Kidney stone laser lithotripsy process

The kidneys are a high-risk area for kidney stones, and many people are troubled by them. If you want to completely cure kidney stones, there are two ways: conservative treatment and open treatment. Conservative treatment refers to the use of lithotripsy to break the stones in the patient's body into smaller pieces so that they can be more easily excreted. At the same time, conservative treatment is divided into laser lithotripsy and ultrasonic lithotripsy. What is the process of laser lithotripsy for kidney stones?

Kidney stone surgery is a treatment method for patients with kidney stones that cannot be broken up by traditional lithotripsy, patients with kidney problems who cannot undergo lithotripsy, and patients with some giant kidney stones.

There are two surgical methods for kidney stone surgery: traditional open surgery and minimally invasive surgery.

Open surgical treatment

1. Pyelotomy and lithotomy: It is suitable for patients with intrarenal renal pelvic stones, larger extrarenal renal pelvic stones, and extrarenal renal pelvic stones accompanied by calyx stones and obvious dilation of the calyx infundibulum.

2. Renal parenchymal incision and lithotomy: It is suitable for staghorn renal pelvis and calyceal stones or multiple stones in the renal calyx, stones that cannot be removed or are difficult to remove through the renal pelvis. In order to reduce bleeding, the renal parenchyma is usually cut at the thinnest part or the part closest to the stone.

If necessary, temporary blocking of renal blood flow and local cooling methods should be used to reduce bleeding.

3. Partial nephrectomy: For multiple stones confined to the upper or lower pole of the kidney, especially when there is stenosis in the neck of the renal calyx, and when stones cannot be removed successfully by nephrolithotomy or pyelolithotomy, partial nephrectomy can be performed to remove the upper or lower pole of the kidney together with the stones.

4. Nephrectomy: for patients with severe hydronephrosis caused by obstruction of one kidney or ureteral stones, thin renal cortex; combined with infection and pyonephrosis, and complete loss of renal function. If the contralateral kidney is functioning normally, nephrectomy may be performed.

Minimally invasive surgery

Minimally invasive surgery mainly uses endoscope + laser treatment. Common minimally invasive surgical treatments are divided into:

1. Fiber-optic flexible nephrolithotomy is a procedure in which a rigid ureteroscope is inserted through the external urethral orifice to explore the bladder for abnormalities. After finding the right ureteral orifice, a zebra guidewire is inserted and the outer sheath of the flexible nephrolithotomy is inserted under the guidance of the zebra guidewire. The flexible nephrolithotomy is then inserted into the renal pelvis through the outer sheath to explore the renal calyx. Stones in the upper calyx are found and broken up by the combined action of neodymium laser and tertiary laser. Some stones are removed by using a stone net and three-claw forceps with a flexible nephrolithotomy scope, and some debris are sucked out by negative pressure suction. A double "J" tube was inserted and the operation was successfully completed. It is safe, non-invasive and clean, allowing you to recover quickly while greatly reducing the chance of recurrence. 2. Percutaneous nephrolithotomy requires the use of high-tech percutaneous nephroscope equipment. The patient's surgical safety is high, the hospitalization time is short, and the range of surgical indications is wide. The use of ureteroscope can reach almost all renal calyces, thereby increasing the stone clearance rate to more than 95%. And there are minor injuries. There is less bleeding, fewer complications, and the trauma can be minimized.

3. Ureteroscopic lithotripsy is a procedure that uses a thin, high-precision instrument to be inserted into the bladder through the urethra to reach the ureter, which is only 0.2 to 0.5 cm in diameter. The stones in the ureter can be clearly observed under direct vision or with the help of a television monitoring system. A lithotripter, stone net, or stone removal forceps is then inserted into the working cavity of the ureteroscope to remove the stones that have been broken up by the laser.

4. The laser lithotripsy technology mainly relies on thermal effect to break up stones. During the lithotripsy process, the water on the surface of the stone and the water in the stone absorb the energy of the laser and vaporize to form small balls. The shock waves formed by the subsequent decomposition of the vaporized small balls generate secondary pressure, which breaks up the stone. The stone crushing rate in a single operation is over 95%, the tissue penetration depth is <0.5 mm, the tissue is not damaged or the damage is extremely slight, no scars will be left after the operation, and the operation process only takes 10-20 minutes. Therefore, laser combined with endoscopy has a unique lithotripsy effect on urinary stones.

The application range of laser mainly includes:

(1) Urinary stones of any composition, location and size.

(2) Patients who have failed extracorporeal lithotripsy.

(3) Those who have not received significant results from pneumatic ballistic treatment.

(4) Long-term obstruction combined with polyps and stenosis.

(5) Stones in special groups such as pregnant women, children, and people with bleeding constitutions