Urolithiasis

Types of stones in the course of urolithiasis

Several types of stones are distinguished by their chemical composition, including calcium oxalate, calcium phosphate, uric acid, magnesium ammonium, phosphate and cysteine. Kidney stones result from the crystallisation of minerals and their salts, while stones in the bladder result from chemicals in the urine not dissolving sufficiently and crystallising. This pathology has a multifactorial aetiology.

Symptoms produced by urolithiasis

Urolithiasis may be asymptomatic for a long time and is therefore often detected incidentally during an imaging study such as an ultrasound or CT scan. Initially asymptomatic urolithiasis, also known as nephrolithiasis, takes on another symptom – severe pain in the lumbar region, which appears suddenly, usually on one side of the body, radiating to the lower abdomen, groin or thigh — so-called renal colic. There may be problems urinating, pain, discomfort in the bladder area. Burning during urination, a feeling of pressure, more frequent visits to the toilet, as well as nausea, vomiting, fever, chills. Urolithiasis often only produces symptoms once the stone has started to move through the urinary tract [4].

Urolithiasis and its treatment

Treatment of renal colic incidents is based on the use of non-steroidal anti-inflammatory drugs, which act by blocking cyclooxygenases (enzymes involved in the synthesis of prostaglandins responsible for regulating many processes in the body such as inflammation, pain or fever) involved in the inflammatory cascade, reducing local swelling and glomerular filtration rate. Drugs that improve peristalsis by relaxing smooth muscle fibres are also used — this is known as medical expulsive therapy but has poor results [5].

Urolithiasis in surgical treatment

The most effective treatment method is surgical procedure for removing stones from the urinary tract. Surgical methods take into account stone location, size, and anatomy of the patient’s urinary tract.

ESWL and URS

Currently, minimally invasive procedures are used in the treatment of stones, e.g. ESWL (extracorporeal shock wave lithotripsy): this is a method using ultrasound waves to break stones into tiny fragments and expel it in the urine. Ureterorenoscopy (URS) is an invasive method that involves inserting an endoscope into the lumen of the ureter, through the urethra and into the kidney to break it up, for example with a laser beam.

PCNL and RIRS

Another method is PCNL (percutaneous nephrolithotripsy) performed for larger stones. This procedure involves inserting an endoscope directly into the kidney through a small skin incision, breaking the stone into tiny fragments and removing it using a suction machine [6]. RIRS (retrograde intrarenal surgery using a flexible ureteroscope), on the other hand, is a procedure involving the endoscopic removal of stones from the renal pelvicalyceal system with access through the ureter [7].

Intraoperative imaging and urolithiasis

It is worth noting, however, that very accurate intraoperative imaging is required to achieve the intended goal (i.e. stone removal). For all stone removal procedures from the kidney or ureter, the so-called C-arm (C-arm x-ray machine) is used. For this type of procedure, compact cameras with monitors placed on a single, shared trolley are used. The monitor is placed on an articulated, pivoting arm to facilitate viewing at the operator’s convenience.

Operating table and intraoperative imaging

The machine works perfectly with the Famed OPITMA table, which, with electrical control, allows the settings to be adapted to the required procedures. The modular design allows the table top segments to be quickly exchanged and, consequently, full transparency for X-rays to be achieved. It is very important to limit the radiation dose to which the patient and staff are exposed, which the table parameters allow [8]. The combination of the Famed OPTIMA table with the GE C-arm allows full imaging and accurate stone localisation, as well as performing procedures in a supine (on the back) or prone (on the abdomen) position.

Famed OPTIMA one of the operating table models used in the treatment of urolithiasis

Contraindications to the removal of stones

Contraindications to kidney stone removal surgery depend on the method chosen and the patient’s health. The most important are: acute urinary tract infections, sepsis, coagulation disorders, pregnancy, use of anticoagulants and allergy to contrast agents. These are some of the most important contraindications, but any treatment can be adequately prepared for under the doctor’s supervision.

Diet in preventing recurrence of urolithiasis

In anticipation of surgery, if the composition of the stones is not known, it is difficult to follow specific dietary recommendations. If this is the case, it is best to choose a balanced diet. Once the composition of the urolithiasis stones is known, more restrictive limitations of certain foods may be recommended. Some of the dietary recommendations for kidney stones are general and should be followed for all types of stones. There are also some rules that depend on the chemical composition of the stones. Therefore, urinalysis, blood and examination of the composition of the stone expelled or removed can determine how to proceed to prevent recurrence of nephrolithiasis [9].

Conclusions

It is extremely difficult to provide all recommendations, so the availability of information about the disease in the mass media is important. Clinic visits should also not be forgotten. In the end, patient education and disease prevention have the best health effects on society. “Dr Google” will provide information and refer you to the adequate facility, but he will not cure you!