Lithiasis

Formation of stones is one of the 3 most common diseases of the urinary tract. They occur in people of every race of all ages and gender and have been known since the ancient times.

Men are more frequently affected than women, with a higher incidence at the age of 30, while in women the formation of stones is more common between the ages of 35 and 55. The likelihood of new stone formation one year after the initial episode of nephrolithiasis reaches 10%, and within 5-7 years the recurrence rate is 50%.

Usually a history of lithiasis is observed in other members of the family, which may be due to the same eating habits and living conditions as well as genetic factors.

What are the symptoms?

Urinary stones may act slowly without necessarily giving rise to symptoms. A stone can be in the kidney for a long time without disturbing the patient, and can be perceived when, after some time, such complications have been established that lead the patient to the doctor.

Usually, urinary tract obstruction appears clinically as acute pain, our known colic, that is, pain in the lumbar region with a reflection in the lower abdomen. The aching patient is typically moving constantly, unable to find relief in any position. As the stone approaches the bladder, the pain typically changes and expands to the bladder area, with a high frequency and tendency to urinate. As the nerves of the stomach and kidney are the same, the pain is most often accompanied by nausea, vomiting and general malaise.

How is it diagnosed?

For the diagnosis of lithiasis, the first approach is taken by the Urologist and requires a detailed historical and careful clinical examination. At our Institute, a full Urological Study is carried out as well as immediate first response actions. Even where the stone is in the lower part of the urinary tract, it can be removed immediately and safely with state-of-the-art endoscopic equipment at the first visit.

It is therefore important to identify the exact spot and follow the stone’s path until it is safely removed from the patient’s body.

In cases where we need to ascertain this, we perform kidney imaging with x-rays. In addition, low-resolution helical computed tomography (CT) is particularly useful in a specific urolithiasis protocol, while if a diagnostic problem is present or when invasive lithotripsy is resolved, axial pyelography is recommended.

Finally, when a metabolic cause is hidden (eg osteoporosis, hyperparathyroidism, increased uric acid, etc.), the diagnostic approach must be directed to finding and correcting it in order to provide a definitive solution.

The most common causes of recurrence of lithiasis are due to diagnostic issues that were not clarified in the patient’s first approach. The most important step in troubleshooting a problem is its proper initial mapping.

What is the treatment for lithiasis?

The treatment of lithiasis has a threefold purpose, first to treat the pain, then to remove the stone and finally to find a possible cause. The best and definitive treatment for an episode of colic is either the stone’s automatic removal or its elimination.

The decision on the type of treatment of a stone depends largely on its size and, secondarily, on its location. About 85% of stones less than 5mm in diameter are automatically removed, while the chances increase the closer the stones are to the bladder. The usual waiting time for automatic stone removal is a few days if no complications have been observed (pyelonephritis, pain, etc.)

It is crucial to treat the metabolic causes of lithiasis. For example, there are stones such as those of uric acid that can “melt” with proper diet and treatment without the need for any other intervention.

Invasive treatment of lithiasis and when?

The treatment of lithiasis consists in removing the stone.

For this reason, nowadays, the surgical removal of stones by open surgical procedures, has been reduced to less than 5%, with few exceptions.

The shift to minimally invasive surgery has now led to the rescue of most lithic kidneys. Heavy surgeries that have endangered both the patient and the kidney itself have now been abandoned, and even patients with concomitant pathologies can get rid of the stones having the right to preserve their kidneys without disturbing their delicate balance.

Flexible fiber optic ureteroscopy is a method where a thin, soft organ, the flexible urethoscope, is advanced through direct vision through the urethra and bladder to the urethra to the point where the stone is located. Through this instrument, the laser cutter fiber is introduced, and the latter crushes the stone with a Laser, as well as the special forceps that capture and remove it.

This method has significant advantages as it uses the natural urine output pathway to find the stone. That is, an existing path is followed and no intersections or holes need to be preceded. Laser lithotripsy is performed directly to the eye, providing immediate results while the patient is hospitalized for several hours. Of course general anesthesia is required due to the subtlety of the manipulations but it is well tolerated and allows the patient to leave the hospital even on the same day.

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