The method of crushing stones in the kidney of the patient

 

(57) Abstract:

The invention relates to medicine, in particular to urology and can be used in medicine, for lithotripsy of kidney stones. The inventive before lithotripsy determine the modes of fragmentation based on the size and chemical structure of ureteral stones, secretory function of the kidneys, of bacteriuria and age of the patient, followed by crushing with the found modes. 14 table.

The invention relates to medicine, in particular to urology, and can be used for lithotripsy (ESWL) for kidney stones man.

The known method lithotripsy of calculus of kidney, consisting in applying shock wave pulses on calculus.

The disadvantage of this method is the lack of criteria for a graded approach to the age of the patient, determining the severity of urolithiasis and main characteristics of ureteral stones (volume and chemical composition).

The purpose of the invention increase the efficiency of crushing urinary concretions, reducing the traumatic impact lithotripsy for kidney parenchyma and reducing posley modes crushing, taking into account the patient's age, size and chemical structure of the stone, the secretory function of the kidneys and the presence of bacteriuria.

The method is as follows.

Known methods visualize calculus, determine its location in Cup pyelocaliceal system kidney and sizes. Determine the presence of bacteriuria, the secretory function of the kidneys and the chemical composition of the concrement in vivo.

1. The required number of sessions depends on the volume of the stone, based on the fact that for the 1st session is crushing section of the stone (or stones) of not more than 2.5 cm; with Staghorn calculi stones used scheme: K1 2-3 session, K2 2-4 session, K3 3-4 sessions, K4 4-6 sessions, where

K1 beginning of Staghorn calculi stone" 100% full pelvis and there are small appendages in Cup system.

K2 "partial Staghorn calculi stone filled all the buckets and one of the cups kidney 30%

K3 "partial Staghorn calculi stone filled all the buckets and 60% of the cups.

K4 complete Staghorn calculi stone" the stone fills the entire Cup-pelvis system of the kidney.

2. The choice of modes of fragmentation (see tab.1-5) renal stone method lithotripsy provides the Ohm:

a) secretory function of kidneys in norm and there is no bacteriuria (titer less than or equal to 3);

b) secretory function of the kidneys is reduced by no more than 50% and no bacteriuria (titer less than or equal to 3);

C) secretory function of kidneys in norm, but there bacteriuria (level 4 and above);

d) secretory function of the kidneys is reduced to 50 and have bacteriuria (level 4 and above).

C1 number of pulses when the capacitance of the charging capacitor is 0.04 µf;

C2 the number of pulses when the capacitance of the charging capacitor is 0.06 μf;

C3 the total number of pulses, i.e., C3= C1+C2;

k1 coefficient possible traumas, k=C1/C2 shows the ratio of low-energy and high-energy regimes;

V voltage;

IEP interelectrode gap.

3. Modes crushing stone, depending on its chemical composition and structure are selected after conversion.

1 stone consists of mono - or dihydrate of calcium oxalate in pure form, in a mixture or admixture of carbonate (Dahlia);

2 stone is composed of uric acid or the lithate of ammonia mixed with mono - or dihydrate of calcium oxalate;

3 stone consists of whitlockite (tricalcium phosphate);

4 stone consists of cystine;

5 stone sostoi mixed in different proportions of mono - and dihydrate calcium oxalate, uric acid or lithate of ammonia, vitakic, struvite;

k2 coefficient possible traumas.

In order to obtain the necessary modes of fragmentation depending on the chemical structure of the stone, you must recalculate the modes specified in paras.2 (a-g) according to the following formula:

1) If -1 < (k1-k2)<1,
2) If -2 < (k1-k2) -1 or 1 (k1-k2)

the C22=C2+Sh(k1-k2)/2,

3) If (k1-k2) -2 or (k1-k2) 2,

the C22=C2+Sh(k1-k2)/4 Then C11 C3-C22.

If C11/C22 < k1/2, it is a relative contraindication to the stone.

k1 coefficient possible traumas of the table. 1-4;

k2 coefficient possible traumas of the table.5;

C2 pulses C2 from table.1-4;

C22 a new value for C2, depending on the composition of the stone;

C11 new value for C1 depending on the composition of the stone;

C3 the total number of pulses from the table.1-4.

