As a global disease, the prevalence of urinary stones is about 1%-5% (higher in the south than in the north). The common age of onset of urinary stones is 30-40 years old, the male to female ratio is 3:1, 25% of which require hospitalization. The causes of stones are very complex, and in recent years, the incidence of urinary stones in China has been increasing year by year.
At the same time, according to clinical research and statistics, urinary stones are prone to recurrence after treatment, with a 10-year recurrence rate as high as 50%. Until now, although the surgical treatment has made great progress, but its incidence and recurrence rate remains high, especially the incidence of upper urinary tract stones still continue to rise.
Therefore, the treatment of stone disease is particularly critical, comprehensive view, to achieve surgical diagnosis and treatment of the three main purposes: the most effective treatment of disease, the maximum possible retention of organ function, the maximum Chengdu to reduce trauma , to "minimally invasive" or even "non-invasive", "non-invasive".
"Conservative" lithotripsy: such as Chinese medicine lithotripsy, Chinese medicine is called "shilun" or "shalun", through the use of money grass, Shiwei, etc. to promote the shunyi tubule.
Conservative: such as the Chinese medicine called "ShiLin" or "ShaLin", through the use of QianZhao, ShiWei, etc. to promote cis-ureteral peristalsis, diuretic urination, etc., Chinese medicine lithotripsy technology for some of the small stone, used to this day, is the western medicine lithotripsy auxiliary treatment means.
"Abdominal" lithotripsy: 10-15cm incision in the lumbar back to remove the stone, and to cut the kidney, traumatic, bleeding, long recovery cycle, open abdominal lithotripsy due to the trauma and the risk of large, has been rarely used.
"Flesh" hit stone : that is, extracorporeal shock wave lithotripsy, in the 1990s this technology is more commonly used, it is the use of extracorporeal shock wave focusing on the body of the stone, so that it is discharged with the urine out of the body.
"Hole" stone: that is, percutaneous nephrolithotripsy lithotripsy, at the end of the last century, this technology is the mainstream technology for the treatment of urological stone treatment, generally in the abdomen or the lumbar back to take 0.5CM small incision, with the laser to the stone crushed and taken out, trauma is small, less pain, wide range of indications. The laser can be used to break up the stones and remove them.
"Non-invasive" stone removal: Ureteroscopy technology, is the 21 actual urological stone diagnosis and treatment of cutting-edge technology, this technology is through the human body's natural lumen - the urethra into the ureter, the bladder, and then inserted into the ureter, and finally reach the renal pelvis; with holmium laser, the ureter, and the ureter, and finally reach the renal pelvis. This technology is through the body's natural cavity - urethra into the ureteral bladder, and then inserted into the ureter, and finally can reach the renal pelvis; with holmium laser, stone basket stone crushing, stone removal, basically no trauma, to achieve non-invasive stone.
Understanding these "stone removal" techniques, we will focus on analyzing these two stone treatment techniques: extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy.
Extracorporeal shock wave lithotripsy is an effective, minimally invasive method of treating urinary tract stones, with the advantages of low trauma, fast recovery and low cost, favored by the majority of patients. However, it is not suitable for all stone patients, due to improper treatment leads to kidney injury, bacteremia and even death should be taken seriously.
Part I: Let's take a look at the indications and contraindications for extracorporeal lithotripsy:
The indications are as follows:
The contraindications are as follows:
Part II: What are the misapplications of extracorporeal lithotripsy?
1, extracorporeal lithotripsy has been done, the stones are gone?
Not necessarily, although done, but not directly from the body to "drive away" the stone, but the large size of the stone will be crushed into a small size of granular stone (gravel particles), these gravel particles may still stay in the original site, or These particles may remain in their original location, or may move from the obstructed location to the non-obstructed location, and need to be accompanied by auxiliary methods of stone removal after the operation, in order to promote the partial or complete elimination of the stones from the body with the urine.
2, ultrasound examination of stones, do extracorporeal lithotripsy
Just based on a single ultrasound single dare to give the patient lithotripsy, this is not right. You also have to do imaging, CT, to see if there is a narrowing of the urinary tract, obstruction, etc., these examination fees can not be saved. The reason is that the broken stones will eventually be discharged through the urinary tract, if there is a stenosis, obstruction, even if the broken stones can not come down, resulting in hydronephrosis, which will damage the renal function in the long run.
Extracorporeal lithotripsy is not suitable for all stone patients, due to improper treatment leading to kidney injury, bacteremia and even death should be taken seriously.
