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Urolithiasis is characterized by the formation of stones in the kidneys, ureters and bladder. There are many reasons for its occurrence. This is a metabolic disorder, and a violation of the outflow of urine due to various concomitant diseases. And stones are already a characteristic consequence of urolithiasis. But be that as it may, the treatment of this disease begins precisely when the already formed calculi begin to largely annoy the patient.
Formation of stones in the ureter
Stone formation usually occurs in the kidneys. They enter the ureters from the renal pelvis along with the outflow of urine. In the presence of stones in the ureters, the main symptom is renal colic. Small stones from the ureter enter the bladder and are excreted from the body naturally, or with the use of conservative therapy. In this case, you should know that the lower the stone is located in the ureter, the greater the likelihood of its independent exit.
Urate stones can be removed from the ureter by dissolving them in substances that help reduce the acidity of urine – using the so-called litholytic therapy.
Stones with a diameter of more than six millimeters cannot be brought out of the ureter on their own. In such cases, they resort to their removal using various surgical methods.
Large ureteral stones with a diameter of more than five millimeters must be removed even when they do not cause any physical discomfort. Especially if they are located in the middle or upper sections of the internal organ. This is due to several important points.
Firstly, the presence of a stone in the ureter always leads to the appearance of renal colic, characterized by acute cutting and pain. Secondly, stones in the ureters are the main obstacle to the normal outflow of urine. Even if there is no complete blockage of the ureter, the presence of a calculus causes increased pressure and unnatural expansion of the urinary tract. Which can lead to hydronephrosis – the expansion of the renal pelvis. And this is a direct path to the destruction of the kidney parenchyma.
Also, a violation of the outflow of urine and a slowdown in its excretion from the body is fraught with another dangerous disease – pyelonephritis, which is characterized by the presence of an infectious-inflammatory process in the urinary system.
Methods of examination and diagnosis, indications for the removal of stones
In order to know exactly what size the calculi formed in the ureter, as well as to check for possible violations of the excretory function, a specialist urologist prescribes without fail a complete clinical examination of the patient, which includes:
- Ultrasound, in which it is possible to determine the size of the calculus;
- radiograph of the kidneys;
- intravenous urography, in which it is possible to determine the presence of violations of the outflow of urine;
- general urine analysis;
- urine culture and microscopy of urinary sediment;
- complete blood count and blood biochemistry.
In addition, in some cases, if there are medical indications, the following can be prescribed: scintigraphy, biochemical analysis of urine, computed tomography, antegrade or retrograde pyelography.
Based on the results of the examination, as well as the presence of certain symptoms, the doctor prescribes certain methods of therapy. Urgent indications for the removal of stones in the ureters are:
- persistent renal colic;
- bilateral localization of stones;
- the appearance of an infectious-inflammatory process against the background of urolithiasis, leading to urosepsis and pyonephrosis;
- persistent chronic pain with proper conservative therapy;
- obstruction of the outflow of urine, leading to renal failure.
Methods for removing stones from the adrenal glands
The main methods for removing stones from the adrenal glands include:
- contact ureteroscopic lithotripsy;
- remote shock wave lithotripsy;
- endoscopic retroperitoneal ureterolithotomy;
- percutaneous nephroureterolithotomy with or without crushing;
- open operation;
- ureterolithoextraction.
Before the invention of stone crushing, which occurred in the early XNUMXs, the main method of removing stones in the ureter was considered to be open surgery.
To date, this technique is resorted to in the most severe cases, when the use of crushing methods is contraindicated.
The choice of one or another method of removing a calculus is influenced by its size, the level of location in the ureter, as well as the density and chemical composition of the stone.
Method of ureterolithoextraction
This method is often used when it is necessary to remove a stone from the middle or lower part of the ureter. It is used when the size of the stone is less than six millimeters, when you can get rid of it without prior crushing.
Such an operation is performed under spinal anesthesia and takes a period of time from ten minutes to one and a half hours, depending on the location and size of the calculus. The individual structure of the ureter also affects the duration of the operation.
Initially, the lumen of the ureter is filled with a special contrast agent, which allows you to confirm the presence of a stone in the ureter, as well as to monitor the condition of the urinary tract, which do not fall into the field of view of the endoscope. After that, a string is inserted into the cup-lochanist region of the kidneys, which contributes to the subsequent installation of the ureteral stent.
Then, ureteroscopy is performed, with the help of which various pathological formations in the lumen of the ureter are revealed – tumors, strictures or stones. This procedure is performed using a ureteroscope – an optical device consisting of a lighting lamp, an eyepiece and a flexible tube with a distal head. Optical fibers, aspiration and instrumental channels pass through the cavity of the tube. Such a device is equipped with video equipment that allows you to project everything that happens during the operation on the screen.
After the localization of the calculus is reached, special extractors are brought to it with the help of a working channel: endoscopic forceps, Zeiss loop or Dormia’s basket, which are used to capture the stone.
Under radiographic and visual control, the calculus is carefully removed from the ureter. If the lumen of the ureter is too narrow, stone crushing in situ may be used to avoid damaging the mucosa.
This procedure ends with drainage of the kidney with an external or internal ureteral stent. The terms for which drainage is installed are purely individual and depend on the time of the operation, the condition of the urinary tract, the duration of the calculus, as well as the general condition of the patient. Usually, the urethral catheter and external ureteral stent are removed one day after the operation.
The presence of an internal stent allows the patient to be discharged on the next day after surgery, but requires re-hospitalization in three to four weeks for its removal.
Contraindications and possible complications of ureterolithoextraction
It is strictly forbidden to carry out such a procedure if the patient has the following conditions:
- prostatic hyperplasia, since this disease leads to a narrowing of the urination channel, which is an obstacle to the passage of the endoscope;
- acute infectious and inflammatory processes of the urinary system (urethritis, pyelonephritis, cystitis), since as a result of ureterolithic extraction, the infection can spread not only through the urinary tract, but throughout the body;
- urethral strictures, narrowing the urinary canal, which prevents the passage of endoscopic equipment;
- large sizes of stones.
In the presence of the above symptoms, it is recommended to perform open surgical interventions – pyelolithotomy or ureterolithotomy.
After ureterolithoextraction, there may be some serious complications in the patient. Among them, the appearance of bleeding of varying intensity caused by damage to the vessels of the urinary tract, obstruction of the urinary tract, which occurs against the background of large stones, when, when it moves outward, it gets stuck in the narrowest place and its further extraction is impossible due to possible damage to the urinary tract, damage to the ureter .
Other types of complications may also occur: infectious lesions of the urinary system, acute urinary retention, strictures and scars of the urinary canals, and others.
Summing up
Ureterolithoextraction is a type of endoscopic procedure used to remove stones in the ureter. This procedure belongs to the minimally invasive methods of treating complex forms of urolithiasis. Before performing such an operation, the doctor should refer the patient to a comprehensive examination, which allows to identify the presence of possible contraindications.