Pyelolithotomy

A pyelolithotomy is a surgical procedure that removes stones from the ureter or renal pelvis. It involves a large incision to access the ureter. This type of intervention is used when it is impossible to perform laser or ultrasound crushing of a stone. The large size of the kidney stone and its ingrowth into various parts of the pelvis recommends pyelolithotomy. The operation is performed in several ways, depending on the severity of the course of the disease.

Indications for pyelolithotomy 

A nephrologist can prescribe a pyelolithotomy to a patient for the following indications:

• Large stones in the pelvis and ureter
• Coral calculi
• A peculiar form of kidney stones that cannot be crushed or removed in any other way

The decision to carry out the operation is made when other alternative methods don’t bring a positive result. Also, pyelolithotomy is indicated for patients with a pathological structure of the pelvis and narrowed ureters.

Contraindications for undergoing pyelolithotomy

Despite the positive effect of the surgery, pyelolithotomy has several contraindications. Nephrologist prevents performing kidney surgery:

• With impaired blood clotting:- The disease can be both acquired and congenital. Also, the presence of hypocoagulation is affected by the intake of certain drugs. In this case, the surgery cannot be performed due to the high probability of bleeding during and post-surgery. 
• Development of infectious diseases:- The infection is preliminarily treated, and then a decision is made to operate.
• Long term pregnancy.
• Severe inflammation that can move into the abdominal cavity during the intervention

Technical difficulties can arise with scarring in the abdomen. When trying to isolate the kidney and adjacent tissues, the surgery becomes difficult, and laparoscopy will be impossible. 

Pyelolithotomy types

A pyelolithotomy is performed in three main ways:

• Open:- It is used in the formation of very large calculi, coral calculus, and, during the absence of specialized equipment in the treatment center. During this procedure, a significant incision is made to maximize access to the affected organ, its pelvis, and ureter.
• Laparoscopic:- It is performed through small punctures in the abdominal wall. These openings are used for the introduction of medical instruments and surgical equipment. Laparoscopy is indicated in cases where other methods have not yielded an effective result, but it is possible not to use abdominal intervention.
• Retroperitoneoscopic:- This endoscopic procedure is performed without incisions. The operation is performed through natural holes. The advantage of the technique is the absence of serious complications.

Pyelolithotomy Preparation

Before carrying out surgical intervention, it is necessary to go through the preparatory stage. It consists of several analyzes and additional examinations:

• general examination of blood and urine
• bacterial urine culture
• electrocardiogram
• general radiography of the kidneys and ureters
• excretory urography

Two days before the operation starts, the patient is given antibiotic therapy with medications that do not have nephrotoxic properties but can accumulate in the kidney tissues. The drugs are selected individually for each patient.

The doctor takes the results of an X-ray and a urogram into consideration before an operation. He keeps it in the operating room at the time of the intervention. You should not eat, drink and smoke for an estimated 8 hours before the operation.

Pyelolithotomy surgery procedure

• Before the intervention, the patient is given general anesthesia. The operation itself takes about 3 hours. The duration depends on the complexity and technique. Endoscopic pyelolithotomy is performed through the urethra, where surgical equipment is inserted, and stones are gradually removed.
• With laparoscopy, a couple of lateral punctures are made, and with strip surgery, a 10-centimeter incision is made along the rib. The lateral or translumbar approach makes it possible not to affect the abdominal cavity. However, to use it, you will need a specific surface. If stones are localized in the lower part of the ureter, a peritoneal incision is used – an abdominal approach.
• When anesthesia starts working, the doctor makes a layer-by-layer incision to determine the genitourinary system area. Then the diseased kidney or ureter is dissected and the stone removed.

After removing the calculus, the surgeon completely sutures the organ with an absorbable thread or partially sutures. Partial closure is used in case of suppuration or hydronephrosis. 

Also, the operated area may not be completely sutured if you need to put a catheter for antibiotics and antiseptic treatment. In the end, the doctor performs layer-by-layer stitching of the incision, and the patient is placed in intensive care.

Pyelolithotomy possible complications

Complications can occur both during the operation and after it. When performing pyelolithotomy, there is a risk of damaging the ureter and inaccurate removing the stone. At the same time, it can cause damage to the pelvic tissue, provoking bleeding from the blood vessels. These types of complications are rare. Serious consequences sometimes arise during the rehabilitation period. The following complications are possible:

• rupture of seams and, as a result, bleeding from the urinary ducts
• leakage of urine from the wound due to rupture of the suture on the renal pelvis
• excessive narrowing of the ureter due to unskilled suturing after surgery
• development of pneumothorax and other problems with the lungs, these disorders can manifest themselves in the first days after the intervention
• infectious complications
• an incisional hernia is very rare

Post-surgery

At the first stages of rehabilitation, the doctor prescribes non-narcotic analgesics, pain relievers, non-steroidal anti-inflammatory drugs to relieve pain. The duration of observation in the hospital directly depends on the type of surgery performed. On average, this period lasts 1-2 weeks. At this time, specialists monitor the patient’s condition and reduce the risk of possible complications.

Operating sutures are removed as early as ten days after laparoscopic and open surgery. The patient is allowed to get out of bed on the second day after the operation. However, during the recovery period, there should be minimal physical activity. For ten days, the patient is prescribed antibiotics.   If required, he needs to take heart and hypertensive drugs.

The diet regimen should be specific for the operated person. You should increase the amount of fluid you drink. Adhering to diet guidelines will help prevent infection within the kidneys. Drinking plenty of fluids will effectively flush the ureters and kidneys from clots of mucus and blood.

The total duration of rehabilitation is at least two months. After the endoscopic operation, this period is halved and is only a month. Throughout the time, a person needs to take phytotherapeutic agents.

Recovery time

For the fastest recovery, the patient you may need to follow specific guidelines:-

• Performing moderate exercise as directed by your doctor. It will help restore renal circulation and stabilize bowel function.
• Eat high-calorie and easily digestible food. It is forbidden to eat pickled, salted, fried, and spicy foods. What exactly can be eaten is determined by the doctor, based on the type of stones removed
• Also, a doctor may recommend competent herbal medicine to prevent complications and the development of new stones.

Pyelolithotomy result

After the pyelolithotomy, you need to monitor your health and visit the clinic for regular checkups. The prognosis for recovery depends on the severity of the disease and the causes of stones. If the correct and complete treatment was carried out, then the percentage of people who recovered exceeds 90%. Modern medicine predominantly uses medical, surgical, laser, and ultrasound methods to remove stones in the urinary organs. The quality of therapy particularly depends on the patient.

A doctor recommends undergoing regular examinations to prevent the formation of calculi in the ureters and kidneys. Also, immediately seek help from specialists at the slightest manifestations of the symptoms of urolithiasis. In this case, it is more likely to avoid surgical mediation and get treatment with drug and laser crushing.