Lithiasis

Effective and immediate elimination of stones

A definitive result offered by the endoscopic laser lithotrispy. The ureter lithiasis consists a common problem, which can cause from a simple colic to the complete obstruction of the ureter with a progressive infection and destruction of the kidney. Colic and haematuria are the most common effects, but there are also cases where the pain can be mild, or deep, where there is no haematuria and, sometimes, where there are no symptoms at all.

The diagnosis of lithiasis is made very easily with a simple x-ray, an intravenous pyelogram and, if necessary, a CT scan, given the fact that all stones do not appear in simple x-rays.

The ultrasound does not directly show the ureteral stones, as it can show kidney and urinary bladder stones, but it can show the presence of a dilatation, which can be caused by an obstruction by the stone. Surgical operations for the removal of stones are very limited today, after the application of extracorporeal lithotripsy, which is the optimal method for renal radiopaque stones with a diameter up to 2 centimeters. Larger kidney stones can be also successfully removed, under some conditions, with extracorporeal lithotripsy. Extracorporeal lithotripsy can be also applied for the elimination of ureteral stones. However, there are some limitations here.

Thus, stones that cause a complete obstruction of the ureter must be immediately treated in order to avoid renal complications. Extracorporeal lithotripsy cannot assure the immediate removal of the ureter obstruction and consequently prevent some possible complications. Furthermore, stones that have remained for a long time in the ureter are “anchored”, due to inflammation and edema, at its wall and thus the extracorporeal lithotripsy is not effective regarding the removal of these stones.

Furthermore, stones that are found lower in the inferior part of the ureter can be difficultly focused by extracorporeal lithotripsy and consequently its effectiveness is significantly reduced. The success of extracorporeal lithotripsy is also limited in case of ureteral stones in obese patients or in patients with skeletal abnormalities, due to the difficulty to focus the shock waves.

The solution for all these cases is ureteroscopic laser lithotripsy. This method is performed with the aid of a special thin instrument, which is called ureteroscope, that passes through the regular exiting way of the urine, without any incision, is entering the ureter under direct view with the aid of a camera and locates the stone. Then, through the working channel of the instrument passes the laser fiber, that breaks the stone into smaller pieces.

These pieces are afterwards either removed by themselves, or removed with special collection “baskets”, that pass again through the working channel of the ureteroscope. This method is performed either with general or with epidural anesthesia and the patient can be discharged from the clinic on the same day, without even one night of hospitalization. The effectiveness of the method is almost 100% and the complications are negligible.

The use of the flexible ureteroscope, in contrast with the rigid one, offers the possibility of accessing kidney stones too, as it can, in contrast with the rigid instrument, pass in the drainage system of the kidney and fragment kidney stones. Of course, the effectiveness of this technique cannot reach the effectiveness of percutaneous nephroscopy (refer to treatment of nephrolithiasis on the questions page), but it is more advantageous, due to the fact that it is minimally invasive, in contrast with nephroscopy, as there is no disruption of tissues and, if combined with the non-invasive extracorporeal lithotripsy for the stone residues that are not accessible with the flexible ureteroscope, the ratio effectiveness -morbidity is excellent.