Urinary stones (2)-4 questions and 4 answers

Question: What is extracorporeal shock wave lithotripsy? Who is suitable for? A: With the development of related disciplines, most cases of urinary calculi do not need surgery-this is the merit of extracorporeal shock wave lithotripsy, no surgery, less trauma, less pain, you can remove stones in the body in vitro Crushed, the crushed stones are as large as mung beans, as small as fine sand, and can be excreted with urine. Therefore, extracorporeal shock wave lithotripsy is called “a revolution in the treatment of urinary stones”. Extracorporeal shock wave lithotripsy is the preferred treatment method for kidney stones with a diameter of less than 2cm and ureteral stones with a diameter of less than 1cm. Of course, for patients with larger stones or comorbid stones, laparoscopic surgery is required, such as percutaneous nephrolithotomy, transurethral ureteroscopy, transurethral cystoscopy, etc., which requires specific treatment. . Second question: what is going on with percutaneous nephrolithotomy? Answer: Stones larger than 2cm in diameter, staghorn stones, multiple stones, ectopic kidney stones, horseshoe kidney combined with stones, infectious stones, cystine stones, isolated kidney stones, etc., these are the big problems that can not be solved by external lithotripters Stones or special stones are also the most susceptible stones. Therefore, for these complicated and difficult stones, we recommend the minimally invasive treatment through endoscopic techniques such as percutaneous nephroscopy and ureteroscopy. &nbsp. The technique of percutaneous nephroscopy is to make a “hole” of the thickness of the pen in the patient’s waist to establish the passage from the skin to the kidney. Under the nephroscope, laser or pneumatic ballistic combined with ultrasonic lithotripsy is used to crush the stone and suck it out of the body. , Our doctor likens it to “holes and stones”. Percutaneous nephroscopy is mainly used for the treatment of difficult giant kidney stones, multiple kidney stones and upper ureteral stones. Three questions: What is the problem of taking stones through ureteroscope? A: For ureteral calculi, extracorporeal shock wave lithotripsy is generally used for treatment. However, ureteral calculi with stones larger than 1 cm in diameter or stones that failed extracorporeal shock wave lithotripsy can be treated with ureteroscopy. The ureteral stones near the bladder can be crushed by transurethral ureteroscopy, while the ureteral stones near the kidney can be treated by minimally invasive percutaneous ureteroscopy. Four questions: How to prevent recurrence of stones? A: Urinary stones are prone to recurrence, which is very headache for doctors and patients. So how to prevent relapse? First, develop the habit of drinking plenty of water. How much do you drink? Look at the color of your urine-when your urine is no longer yellow, it means you have enough water. Generally speaking, drink 2000-3000ml of water every day, clinically called “hydration”, is very important to prevent the formation of stones. Second, pay attention to diet regulation. For example, patients with high urinary calcium should eat less high-calcium foods, such as milk; patients with high oxalic acid urine should eat less foods rich in high oxalic acid, such as spring spinach, black tea, etc.; patients with uric acid stones should eat less purine-rich foods, such as Liver, kidney and other animal internal organs. Finally, insist on taking medicine to prevent, especially for patients with recurrent stones, you should go to the hospital to find the cause of stones, so as to carry out selective drug treatment. As long as you insist on taking medicine, most can prevent recurrence of stones. &nbsp.

How does the holmium laser become the darling of minimally invasive lithotripsy surgery?

In recent years, minimally invasive surgery has become prevalent, and I often hear various new vocabulary on the tall, holmium laser, thulium laser, green laser … What exactly is a laser, can actually become a new darling of surgery! Today, Dr. Wang Wei will show you how the holmium laser with a single crushing success rate of more than 95% is crushed. △ & nbsp. Holmium laser & nbsp. △ Popular science time: Holmium laser is a solid-state pulsed laser with a wavelength of 2100nm, which is an invisible light, and the light is located in the near infrared region of the spectrum. The holmium laser has an excellent stone ablation effect. The shock wave generated by the holmium laser is relatively weak, and its lithotripsy mainly depends on the thermal effect that can cause the gasification of the stone; each laser pulse and heating act on the surface of the stone, causing water vaporization inside and on the surface of the stone, which causes a small range The stones are melting. Once stress fragmentation is formed inside the stone, the weaker shock wave generated by the laser also plays a role in the stone fragmentation process, so that the stone is further fragmented along those slight cleavage planes, and the small stone head is vaporized or emitted Become stone powder. △ & nbsp. Holmium laser lithotripsy & nbsp. △ Compared with other lithotripsy devices, holmium laser has many unparalleled advantages: ①The optical fiber is soft and flexible, can be used in flexible nephroscope, and the removal rate of stones is high; ②The holmium laser can treat soft tissue lesions while crushing stones, such as stenosis of the renal pelvis and ureter or upper urinary tract tumors and condyloma acuminatum; ③The thermal radiation of the holmium laser has antibacterial effects, especially for the treatment of staghorn stones with bacterial infections. Help; & nbsp. & Nbsp. △ & nbsp.Uretoscope microscopic survey stone & nbsp. △ ④Holium laser can grind the stone into small parts so that it can be easily discharged from the body. This is very suitable for huge ureteral stones, you can avoid using stone baskets or forceps to add larger pieces. It can completely disintegrate the stones to avoid repeated entry and exit of ureteral forceps and gravel and shorten the operation time. ⑤The high-power holmium laser can also perform prostate enucleation or vaporization, which can be used for one machine and improve the efficiency of the machine. The holmium laser fiber can be used repeatedly, reducing the cost of equipment. △ & nbsp. Holmium laser lithotripsy & nbsp. △ For patients, the biggest benefit of holmium laser is accurate target, safe, reliable, small secondary damage, and short hospital stay. The holmium laser is so good, what need to use holmium laser? Indications for ureteroscopy lithotripsy: 1, middle and lower ureteral stones, drug treatment is ineffective. 2. The upper ureteral stones have a longer residence time, and there may be ureteral edema stones incarcerated, and the external lithotripsy is invalid. & nbsp. △ & nbsp.Ureteral stones & nbsp. △ Percutaneous nephrolithotripsy lithotripsy indications: 1. Kidney stones that are not suitable for the use of extracorporeal lithotripsy, or kidney stones with in vitro lithotripsy. For cast stones or multiple stones, percutaneous nephrolithotripsy can be used to remove the stones, and the remaining stones can be removed in vitro. 2. Symptomatic kidney calyx stones. 3. Ureter stones above the 4th lumbar vertebra level, with long obstruction and hydronephrosis. 4. Kidney stones combined with stenosis of the renal pelvis and ureter. 5. Remains of stones after open surgery to remove stones. Warm reminder: If you have a stone, you must go to a regular hospital for examination, find a doctor to confirm the diagnosis, and treat it in the way recommended by the doctor.