Why? Firstly, people began to worry more about their own health and manage to fix the disease before complications develop. Secondly, lithotripsy is much more popular among doctors and patients. This is a minimally invasive method by which the surgeon crushes stones into small fragments using an ultrasonic / laser / radio wave shock wave. But doctors distinguish a number of cases in which they are ineffective, and the only chance for salvation and a quality life of the patient is ureterolithotomy.
Intervention is indicated for the removal of too large and dense calculi. The shock wave simply will not be able to crush them apart, and the doctors will lose precious time. The operation is necessary when there is a sharp difficulty in the outflow of urine. The condition can develop with the expansion of the pelvicalyceal system, damage to the kidneys and a failure in their functionality.
Ureterolithotomy is performed when the ureter is blocked. The complication develops against the background of acute pyelonephritis (inflammation of the pelvicalyceal zone). Stagnation of urine only aggravates kidney damage, and the patient himself needs immediate medical attention. The operation is indicated when other treatment tactics are ineffective and there is a high risk of damage to the urinary tract.
Contraindications to the procedure
Intervention is contraindicated in only three cases. The first of them is the presence of an acute inflammatory process in one or more organs of the urinary system. The infection can easily enter the bloodstream, abdominal cavity and spread throughout the body. Where it leads? To infection of the abdominal cavity, general infection of the body, the transfer of dangerous microorganisms to other organs, which will affect their work.
The second contraindication is obesity of the third degree and above. Excess fat will not allow the doctor to freely operate the equipment, which can cause complications. The third group of contraindications is general surgery. They include too young or old age for surgery, pregnancy / lactation, a specific reaction to anesthesia, concomitant diseases or conditions that may affect the course of the intervention.
How to prepare for the operation?
The first step is to undergo a comprehensive diagnosis of the body. It includes:
- Urologist consultation. The specialist will study the history, listen to complaints, identify the problem and issue a referral for tests and diagnostic procedures.
- Ultrasound examination of the ureters. Ultrasound will confirm / refute the presence of calculi, help to assess their size and location. In some cases, the patient will need to study not only the ureter, but also the bladder or kidneys.
- X-ray or computed tomography. Methods allow the doctor to clarify the characteristics of the disease and choose the best method of treatment.
- Biochemical blood test, urinalysis. They allow you to find out the chemical composition of the calculus, to identify the state of the blood before surgery.
- Therapist’s consultation. The doctor conducts a general consultation, may prescribe additional studies such as an ECG or ultrasound in order to protect the patient as much as possible.
- Anesthesiologist consultation. The specialist excludes intolerance / hypersensitivity to a particular method of anesthesia.
Immediately before the operation, the patient is prescribed antimicrobial drugs, cleanses the intestines, removes hair from the pubis and lower abdomen. The surgeon will inform you about additional manipulations on an individual basis.
Surgical technique
Before the operation, the surgeon consults the patient, asks him to sit comfortably on the couch on his healthy side, injects anesthesia and proceeds with the removal. The doctor makes an incision (about 7 of them are made during the operation), highlights the ureter and separates it from the connective tissue. With the help of palpation, the surgeon determines the location of the stone, applies clamps, makes an incision on the wall of the ureter and expands it with scissors. The calculus is removed with clamps through the lumen. At this stage, it is very important not to damage the walls of the internal organs and not to destroy the calculus into pieces.
After removing the stone, the specialist checks the patency of the urinary tract, additionally examines the ureter for pathological changes. If they are not identified, the wound is sutured and drainage is installed in it. Then the surgeon checks for the presence / absence of bleeding, eliminates side effects if necessary, and sews up the remaining incisions. The operation time varies from 40 to 90 minutes.
Rehabilitation period
After surgery, the patient is transferred to the intensive care unit. There, medical staff monitor him, monitor vital functions (respiration, heart rate, etc.), evaluate the body’s reaction and monitor general well-being. The patient spends at least 3 days in the hospital. You can take care of yourself and move freely the very next day after the intervention. All this time, the patient is injected with individually selected medications, the condition of the wound is checked and treated with antibacterial substances.
The first 2-5 days the patient feels pain or slight discomfort in the area of intervention. The intensity of the pain can vary, so assess your condition and let your doctor know if you need pain relief. Possible side effects include nausea, vomiting, lethargy, and weakness. All of these symptoms are a normal reaction of the body to stress and should go away on their own within a few days.
Skin sutures are removed 7-10 days after the operation. If there are no complications, and the patient’s well-being is not suspicious, the rehabilitation period is about a month. During this time, the patient is prohibited from physical activity, a change in diet, the use of drugs, daily treatment of the intervention area and regular consultations with a doctor are indicated. So the doctor can prevent complications, side effects and quickly put the patient on his feet.
Possible complications and side effects
After the intervention, the patient may bleed. Most often, blood loss is minimal and amounts to 100 milliliters. But the reaction of the body can be unpredictable. If you notice symptoms of bleeding, tell your doctor immediately. On the first day after surgery, urine may accumulate in a certain part of the ureter. A small amount will penetrate the surrounding tissue through the sutures. The problem can be easily eliminated by high-quality drainage.
A high risk is also associated with infection. The infection can get inside simply during the operation, if it takes place in non-sterile conditions, or during the contact of the sutures with the pathological environment. How to avoid it? Before the intervention, the patient is always offered to undergo an antibacterial course in order to minimize the risk of infection. Follow your doctor’s instructions, clean the wound daily, maintain personal hygiene, and avoid visiting potentially dangerous places. Among the possible complications, doctors distinguish damage to neighboring organs and the development of a postoperative hernia. Both conditions are extremely rare and depend on the actions of the surgeon.
A ureterolithotomy is a surgical procedure to remove stones from the ureter. The method is used for complicated course of urolithiasis. Any operation is a colossal stress for the body, after which intensive recovery is required. In the first month, it is necessary to exclude physical activity, switch to a healthy diet, follow the doctor’s instructions and protect yourself from serious stress. This speeds up rehabilitation and contributes to a quick return to the usual rhythm of life. Remember to visit your doctor regularly and stay healthy.