3, 1, 2, 3 times not discharged, can be shocked until discharged
In fact, the principle of extracorporeal lithotripsy is a physical lithotripsy, the general normal people, the finger disease and does not belong to the scope of contraindications, the acceptance of extracorporeal lithotripsy should not be more than 3, and the interval between each time not less than 2 weeks. Extracorporeal lithotripsy can cause some damage to kidney function, and more than 3 times lithotripsy may cause kidney atrophy.
Part 3: Extracorporeal lithotripsy can not be done indiscriminately
Through the analysis of indications and contraindications, it can be found that the size of the stone can not be used to determine the treatment plan, and some patients with small stones, special location (lower calyces, calyces of the kidney), poor lithotripsy, patients with special physical conditions (obesity, deformities), etc., can not pass the extracorporeal shock wave lithotripsy. The patient's special physical condition (obesity, deformity), etc., can not pass the extracorporeal shock wave lithotripsy, and should be changed to minimally invasive surgery. Therefore, the most appropriate stone surgery should be based on the patient's stone size, location, number, renal function and general condition and metabolism, obstruction and degree of difference, specific analysis, choose the best surgical treatment.
Ureteral flexible mirror non-invasive stone technology, because the natural lumen of the human body urethra into the human body, without surgery, no holes, high degree of security, minimal damage (basically no damage), so it is known as the world's urological stone diagnosis and treatment of the "ace technology", this technology for the less than 2.5cm kidney stones and ureteral stones on the upper end can be easily dealt with, the use of the ureter, the ureter, the ureter, the ureter, the ureter and the ureter. The stone can be easily handled, the use of this stone technology patients usually only need to be hospitalized for 1-3 days, can be discharged.
Part I: Advantages of ureteroscopy:
Part II: Indications for ureteroscopy:
Part III: Knowledge of ureteroscopy:
Part III: Knowledge of ureteroscopy:
This is the first time that a patient has been hospitalized for a period of time.
1, soft mirror technology to carry out "less"?
As today's urolithiasis treatment is the most advanced, the most top "ace technology", is only in the first and second tier of tertiary hospitals focus on urology to carry out.
Equipment is expensive: a soft mirror price of about 600,000 = 1 BMW 5 series
easy to damage: in general, the mature experts operate about 40 operations, the soft mirror that is in need of major repairs (the novice operation 1 less careless that is the need for repair);
Maintenance costs:
All of these costs are due to the fact that the mirror has been used in the past, but it has been used in the past, so it is not necessary for the user to use it. strong> Maintenance costs: "soft lens 4S store" maintenance offer more than 40,000 / time
2, soft lens technology surgery fee "expensive"?
The high cost of soft lenses and the lack of technical talent make them slightly more expensive than other procedures (4K-5K more). However, compared to other techniques, soft lens technology is further advanced:
1, the abdomen does not play "hole", 0 trauma;
2, the kidney does not play "hole", safer;
3, the same day after the operation, you can get out of bed activities
4. Generally, you can be discharged from the hospital on the next day.
3, soft mirror technology is safe?
Note: At present, in the domestic key urology hospital, has matured and popularized the application, and has been recognized by the industry and patients. It is the future direction of development of urological stone technology, usually, stone surgery to take the lumbar hard joint way, then the surgical process of the patient is in a state of wakefulness, you can watch their own lithotripsy, stone removal surgical process.
According to Dr. Heers, a urologist at Oxford University Hospitals in the United Kingdom, it can be found that: the volume of extracorporeal lithotripsy surgery in the last five years has remained relatively stable, and even in 2013-2014 there is a downward trend. On the other hand, the number of patients using ureteroscopic devices to treat stones is growing, with a 5-year growth rate of 103%. This indicates that minimally invasive surgical interventions (percutaneous nephrolithotomy, ureteroscopy) will replace extracorporeal shock wave lithotripsy in the next three years.
At the same time, ureteroscopy technology, due to advanced equipment, to surgical diagnosis and treatment of the three main purposes: the most effective treatment of the disease, the maximum possible to preserve the function of the organs, the maximum Chengdu to reduce the trauma , at the same time, can be minimally invasive or even "" non-invasive "" to achieve the stone removal. At the same time can be minimally invasive" or even "non-invasive" to achieve the purpose of removing stones, so it is worth studying and promoting.
This is the first time I've ever seen the world's most popular medical device.