Patient's question:
How big of stones can be removed with a ureteroscope?Doctor's answer:
Hello: Ureteral calculi can be easily diagnosed through clinical ultrasound examination. Generally, kidney stones that fall into the ureter can be diagnosed as ureteral calculi. They often cause ureteral obstruction, leading to renal pelvis dilation and hydronephrosis. If ureteral calculi causing obstruction are not promptly removed, it may result in kidney damage and renal failure. In the early stages, it often presents with lower back pain and discomfort, severe renal colic, causing great suffering to the patient. Lower and middle ureteral calculi can radiate pain to the penis, testicles, and perineum. Accompanied by symptoms such as nausea and vomiting. It is recommended to use extracorporeal shock wave lithotripsy (ESWL) as the first choice for stone removal treatment. Early treatment is crucial for better stone removal results.First, let me explain that extracorporeal shock wave lithotripsy (ESWL) is a non-invasive, innovative stone removal treatment device and technology. Its principle is entirely different from extracorporeal shockwave lithotripsy. The advantage of ESWL lies in its lack of organ damage, thorough stone removal, minimal patient pain, and easy acceptance. In contrast, extracorporeal shockwave lithotripsy can cause organ damage and is more painful.
The ESWL technology employs high-frequency superconducting fluid dynamic shock wave three-dimensional integrated stone removal technology, assisted by large digital ultrasound for precise localization. It features accurate positioning, rapid stone removal, and complete removal of bile duct stones and ureteral stones, especially effective for in the intrahepatic bile ducts. The most prominent feature of this equipment is its user-friendly operability, thorough stone removal for various types of stones, wide applicability, minimal side effects on the human body, painless stone removal process, no need for hospitalization, and low treatment costs, making it highly acceptable to patients. It is a reliable, effective, simple, and practical treatment device with unique equipment and technical advantages. Therefore, it is currently the best choice for treating various types of stones.
ESWL is most suitable for kidney and ureteral stones under 10mm. Generally, after several treatments, stones can be completely removed. For larger stones, the principle of first crushing and then removing the stones can be adopted to achieve complementary advantages. However, for ureteral stones, it is necessary to wait for 3-5 days after the stone has lodged locally in the ureter to subside before initiating stone removal treatment. Generally, stones are relatively easy to remove. Whether it is small ureteral stones or larger multiple stones, due to the widespread use of ultrasound, the diagnosis of ureteral stones is timely and easy. Small stones entering the ureter are usually detected early, providing the best conditions for ESWL treatment. For stones lodged in the ureter for a long time, it is difficult to remove them without surgical or ureteroscopy procedures. At the same time, it is more important to provide patients with the latest measures for early stone removal to avoid excessive treatment methods that cause significant organ damage, poor efficacy, pain, and high costs.
The indications and scope of treatment for ESWL are as follows:
(1) For various kidney and ureteral stones less than 1.2 cm, extracorporeal shock wave lithotripsy should be the first choice for stone removal treatment. This method avoids kidney damage, ensures thorough stone removal, is safe and painless, and has no side effects from shockwave lithotripsy. If the stone diameter exceeds 1.2 cm, extracorporeal shockwave lithotripsy should be used first to crush the stone, followed by ESWL for thorough stone removal, achieving complementary advantages.
(2) This equipment is particularly suitable for acute ureteral stones and the resulting renal pelvis dilation, hydronephrosis, ureteral obstruction, ureteral dilation, and renal colic. It can quickly remove ureteral stones, alleviate immediate pain, and rapidly relieve symptoms, making it the preferred treatment for ureteral stones.
(3) For patients with multiple kidney stones on the same side combined with ureteral stones, the ureteral stones should be removed first, followed by the removal of multiple kidney stones, to prevent the formation of a "stone street" in the ureter.
(4) For large kidney stones that remain in the lower pole of the kidney pelvis or calyces after ESWL fragmentation, these small stones are the best indication for ESWL for thorough stone removal. This is because the handheld high-frequency superconducting shock wave can directly touch the stones in the lower pole of the kidney, moving them into the renal pelvis and ureter for removal.
(5) For the stone removal treatment of the above-mentioned stone diseases, if urinary tract infections lead to conditions such as pyelonephritis, ureteritis, cystitis, prostatitis, or urethritis, and if inflammatory congestion and swelling of the mucosa affect stone removal, it is necessary to first undergo antibiotic treatment to reduce inflammation before initiating ESWL.
(6) Generally, 1-3 ESWL treatments are sufficient to completely remove stones, with a duration of 5-7 days. Patients in good physical condition can undergo continuous treatments, while those with poorer physical health can have treatments every other day. If patients have poor urinary function or infections, the hospitalization period may be longer. According to clinical observations, Professor Chen Bangjing believes that ESWL is currently the leading new technology for treating stones both domestically and internationally. It is the preferred method for treating kidney stones, ureteral stones (which are generally removed within two hours), gallstones, and extrahepatic bile duct stones, as well as intrahepatic bile duct stones. Its completely thorough stone removal effect, lack of organ damage, and low cost have benefited a vast number of patients. For stones beyond the scope of ESWL, extracorporeal shockwave lithotripsy should be performed first, followed by stone removal. For large kidney cast stones and gallstones, surgical stone removal is recommended upon discovery.
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