Percutaneous nephrolithotripsy (crushing of kidney stones)

Various surgical methods are used to crush concretions or "stones" in the kidneys, but percutaneous nephrolithotripsy is the most effective one. Direct access to the kidney and the stone located in it, the urologic surgeon receives through a hole in the patient's skin, into which an endoscope is inserted. A laser destroying the stone is brought to the stone through the channels of the endoscope.

INDICATIONS FOR LASER PERCUTANEOUS NEPHROLITHOTRIPSY

The operation can be performed in case of single or multiple concretions ("stones") in the kidneys. The main indications for the surgery are: 

• coral-like concretions;

• large size stones (more than 3 cm);

• inability to remove remotely or by means of  flexible nephroscope;

• cystine stones;

• stones in abnormal or single preserved kidney;

• skeletal deformities and some forms of obesity that make remote lithotripsy impossible.

Contraindications for percutaneous nephrolithotripsy are untreated urinary tract infections, blood clotting disorders, skin lesions in the access area, pregnancy and pathologies that prevent access to the kidney (splenomegaly, some forms of obesity).

BENEFITS OF PERCUTANEOUS NEPHROLITHOTRIPSY

Percutaneous nephrolithotripsy is a very complex but wide-spread operation. This fact is explained by its advantages in comparison with other methods:

• high efficiency (removes 98% of stones);

• low-traumatic –during the surgery only one puncture is made, the surrounding organs are not damaged;

• rapid rehabilitation and short hospitalization time.

PREPARATION AND CONDUCT OF PERCUTANEOUS NEPHROLITHOTRIPSY

Preoperative preparation includes a set of laboratory and device-based tests. They are necessary to confirm that there are no contraindications for surgery. The patient undergoes blood, urine and feces tests. Ultrasound, ECG and fluorography are also performed. Gynecologist’s consultation is obligatory for women. 

In the course of operation, the surgeon pierces the skin in the lumbar region and through this puncture gets access to the kidney. Then the doctor inserts a nephroscope into the kidney, through which the stone is removed or crushed with a laser lithotriptor, and the fragments are removed. Then a nephrostoma is introduced in the kidney for a few days. It’s a special tube for the outflow of urine into the urine-collecting bag. After removing the drainage a sterile bandage is applied.

During rehabilitation period antibacterial drugs are prescribed, a dietary regime is introduced (salty and fatty foods, alcohol are prohibited), physical activity is limited. It is important to protect the body from hypothermia, as well as from overheating - visiting suanas is prohibited.