Crushing kidney stones: basic methods

When kidney stones have formed, impairing the functioning of the urinary system, and all attempts to get rid of them with the help of drug therapy have been unsuccessful, one way remains - crushing kidney stones or lithotripsy. This is the destruction of the structure of insoluble calculi into tiny fragments, which makes it possible to eliminate them from the kidneys without surgical intervention. [1]

Indications for the procedure

The main indication for this method is nephrolithiasis (kidney stones) and  urolithiasis .

Crushing is carried out when the size of stones is in the range of 2-15 (20) mm (depending on the specific method), and if they are dense or crystalline, and also fixed in the tissues of the kidney structures (which causes various symptoms, up to renal colic). [2]

Often, nephroliths are detected by chance. And asymptomatic small stones that do not affect renal function and do not impair urodynamics are monitored by periodically examining patients.

Preparation

Since lithotripsy is prescribed by the attending physician, patients have previously undergone a complete  examination of the kidneys  with all the necessary urine and blood tests, as well as cystoscopy of the bladder and  computed tomography of the kidneys . So, having an established diagnosis of kidney stones, before the crushing procedure, the preparation of patients consists in passing a blood test for HIV and RW, for the rate of its coagulability, conducting  ultrasound of the kidneys and ureters  (to clarify the number, size and localization of stones at the time of lithotripsy behavior) and electrocardiography (ECG). [3]

10 days before the procedure, you should stop taking Aspirin and drugs containing acetylsalicylic acid, anticoagulants and non-steroidal anti-inflammatory drugs. And before ultrasonic crushing, patients are injected with a solution of Euphyllin or Pentoxifylline - to improve local blood flow and protect the kidney from possible damage to its tissues by shock wave impulses. [4]

Technique of the crushing kidney stones

The technique of carrying out procedures for the destruction of nephroliths depends on the method used. Kidney stones are crushed under anesthesia (injection) or epidural anesthesia.

In endoscopic contact crushing, a nephroscope (ureteroscope) is inserted through the urethra - without an incision or puncture, and particles of crushed stone (also through the urethra) are removed from the kidney with a special instrument. In some cases, at the end of the procedure - after removing the endoscopic instrument - a stent catheter is placed in the patient's ureter for a certain time.

In case of percutaneous nephrolithotripsy, kidney stones are crushed by a puncture in the lumbar region (through which an endoscopic lithotripter is inserted), and insufficiently small fragments of stones are also removed. This is the longest procedure and ends with the placement of a nephrostomy drainage catheter to restore urine flow. [5]

And finely dispersed remnants of crushed stones after non-contact distance lithotripsy come out in the urine on their own.

Methods for crushing kidney stones

In modern clinical nephrology and urology, methods of crushing kidney stones are used, such as:

• endoscopic destruction of calculi, that is, contact crushing of kidney stones with transurethral introduction of a flexible probe (special ureteroscope or ureteronephroscope). It is used only for small stones (no more than 2.5-3 mm);
• crushing kidney stones with ultrasound - an ultrasound lithotripter;
• extracorporeal shock wave lithotripsy or non-contact remote crushing of kidney stones (ranging in size from 5 mm to 20 mm) with various methods of obtaining a shock wave, with ultrasonographic or fluoroscopic accompaniment of the procedure;
• percutaneous (percutaneous) nephrolithotripsy - ultrasonic or laser endoscopic crushing of stones of larger sizes, including coral stones. 

Preparations for crushing kidney stones

It must be borne in mind that drugs taken by mouth cannot crush kidney stones, as it happens with lithotripsy: they can only dissolve some small stones. And this treatment is called drug litholysis. Therefore, further preparations for dissolving kidney stones will be considered.

For litholysis, the chemical composition of urinary stones is of paramount importance  . If stones are formed from uric acid, then they are uric acid (or uric acid); oxalate calculi are composed of calcium and ammonium salts of oxalic acid, and phosphate calculi are composed of phosphorus-calcium and phosphate-ammonium salts; Cystine stones are formed from crystals of aliphatic aminocarboxylic acid cystine. There are also struvite stones, which are composed of the phosphate mineral struvite (formed by the presence of bacteria in the urinary and urinary tract that produce ammonia). [6]

According to experts, only urate calculi lend themselves to dissolution by pharmacological agents.

