A winding path leads to a "stone" - Let you learn about ureteroscopic lithotripsy

Author: Ye Zixing Peking Union Medical College Hospital

Reviewer: Xiao He, Chief Physician, Peking Union Medical College Hospital

Stones are a common disease of the urinary system. The pain caused by stone attacks is often unforgettable. The hydronephrosis caused by stones often damages the patient's renal function without knowing it. Therefore, it is very important to treat urinary stones in a timely manner.

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There are many treatments for stones, and different methods are used for stones in different parts of the body. Both extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy can be used to treat stones with a diameter of less than 2 cm in the kidney and ureter. You may have heard more about extracorporeal shock wave lithotripsy, but today we will introduce you to ureteroscopic lithotripsy.

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Ureteroscopic lithotripsy is mainly suitable for the following situations: kidney and ureteral stones that are negative in X-ray examination; stone streets formed after extracorporeal shock wave lithotripsy; stones that have been impacted in the ureter for a long time; twisted and narrow ureter below the stone; bleeding tendency or inability to stop taking anticoagulants and antiplatelet drugs; hard stones that are not conducive to extracorporeal shock wave lithotripsy; stones in the renal calyx diverticulum; difficulty in establishing a percutaneous nephrolithotomy channel; extremely obese patients; kidney stones combined with parapelvic cysts; ectopic kidney combined with kidney stones; severe spinal deformity.

Ureteroscopy is divided into two types: hard and soft. The hard ureteroscope is mainly used to treat stones in the middle and lower ureter, while the soft ureteroscope can "drill" into the upper ureter or even the kidney like a small snake, and move around in the kidney through the bend of the head to find stones hidden in the renal pelvis and calyx. During the lithotripsy process, the ureteroscope can reach the location of the stone along the ureter, and after the stone is crushed by energy equipment such as laser, the stone is removed with the stone removal and suction tools that match the ureteroscope. The remaining powdered stones can be gradually discharged with the patient's urine. After the operation, it is often necessary to leave a ureteral stent to facilitate the discharge of stones and prevent ureteral stenosis.

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There may be certain risks in using ureteroscopic lithotripsy. Ureteral injury is the main surgical risk. Most ureteral injuries are mild and can be gradually healed by placing a ureteral stent. However, in rare severe cases, ureteral rupture may occur, which requires surgical treatment. In addition, urinary tract infection is a risk that needs to be fully taken seriously during and after ureteroscopic surgery. Advanced age, coexistence of underlying diseases such as diabetes, immunosuppressive state, hydronephrosis, etc. are risk factors for aggravation of perioperative urinary tract infection. Therefore, the risk factors for infection should be fully evaluated during the perioperative period, and infection prevention and empirical treatment should be carried out in a timely manner.

In terms of the patient's recovery, most ureteroscopic surgeries have little impact on the whole body, and the patient can return to the preoperative state after fully waking up from anesthesia. Therefore, the patient can return to normal life on the first day after surgery or even on the day of surgery. In some hospitals, ureteroscopic lithotripsy has become a day surgery. However, since most patients still have ureteral stents in their bodies after surgery, patients may still experience hematuria, bladder irritation symptoms, and low back pain. However, as the body recovers and gradually adapts to the ureteral stent, the above discomfort will gradually subside, and generally has little impact on life. For patients with more obvious discomfort, α-receptor blockers (such as tamsulosin), M-receptor blockers (such as solifenacin), analgesics, etc. can be appropriately used to relieve symptoms. After the ureteral stent is removed, the physical discomfort will gradually subside, and no sequelae will be left.

So how do we judge the effectiveness of ureteroscopic lithotripsy? Just like judging the effectiveness of other stone treatments, the effectiveness of stone removal can be further judged by reviewing kidney, ureter and bladder X-rays, as well as urinary system ultrasound or CT scans during postoperative follow-up.

In conclusion, ureteroscopic lithotripsy is a safe and effective treatment for urinary tract stones. It has a definite surgical effect and patients recover quickly after surgery. It can be used to treat most kidney stones and ureteral stones. With the development of related surgical concepts, surgical instruments and surgical techniques, the stone clearance rate of ureteroscopic lithotripsy will gradually increase, the surgical risks will gradually decrease, and it will become the preferred treatment for more patients.