Is it necessary to eliminate inflammation before lithotripsy?

Kidney stones, urethral stones, bladder stones and other stone diseases have a great impact on the body. Not only will they cause low back pain, they may even affect the urinary system. If you want to undergo extracorporeal lithotripsy, you must first ensure that there is no other inflammation, and pay attention to the people who are suitable for it, as well as the precautions before the operation.

Indications and contraindications

Theoretically, except for uncorrectable bleeding diseases and lumen obstruction distal to the stone, which are absolute contraindications for extracorporeal lithotripsy, other conditions can be treated with extracorporeal shock wave lithotripsy within the controllable range. However, during clinical treatment, the following situations require special treatment.

1. Pregnant women with stones are generally not suitable for lithotripsy, especially those with lower ureteral stones. This is to avoid the adverse effects of shock waves and radiation on the fetus. Lithotripsy can be performed after delivery. For mid- and upper-ureteral stones that cause unbearable pain, ESWL treatment can be performed under strict control. There are many research reports on ESWL treatment of pregnant women at home and abroad, but no effect of ESWL treatment on the baby has been found.

2. Patients with diabetes mellitus are not suitable for lithotripsy if their condition is not under control, so as to avoid uncontrollable infection after lithotripsy.

3. Patients with severe or acute infection should consider carefully before lithotripsy. ESWL may aggravate the severity of infection and cause serious symptoms such as bacteremia and toxemia.

4. High-risk patients and patients with poor single or multiple organ function, such as patients with heart failure, renal insufficiency, or solitary kidney, can undergo EWSL treatment in an emergency under the control of the medical conditions at the time. In case of complications, they must be treated in a timely manner.

5. Obese patients may not be able to undergo lithotripsy due to positioning difficulties.

Preparation before gravel

1. Perform relevant systemic examinations, such as blood clotting time, platelet count, liver and kidney function, electrocardiogram, etc., to understand the real condition of the body in advance to facilitate symptomatic treatment.

2. Understanding the condition of the urinary system is an essential preparation before ESWL treatment of urinary stones. It must be thorough. Do not rush into lithotripsy without a clear understanding of the urinary system. The following checks must be done before crushing.

⑴ Abdominal plain film (KUB): More than 95% of urinary stones are positive stones, so for patients suspected of having urinary stones, KUB examination should be the first choice. Its advantage is that it can fully understand the location, size, position, number and density of the stones. The most important thing is that it will not miss the stones in the middle and lower ureter.

⑵B-ultrasound: It is mainly used for the diagnosis of negative stones. It has a good display effect on kidney stones and hydronephrosis. However, it has a very low detection rate for ureteral stones, especially those in the middle and lower ureteral stones, and it is difficult to determine the composition of the stones.

⑶ Urinary tract imaging: including intravenous urography (IVP) and retrograde urography. Intravenous urography is commonly used and can accurately locate stones. It is very helpful in determining whether it is a diverticular stone or whether the renal calyx opening is narrow. Retrograde urography is used when the renal urinary function is poor and the kidneys are not visualized. The purpose is to clearly understand whether the urinary tract is obstructed after the failure of intravenous urography.

(4) Renal examination: For patients with allergic stones, a renal examination is recommended to understand renal function.

⑸ Trinity combined examination: Our department combines B-ultrasound, abdominal plain film (KUB) and abdominal electrodialysis to monitor the stones in the entire urinary tract. Dynamic electrodialysis and static plain film are combined with B-ultrasound exploration, combining the advantages of the three. In most cases, the results are not inferior to those of angiography and CT scans.