Therapy for urinary calculi

Urolithiasis is a disease of civilization, which is brought about by lack of exercise, overweight, an unbalanced diet and certain lifestyles.

Never before have the technical capabilities for urolithic therapy been better. All the more important therefore are the medically sensible use of  the techniques that are available  and the correct indication.

In many cases, urinary calculi remain undetected during the entire life time or are suddenly diagnosed for the first time in connection with a ureteral colic.  Lifestyle habits such as lack of exercise, an unbalanced diet and overweight play a significant role in the development of urinary calculi . In addition to these, however, there are also other factors such as anatomic anomalies,  metabolic disorders and genetic factors which can promote the development of urinary calculi.

Men are affected more than women, whereby the balance is shifting to the disadvantage of women.

Urinary calculi are formed by urine that is supersaturated with salts. In this context salts are precipitated, forming crystals that can become very large. Even a person with healthy kidneys generates crystals. These usually pass the ureter spontaneously, without leading to the extremely painful colics.

The therapy of symptomatic urinary calculi  is manifold.

Therefore careful diagnosis is necessary in order to define the right therapy. In addition, the success of the therapy very much depends on the skills of the surgeon.

The preferred treatment of urinary calculi today is the fragmentation of the stones by the means of Extracorporeal Shock Wave Lithotripsy (ESWL),  endoscopic procedures for direct removal of the stone (utererorenoscopy, URS), (percutaneous nephrolitholapaxy, PCNL) as well as open removal of stones by opening the urinary tract via an incision.

 

ESWL (Extracorporeal Shock Wave Lithotripsy)

ESWL is a minimally invasive technique for breaking down a stone within the kidney. This procedure is minimally invasive and has hardly any side effects. However it cannot be expected that all stones are completely removed immediately after the treatment. With this procedure the stones are only broken down into smaller fragments. The patient himself is responsible for passing the stones (by increasing his fluid intake, physical exercise and vibration therapy). After 2-3 months most patients are practically free of stones.

URS (Ureterorenoscopy = ureteroscopy of ureter and renal pelvis), rigid and flexible

For stones that are in the ureter, the direct Ureteroscopic Stone Removal method has proved to be the best method for removing stones (ureteroscopy using laser, basket and forceps). The URS is a very elegant procedure for stone removal. In comparison to ESWL, however, it is much more invasive and also involves a higher risk of complications. Although when performing ureteroscopy the surgeon uses a path that already exists, freedom from stones cannot be guaranteed 100%, because narrow anatomic conditions sometimes make primary stone removal  impossible. Just as with ESWL, correct indication is vital for the success of  the surgery.

PCNL (Percutaneous Nephrolithotomy)

PCNL is a procedure for removal of a large stone (larger than 1.5 cm) that is located within the kidney. Access to the kidney is gained transcutaneously in the flank region. Following ultrasound examination (nephroscopy) the kidney with the stone is punctured,  the puncture passage is dilated up to 1cm and a working sheath is introduced in to the kidney. Various instruments can be passed through this working sheath to crush and remove the stone. This procedure is very invasive and likewise requires correct indication.

Open surgery of kidney stones

Open surgery of kidney stones has become a very rare form of therapy. Although in most cases open surgery has been been replaced by endoscopic procedures, in some cases it does make sense. For example with kidney stones, that have developed due to a narrow renal pelvis. Here the simple removal of the stone would not resolve the problem. In this case the cause of the stones, the narrowness of the renal pelvis, would also be corrected during the same surgical procedure.

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St.-Antonius-Hospital

Academic teaching hospital of the RWTH technical university, Aachen

Clinic for Urology and Paediatric Urology

Dechant-Deckers-Str. 8
52249 Eschweiler

+49 2403 - 76-1861

 
St.-Antonius-Hospital Eschweiler
Dechant-Deckers-Str. 8
52249 Eschweiler
tel.: 02403 76 - 0
fax: 02403 76 -1119