The method of parenteral litholysis of urate stones by intravenous drip administration of the antiacidymic drug Trometamol N. [7]

Here are some names of medicines that belong to litholytics and are taken orally for urine and kidney stones:

• Magurlite (contains citrates of potassium, sodium and magnesium; vitamin B6 and citric acid);
• Soluran (Blemaren) - similar in composition to the previous remedy;
• Uralite-U (potassium and sodium citrates); [8], [9]
• tablets containing extracts of medicinal plants for crushing kidney stones - Phytolit, Cyston, Nephrolit, Uroston;
• phytosyrup Uronefron;
• tincture Nieron (tooth ammonia, madder dye, field steel, calendula);
• drops  Urolesan  and Cistenal; [10]
• Dietary supplements based on medicinal plants - Renolit, Kamnelom, Nokamen, etc.

Crushing kidney stones with alternative remedies

Alternative means, you can also try to dissolve the kidney stones, since they still cannot be crushed.

It is recommended to drink not only bicarbonate (alkaline) mineral water, but also juices: birch, carrot (with vegetable oil, with the addition of juices from parsley or celery roots). Some claim the effectiveness of ingestion of a mixture of fir essential oil with lemon juice. [11]

The main herbs for crushing kidney stones, from which decoctions and water infusions are prepared: madder dye (root), hay fenugreek (seeds), knotweed, stalnik field, dioecious nettle, creeping wheatgrass (rhizome), penny plant (root), heather, sowing carrots (seeds), tooth ammonia (seeds), lingonberry and wild strawberry leaves.

It is also advised to brew in a thermos and drink teas for crushing kidney stones: from rose hips (fruits and roots); birch, black elderberry or dandelion leaves; erva woolen herbs; sunflower roots or common burdock. [12]

Read also -  Sand in the kidneys in women and men: what to do, treatment with alternative means at home .

Not so long ago, Indian researchers confirmed the litholytic properties of the tropical legume Dolichous biflorus, which in Ayurveda is called kulattha, and the efficiency of dissolving oxalate stones with its extract. [13]

Contraindications to the procedure

The listed methods of crushing renal calculi are contraindicated:

• in acute inflammatory diseases, primarily cystitis and pyelonephritis;
• patients with functional kidney failure;
• with dystopia of the kidney;
• in case of impaired renal blood flow associated with an aneurysm or stenosis of the renal artery;
• with oncology of the pelvic organs and urinary system;
• in the presence of severe cardiovascular failure and / or arterial hypertension;
• if blood clotting is reduced;
• during pregnancy and during menstruation;
• with significantly increased body weight.

Consequences after the procedure

Despite the fact that the named methods of getting rid of kidney stones are minimally invasive procedures, the consequences after their implementation take place and include pain in the lumbar region and the presence of blood in the urine. Unpleasant sensations, including pain, as well as problems with urination, can cause swelling of the kidney after crushing stones.

The development of infection is indicated by a subfebrile or significantly increased temperature after crushing the stone.

Possible long-term consequences after the procedure lead to functional kidney failure, nephrogenic hypertension, ischemia and calcification of renal tissues.

Complications after the procedure

After the nephrolithotripsy procedure, there may be complications in the form of an allergic reaction to anesthesia, nausea, cardiac disorders (changes in heart rate), as well as damage to the parenchyma, resulting in prolonged hematuria, subcapsular or intraparenchymal hematoma in the kidney after stone crushing,  [14] acute renal failure, glomerulonephritis abscess. [15], [16]

Care after the procedure

In principle, after the lithotripsy procedure, care and rehabilitation are reduced to the use of up to 1.5-2 liters of water per day and a temporary (up to one and a half to two months) restriction of physical activity, the diet should also be followed after crushing kidney stones, in more detail:

• Diet for kidney stones
• Diet for urolithiasis
• Diet with high uric acid

In case of an increase in temperature, antibacterial drugs are prescribed; with hematuria exceeding the permissible five to seven days, as well as with the formation of a hematoma in the kidney, bed rest and the use of hemostatic agents are supposed. [17]