4. Modes crushing for children selected low-energy. Therefore, ceteris paribus (the patient's condition, size, localization and chemical structure of ureteral stones) modes change as follows: C1 (capacitance of the charging capacitor is 0.04 µf) increased by 40% C2 (capacitance of the charging capacitor is 0.06 μf) or not used or premieretrade period is reduced by 15%

P R I m e R 1. B-Naya C. for 20 years, stone pelvis of the left kidney 1x0,9 see kidney Function is normal, the urine culture flora not found. Was conducted one session with the following modes of fragmentation (see tab.6).

Stone completely destroyed.

P R I m m e R 2. B-th b 57 years, stone pelvis of the left kidney volume 1,3x2 see kidney Function is reduced by 11% in urine culture bacteriuria is missing. Conducted 2 sessions with the following modes of fragmentation (see tab.7).

Stone completely destroyed.

P R I m e R 3. B-th HP 64 years, stone pelvis of the right kidney size 1,h,0 see kidney Function is normal, the urine culture Proteus with a title 4. Conducted 2 sessions with the following modes of fragmentation (see tab.8).

Stone completely destroyed.

P R I m e R 4. B.-H. Oh, 17 years, stone pelvis of the left kidney volume 2x1,7 see kidney Function is reduced by 10% in the urine culture Pr.mirabilis with a title 4. Conducted 2 sessions with the following modes of fragmentation (see tab.9).

Stone completely destroyed.

P R I m e R 5. B-d B. 42 years, Staghorn calculi stone in right kidney K2, kidney function is reduced by 33% in the urine culture Pr.mirabilis with title 5. Conducted 3 sessions with the following modes of fragmentation (see tab.10).

Stone completely destroyed oxalate calcium + carbonate. Kidney function is normal, bacteriuria is missing.

To obtain the necessary modes spent the following calculations: since kidney function in normal and no bacteriuria (see tab.1 for the volume of a stone more than 2,5 cm):

Initial conditions: k1=1,44 C2=961 C3=2353 (from table.1), k2=1,1 (from table. 5)

k1-k2=1,44-1,1=0,34

H,34+961=1288=C22

2353-1288=1065=C11

1065/1288=0,83 > 1.44MB/2 splitting is not contraindicated.

Conducted 3 sessions with the following modes of fragmentation (see tab.11).

Stone completely destroyed.

P R I m e R 7. B-Oh, Doctor of 56 years, multiple stones pelvis total 5,76 see kidney Function is reduced by 22% in the urine culture Proteus with a title 3. The chemical composition of stones: struvite and lithate of ammonia.

To obtain the necessary modes spent the following calculations: because kidney function is reduced and there is urine bacteriuria (see tab.2 for the volume of a stone more than 2,5 cm):

Initial conditions: k1=1,76 C2=869 C3=2398 (from table.2), k2=1,7 (from table. 5)

k1-k2=1,76-1,7=0,06

H,06+869=921=C22

2398-921=1477=C11

1477/921=1,6>1,76/2 splitting is not contraindicated.

Conducted 2 sessions with the following modes (see table.12).

Stone completely destroyed.

P R I m e R 8. B-e B. 6 years, stone pelvis SS="ptx2">

Stone completely destroyed.

P R I m e R 9. B-th C. 11 years, Staghorn calculi stone in right kidney K4, function reduced by 7% in the urine culture Pr.mirabilis with title 5. Conducted 3 sessions with the following modes (see table.14).

Stone completely destroyed.

The proposed method has the following advantages over known: enables the use of lithotripsy for children, differentiated approach to the choice of grinding regimes depending on the size of the stone in different functional abilities of the kidney and the presence of bacteriuria, and depending on the chemical structure of the stone. The choice of the optimal modes crushing improves the efficiency of destruction of concrements, reduce injuries parenchyma of the kidney, reduce the number of postoperative complications and reduce the average bed-day in the treatment of patients with urolithiasis.

The METHOD of CRUSHING stones IN the KIDNEY of the PATIENT, including the effects of shock wave pulses on the concrement, wherein the pre-determined modes of fragmentation based on the size and chemical structure of ureteral stones, secretory function of the kidneys, of bacteriuria and the patient's age, then PR is

 

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