Stone Crushing Methods in Urolithiasis: Explains the Urologist

Stone Crushing Methods in Urolithiasis: Explains the Urologist



It is known that Armenia is an endemic zone for urolithiasis and this is conditioned bythe heredity, as well as the climate, local water composition and diet. Various treatment methods are used according to the size of stones, chemical composition and location: conservative, as well as interventional.  The types of stones and new technologies for urolithiasis treatment were explained by Armen Avoyan, the head of the Urological Department of “Astghik” MC, during the interview with the Medicine reporter.

As the doctor says, urine is an oversaturated salt solution which contains components that prevent the formation of stones. When the balance of these components is violated, the salt in urine crystalizes and stones are formed.

According to the chemical composition of stones, there are uric acid (urates), oxalate, phosphate, infection and other types of stones. Uric acid and oxalate stones are more common. Very often the composition of stone is not homogenous: it contains both urates and oxalates.

If the analysis shows that the patient has only urates (these stones are visible by X-ray examination), in that case a conservative drug therapy is very effective. The urine acidity changes due to the appropriate preparations, stones solve and come out with urine. In case of other stones – the oxalate and mixed types, the drug treatment is less effective, as noted by Armen Avoyan. The method choice is conditioned by the stones size and location.

If the size of a renal stone is more than 7mm, then a stone crushing is recommended, even if it does not bother the patient. If the stone is located in the ureter then in case of up to 4mm a drug therapy is recommended.  For those of 4-8mm size a drug therapy may be effective for the 50%of cases. But it should also be taken into account that a ureter stone incurs severe colics and in that case crushing will release the patient from the torturous pain.

As the urologist explains, modern medicine suggests several methods of stone crushing: contact (pneumatic, laser or ultrasound) or remote control (shock-wave). The method for stone crushing is selected by considering the stones size, chemical composition (solidity) and localization.

The most convenient method for the patient is the remote shock-wave stone crushing. It is used for any localization of stones. The procedure is performed without patient hospitalization and anesthesia.

Particularly, the flagman stone crushing device of famous European brand installed in “Astghik” MC enables to crush the quite solid stones, including the stones of overweight patients as the table of the device is resistant up to 225kg weight

The shock-wave stone crushing is carried out under X-ray control if the stones are visible for the X-rays. Otherwise, the procedure can be done under ultrasound control.

But, as to Armen Avoyan, there are cases when even a powerful device is unable to crush the stones because of their large size and strong solidity. At that time the contact stone crushing helps. It is performed by an endoscopic method by using the laser or pneumatic stone crushing device, again according to the size and localization of stones. For example, the bladder stones are grained by an endoscopic method because, as a rule, they are large in size. This procedure is done with anesthesia; the cystoscope (endoscope) is inserted via urethra. A percutaneous endoscopy is also used if the stones are localized in kidneys. And if the reason of stone formation is the narrowing of urethral section, then first of all the cause of stone formation should be eliminated.  Therefore, a laparoscopic or open surgery is done during which the stones are also removed.

As to Armen Avoyan, sometimes the laser stone crushing works well, sometimes the pneumatic, but in any case the contact method of graining is effective in 100% for stones of all types. For this reason, currently the open surgery for stone removals is performed very rarely. In “Astghik” MC they form the 5% of all such cases and are mainly done for stag-horn stones.