Urology Casablanca

Urinary stones Extracorporeal lithotripsy Some notions of anatomy of the urinary system This will allow you to better understand the explanations of your surgeon who indicated this treatment. In your abdomen (tummy) is the entire system for making and storing urine and the passages for its evacuation. The diagram below will help you locate the different parts of the urinary system. The kidneys (R) are located at the top and back of the abdomen. There is usually one kidney on the right and one on the left. The kidney is about 12 cm high and contains cavities (calyxes) to collect urine. These calyxes come together to form the renal pelvis (B). From there a thin channel leads the urine from the kidney to the bladder (V): this is the ureter (U). It measures approximately 20 cm in length. The two ureters (right and left) carry urine to the bladder. The bladder is the reservoir for urine. Urine leaves the bladder (urination) through a tube called the urethra

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Disease It affects 10% of the population, with a risk of recurrence of 50% at five years; the stones are oxalo-calcic in nature in 80% of cases. These calculations can remain blocked during their migration to different places depending on their size, and prevent the passage of urine. The pressure of the urine then increases in the kidney and produces pain: renal colic. The formation of stones occurs by crystallization of urine in the kidneys. These small stones can sometimes be responsible for bleeding (red urine). They can also promote the development of a urinary tract infection. Support options at this stage There are other ways to treat urinary stones: ureteroscopy, percutaneous surgery, or exceptionally laparoscopy or open surgery). The indication for each technique depends on the size, the situation, the nature of the stone and the specific characteristics of the patient. Your urologist has explained to you the advantages and disadvantages of each technique and the reason why he is suggesting extracorporeal lithotripsy. Principle of the intervention This is an extracorporeal method that allows the stone to be fragmented using shock waves generated by a lithotripter. The contact of the treatment head with the patient's skin makes it possible to propagate and focus the shock waves on the stone. This is thus reduced to fragments which will then be eliminated in the majority of cases. This elimination takes place through the urinary tract. There is therefore no surgical opening. The placement of a ureteral catheter between the kidney and the bladder (known as a “JJ or double J” catheter) may be necessary as part of the treatment. Depending on the size, strength of your stone and response to treatment, one or more sessions may be required.

Average length of stay The treatment usually lasts less than an hour, during which time you are lying down. In the event of hospitalization, this varies from a few hours to two or three days depending on the type of stone, your general condition and the postoperative course (pain, fever). Preparation for the procedure It is important to indicate if you are taking medication that thins the blood such as aspirin, anti-platelet agents or other anticoagulants, if you have a pacemaker or if you are pregnant. If your lithotripsy requires general anesthesia, a consultation with an anesthesiologist is necessary before treatment. The medical team will ensure that there is no urinary tract infection and will check your radiological file. Procedure of the intervention You are lying on a treatment table, a tracking device (X-rays or ultrasound) can locate the stone. A balloon filled with water and covered with ultrasound gel is then brought into contact with the skin to allow the shock waves to propagate to the stone to fragment it. You will hear the sound of these shock waves. The number of impacts will be determined by your urologist. A new session may be necessary. Pain management: the intervention takes place with or without anesthesia according to the practice of the medical team.

Usual suites Usually the urine is colored with blood for a few hours to a few days. Pain and difficulty in urinating may occur which corresponds to the migration of the fragments. An analgesic treatment may be offered to you by your urologist. The fragments are eliminated by natural means within a period of between a few days and a few weeks. In the absence of pain, abundant drinks will facilitate this elimination. It is recommended to filter your urine and collect the fragments for analysis. This will allow us to offer you a suitable diet and drink in order to reduce the risk of recurrence of the stones. The success rate noted in the medical literature is 60 to 85%. If lithotripsy fails, your urologist may suggest another session or another method of treatment. Return home At the time of discharge, the healthcare team will give you the necessary documents for your return home and your follow-up. Risks and Complications Any intervention carries a risk of complications which are not always foreseeable but can sometimes be serious, in relation to the disease with which you are affected and/or individual variations. Lithotripsy can give rise to the following complications Renal colic Intense pain can appear if a fragment of the stone blocks the passage of urine between the kidney and the bladder. In this case, you need to decrease fluid intake. Appropriate medical care can in most cases calm the symptoms. Chills / fever If you experience chills and/or fever, you should immediately contact your urologist, the emergency department and/or your doctor for appropriate treatment. Other Complications Exceptionally, a hematoma may appear in or around the kidney, which may require a blood transfusion and/or surgery. The organization of the follow-up Your urologist will prescribe radiology examinations to assess the results of the session after several days or weeks. This will make it possible to define the follow-up or reprocessing methods if deemed necessary. The analysis of stone fragments (infrared spectrophotometry) is necessary to determine the exact nature of your stone. Subsequently, a metabolic assessment will be proposed to you in order to prevent a possible recurrence.