Kidney stone crushing: main methods

When kidney stones have formed that impair the functioning of the urinary system, and all attempts to get rid of them with the help of drug therapy have been unsuccessful, there is only one way left – crushing kidney stones or lithotripsy. This is the destruction of the structure of insoluble stones into tiny fragments, making it possible to eliminate them from the kidneys without surgical intervention. [ 1 ]

Indications for the procedure

The main indication for the use of this method is nephrolithiasis (kidney stone disease) and urolithiasis.

Crushing is performed when the size of the 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, including renal colic). [ 2 ]

Often nephroliths are detected by chance. And asymptomatic small stones that do not affect renal function and do not disrupt 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 stone disease, before the crushing procedure, the preparation of patients consists of taking a blood test for HIV and RW, for the speed of its coagulation, conducting an ultrasound of the kidneys and ureters (to clarify the number, size and localization of stones at the time of lithotripsy) and electrocardiography (ECG). [ 3 ]

Aspirin and medications containing acetylsalicylic acid, anticoagulants and non-steroidal anti-inflammatory drugs should be discontinued 10 days before the procedure. And before the ultrasound crushing, patients are given an injection of Euphyllin or Pentoxifylline solution to improve local blood flow and protect the kidney from possible tissue damage by shock wave impulses. [ 4 ]

Technique kidney stone crushing

The technique for performing the procedure of destruction of nephroliths depends on the method used. The crushing of kidney stones is performed under anesthesia (injection) or epidural anesthesia.

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

Percutaneous nephrolithotripsy involves crushing kidney stones by a puncture in the lumbar region (through which an endoscopic lithotripter is inserted), and insufficiently small stone fragments are also removed. This is the longest procedure, ending with the installation of a nephrostomy drainage catheter to restore urine flow. [ 5 ]

And the finely dispersed remains of crushed stones after contactless remote lithotripsy are excreted with urine on their own.

Kidney Stone Crushing Methods

In modern clinical nephrology and urology, the following methods of crushing kidney stones are used:

• endoscopic destruction of stones, i.e. contact crushing of kidney stones with transurethral insertion of a flexible probe (a special ureteroscope or ureteronephroscope). It is used only for small stones (no more than 2.5-3 mm);
• crushing kidney stones using ultrasound – ultrasound lithotripter;
• extracorporeal shock wave lithotripsy or contactless remote crushing of kidney stones (size from 5 mm to 20 mm) with various methods of producing a shock wave, with ultrasonographic or fluoroscopic support of the procedure;
• Percutaneous nephrolithotripsy – ultrasound or laser endoscopic crushing of larger stones, including coral stones.

Kidney Stone Crushing Drugs

It is important to keep in mind that medications taken orally cannot crush kidney stones, as happens with lithotripsy: some small stones they can only dissolve. And this treatment is called drug litholysis. Therefore, further we will consider medications for dissolving kidney stones.

The chemical composition of urinary stones is of the utmost importance for litholysis. If the stones are formed from uric acid, they are urate (or uric acid); oxalate stones consist of calcium and ammonium salts of oxalic acid, and phosphate stones consist of calcium-phosphorus and ammonium-phosphate salts; cystine stones are formed from crystals of the aliphatic aminocarboxylic acid cystine. There are also struvite stones, consisting of the phosphate mineral struvite (formed due to the presence of bacteria in the urinary and urinary tract that produce ammonia). [ 6 ]

According to experts, only urate stones can be dissolved by pharmacological means.

The method of parenteral litholysis of urate stones by intravenous drip administration of the antiacetylene drug Trometamol N has not received wide acceptance. [ 7 ]

Here are some names of drugs that are litholytics and are taken orally for urinary and kidney stones:

• Magurlite (contains potassium, sodium and magnesium citrates; vitamin B6 and citric acid);
• Soluran (Blemaren) – similar in composition to the previous drug;
• Uralit-U (potassium and sodium citrates); [ 8 ], [ 9 ]
• tablets containing extracts of medicinal plants for crushing kidney stones - Fitolite, Cyston, Nephrolit, Uroston;
• phytosyrup Uronephron;
• tincture Nieron (ammi dental, madder, field horsetail, calendula);
• drops Urolesan and Cystenal; [ 10 ]
• Dietary supplements based on medicinal plants – Renolit, Kamenelom, Nokamen, etc.

Crushing kidney stones with folk remedies

You can also try to dissolve kidney stones using folk remedies, since it is still not possible to crush them.

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

The main herbs for breaking up kidney stones, from which decoctions and water infusions are prepared: madder (root), fenugreek (seeds), knotweed, field horsetail, stinging nettle, creeping wheatgrass (rhizome), kopeck grass (root), heather, sowing carrot (seeds), toothbrush (seeds), lingonberry leaves and wild strawberry.

It is also recommended to brew in a thermos and drink teas to break up kidney stones: rose hips (fruits and roots); birch leaves, black elderberry or dandelion; woolly erva herb; sunflower roots or common burdock. [ 12 ]

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

Recently, Indian researchers have confirmed the litholytic properties of the tropical legume Dolichous biflorus, which is called kulattha in Ayurveda, and the effectiveness of its extract in dissolving oxalate stones. [ 13 ]

Contraindications to the procedure

The listed methods of crushing kidney stones are contraindicated:

• for acute inflammatory diseases, primarily cystitis and pyelonephritis;
• patients with functional renal failure;
• in case of kidney dystopia;
• in case of impaired renal blood flow associated with aneurysm or stenosis of the renal artery;
• for oncology of the pelvic organs and urinary system;
• in the presence of severe cardiovascular insufficiency and/or arterial hypertension;
• if blood clotting is reduced;
• during pregnancy and 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 do occur 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 an infection is indicated by a subfebrile or significantly elevated temperature after the stone is crushed.

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

Complications after the procedure

After the nephrolithotripsy procedure, complications may occur 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 crushing stones, [ 14 ] acute renal failure, glomerulonephritis, perirenal abscess. [ 15 ], [ 16 ]

Care after the procedure

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

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

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