A kidney stone is crushed using a laser. Photo: archive of the 7th City Hospital of Ivanovo
High-tech operations in urology, which just recently seemed like science fiction, have become everyday practice for doctors at Ivanovo Hospital No. 7. Endoscopic operations, flexible urethroscopes, and stone crushing using the sonic boom principle are available to residents of the Ivanovo region free of charge under compulsory health insurance (CHI), writes ” Ivanovo newspaper”.
Endoscopic operations gave impetus to development
As Evgeny Varentsov, head of the urology department of Ivanovo Hospital No. 7, says, the progress in urology compared to the time when he started working is enormous. In fact, doctors no longer compare today’s technologies with the methods that were used 20–30 years ago.
“I would say that rapid progress began in 2009, when we began to perform endoscopic operations. For example, over the past eight years we have not had a single “open” operation for urolithiasis,” notes Evgeniy Anatolyevich.
The most common problem faced by patients in the urology department is stones in the urinary system (i.e. urolithiasis). A foreign body inevitably causes inflammation around itself, and if the outflow of urine is disrupted, it also causes pain, which is considered the most severe, comparable to oncology in the later stages. This means the stone needs to be removed.
Once upon a time, any surgical intervention meant tissue dissection, isolation of an organ altered by pathology, which was accompanied by significant surgical trauma and a long recovery period. Recently, the focus has shifted to minimally invasive operations – the incisions have become smaller and the postoperative recovery shorter. And now doctors are striving to carry out interventions without a traditional scalpel.
Good to know. In order for your kidneys to remain healthy for as long as possible, you need, firstly, to eat in moderation and eat a varied diet, without relying on the same foods. And secondly, drink enough water. There is a simple experiment: if you pour table salt into a glass of water, it will dissolve for some time and then begin to precipitate. The same thing happens in the kidneys. And it’s not far from the stones.
Aircraft designers invented hospital device
However, methods that seemed fantastic just yesterday have today become an everyday routine.
“Have you ever heard a sharp bang that is heard when an airplane passes the sound barrier? This is a sonic boom. The lithotripter, a medical device for crushing stones in urolithiasis, operates on the same principle. It was, in fact, invented by people who worked in the aircraft industry.” , says Evgeny Varentsov.
The principle of operation of a lithotripter is that a shock wave is applied to the stone using X-rays or ultrasound, and then fragmented. Ideally, the stone crumbles into separate fractions, which are removed naturally.
The method of extracorporeal lithotripsy has proven itself well. Doctors have been using it for many years. But there are also disadvantages. The main thing is that the density of the stone may be too high and then it will not be possible to crush it. And with increasing power of exposure, the risk of complications increases.
Since 2021, doctors of the urology department of the 7th hospital have been using a spiral computed tomograph for diagnosis, which is also available through compulsory medical insurance (that is, the examination is free for patients) as part of a public-private partnership. The examination allows you to determine the density of the stones and predict whether they will be crushed. If the density is high, you need to look for alternative treatments.
Meanwhile. In federal centers, many operations are performed using robots. Of course, it is not the “electronician” who operates – the surgeon sits at the console. But this eliminates the possible negative impact of certain factors.
Flexible endoscope can reach any stone
As Evgeny Varentsov says, today doctors have at their disposal a full arsenal of means to combat the disease. These are, for example, minimally invasive percutaneous methods for removing stones, when a small puncture is made through the lumbar region, the canal is widened, and a special Teflon tube is installed in the collecting system. “And during the operation, using an endoscope camera, we see the structure of the kidney from the inside, determine the location of the stone and its size, and destroy it using laser or ultrasound energy,” says the specialist.
But, unfortunately, not all parts of the kidney are accessible for examination due to the peculiarities of the anatomical structure of the organ – it is not always possible to reach some stones using such methods.
“In this case, we use flexible endoscopy, when the instrument is passed along the natural urinary tract. We can bend the tip of the optical device at the desired angle and look into almost any part of the kidney. Endoscopes are disposable, sterile, with their own video system. Using a laser as an energy source fiber allows you to destroy stones of any density. In essence, we achieve the effect when the stone turns into sand and more or less large fragments are removed by doctors,” explains Evgeny Varentsov.
The operation, which doctors call “beautiful,” is the removal of stones in the ureters using endovideosurgery. Access to the desired location is carried out through a puncture on the anterior abdominal wall, laparoscopically. Within two to three days after such operations, a person can be discharged for outpatient treatment.
“By the way, many operations can be performed not only by venerable surgeons, but also by young specialists who have relatively recently graduated from university. And this is especially pleasing. They begin to work with experienced doctors, and then approach operating on their own. High-tech operations require serious and expensive equipment, but the surgeon’s algorithm of actions is clear,” notes Evgeny Varentsov.
Hatch. Residents of other regions of Russia often come for operations at the 7th Ivanovo Hospital. The “farthest” was a patient from Magadan who had a stone removed in our clinic. And even before Covid, a foreigner came here and was amazed at how quickly and efficiently he received help.
Patients are discharged home much faster
The reader will probably ask: won’t he have to wait for such a free operation for years, get his quota, and ultimately surrender to the mercy of commercial medicine?
“We really use many methods that are used in federal centers. And they are available to residents of the region absolutely free of charge under the compulsory medical insurance policy,” answered the head of the urology department. “As for quotas. They are enough to evenly distribute and provide assistance to everyone who needs it.” is needed. Thanks to modern methods, our bed turnover is very high. Patients are not delayed and are quickly discharged home. “
By the way, about 80% of the department’s patients come here urgently, by ambulance. For example, with renal colic.
In fact, all urological care is concentrated on the territory of one hospital association. For follow-up treatment, patients are discharged either to a day hospital or to outpatient treatment at a nearby urological center.
Botox will be used in surgery
Of course, kidney stones are far from the only problem that is dealt with in the urology department of City No. 7. Many “fantastic” methods (also available under compulsory medical insurance) are used in the treatment of prostate adenoma. For example, during enucleation, the energy source is an electric arc. And to treat patients with stents or pacemakers, for whom the current is dangerous, a laser is used.
When relieving women of urinary incontinence (one of the most common problems in urology), a special sling is installed under the urethra – a polypropylene mesh, which is stretched in measured doses, forming a closure mechanism. And now the patients can even dance, even do fitness, or even attend the theater.
For urinary disorders associated with diseases of the nervous system, when there is a disruption in the passage of nerve impulses, doctors intend to use… Botox. Botulinum toxin is injected directly into the bladder muscle and denervates it. The first such operations in the “seven” are planned to be carried out in the near future.
Marina MOSKALYOVA
