Lithiasis: treatments and more

If the lithiasis It produces ureteral obstruction and febrile syndrome with the urgent need to place a urinary diversion catheter to solve the infective problem.

Deobstructive treatment can be performed with the placement of a double J catheter, an external ureteral catheter, or by percutaneous nephrostomy. Once the urinary infection has been solved with antibiotics and the urinary tract is unblocked, the treatment for the lithiasis is decided.

Extracorporeal shock wave lithotripsy (ESWL)

Extracorporeal shock wave lithotripsy (ESWL) is the treatment of choice for most stones. It is based on the generation of shock waves by means of a piezoelectric or electromagnetic generator that are radiologically focused on a target that is lithiasis. Is a treatment for lithiasis not very aggressive and very decisive but not without complications.

Depending on the size and location of the stone, different success rates are achieved:

• On many occasions, a single ESWL session is not enough to fragment the stone, and two or up to three sessions for the resolution of it.
• Once the lithiasis is fragmented, the patient has to expel the stone chips being able to produce and voiding syndrome.
• Sometimes, when the stone size is very large (more than 2 cm.), The placement of a double J catheter prior to ESWL. Other typical complications of SWL are hematuria and the formation of a renal hematoma.

Ureteroscopy

When SWL fails, different types of surgery can be performed to solve the problem. If the lithiasis is ureteral, a ureteroscopy can be performed.

This surgery is performed entering with a endoscopy machine with camera through the urethral meatus to the bladder and from there the ureter is entered to the stone to be able to fragment it with different types of energy sources (laser, pneumatic etc…). It is a not very aggressive surgery, taking advantage of the natural orifices and with a high resolution rate of the stone. The closer the stone is to the bladder, the higher the resolution rate. Once the ureteroscopy is finished, a ureteral catheter may or may not be left.

Percutaneous nephrolithotomy

When the size of the stone is greater than 2-3 cm and it is in the kidney, in stones that have not responded to SWL, and especially in cases of staghorn stones, a Percutaneous Nephrolithotomy (PNL) is performed. NLP is performed puncturing the kidney and dilating the punctured path to enter the kidney with an endoscopy camera and subsequently directly fragment the stone with different energy sources. PNL allows you not to have to open the patient, and it is less aggressive, but it is not without complications, the most serious being the hematoma and bleeding of the kidney.

Types of treatment for lithiasis according to composition.

There are different types of medical treatment depending on the composition of the lithiasis, but they are above all preventive treatments and it will be difficult by themselves (except for exceptions) to undo the lithiasis.

• Uric acid lithiasis should be managed with plenty of water intake and alkalizing the urine with potassium citrate or bicarbonate, apart from trying to eliminate from the diet all foods that can carry urates such as shellfish, organ meats, sausages and salted foods.
• In the cystine lithiasis The urine should also be alkalized with potassium citrate and forced fluid intake, and specific treatments are given against cystine type D-penicillamine, azetozolamide, etc.
• The Struvite lithiasis or magnesium ammonium phosphate is of interest the other way around than in the two previous stones, acidify the urine with acetohydroxamic acid, insist on adequate hydration and treat infections with antibiotics, which are the basis of these stones.
• The calcium oxalate lithiasis They are the most frequent, and they also benefit from increased water intake, as well as treatment with potassium citrate, trying to remove foods rich in oxalate from the diet such as spinach, chard, chocolate and also foods rich in urates.