Emergency contact lithotripsy in the treatment of anemia postrenal calculous
Science Articles / / August 12, 2017
Pankratov AV, AS Guryanov
Urolithiasis is one of the leading places in the structure of urological diseases in frequency distribution and the place among the most frequent surgical diseases in patients who come to the emergency room and received an urgent hospitalization.Sufferers urolithiasis require the use of high-tech methods of examination and treatment as minimally invasive and surgical.Creating a method of extracorporeal lithotripsy is much reduced the number of surgical interventions on the kidney and ureter stones.This, however, does not preclude surgery due to complications: acute pyelonephritis apostematoznym, paranephritis, acute renal failure.At the same time there are indications for urgent surgical intervention requiring high operational technology in terms of complications occurring.
One of the most severe complications of urolithiasis is anuria caused by occlusion of the urinary tract calculi.Frequency anurii urolithiasis ranges from 1.19 to 2.5%.As a rule, it is the patients wi
Until recently, after an emergency examination of the patient and the diagnosis only way to eliminate this complication were: ureteral catheterization and emergency surgery.With the introduction into wide practice endourological interventions appeared ability to perform emergency ureteroscopy, uretrolitoekstraktsii and contact lithotripsy both for diagnosis and elimination of anuria.
from 2001 to 2004.in the urology department №2 were treated 5 patients with calculous anuria postrenal using endourological technologies.Four patients were receiving treatment for ureteral stones a solitary kidney, complicated by acute renal failure.3 patients were located in the bottom stones ureter, one patient - a stone in the upper ureter.Dimensions diagnosed stones from 7 to 10 mm.Time of occurrence anuria before surgery was from 12 to 24 hours.In order to identify the reasons for and the level of obstruction was performed ureteroscopy lithotripsy followed by contact and maximum evacuation of stone fragments.Complications during surgery and the postoperative period was not.A special group of patients are patients, the cause of anuria who is urate urolithiasis.As a rule, carried out X-ray examinations are not effective due to the nature of the roentgen stones.Ultrasound examination often reveals the presence of kidney stones and a two-way ureterohydronephrosis without determining the cause of the obstruction, and especially the size and location of stones located in the ureters.In a situation of emergency ureteroscopy is both diagnostic and therapeutic measures.
We have experience in the treatment of patients with multiple stones and both kidneys with anuria caused by bilateral urate ureterolitiazom.During ureteroscopy found the stone of the lower third of the left ureter of about 8mm, and 3 to 7 mm stone in the middle third of the right ureter.After contact lithotripsy restored patency of the ureters and renal pelvis catheterization performed on both sides.
Postoperatively conducted antibiotic therapy, treatment with allopurinol in connection with sharply elevated levels of blood uric acid, vitamin c.B and urine blemarenom controlled reaction.Ureteral catheters removed on the 7th day.At follow-up examination of stones in the urinary tract and ureterohydronephrosis not found.
These observations confirm the high efficacy, minimal invasiveness and low rate of complications and emergency ureteroscopy contact lithotripsy performed in connection postrenal calculous anuria.