Extracorporeal shock wave lithotripsy in the treatment of the urolithiasis

Abstract

Urolitijaza je bolest, kod koje dolazi do stvaranja mokraćnih kamenaca u mokraćnom sustavu. Ona je dosta česta, ali se stvarna incidencija ne moţe točno odrediti pošto su dio kamenaca asimptomatski, a dio prolazne naravi. Smatra se da će 5– 10 % opće populacije imati jednu ili više epizoda mokraćnih kamenaca tijekom ţivota. Kod urolitijaze postoji obiteljska i nasljedna sklonost, a vaţan faktor u nastanku mokraćnih kamenaca predstavlja način ţivota i prehrane. Liječiti bolesnika s urolitijazom moţe se medikamentozno i kirurški. Kirurško liječenje mokraćnih kamenaca obuhvaća klasičnu, otvorenu operaciju, koja se koristi samo kada su druge mogućnosti isključene i minimalno invazivni postupci u koje spadaju nefrolitrotripsija, ureterorenoskopija i izvantjelesno mrvljenje kamenaca. Izvantjelesna litotripsija ili litotripsija šoknim valovima (ESWL) relativno je novija terapijska metoda u liječenju urolitijaze. Ona se temelji na uporabi šok-valova koji nastaju u posebnom generatoru, Nakon toga šok valovi se fokusiraju i usmjeruju na kamenac u tijelu pacijenata. Korištenje ESWL-a kao modaliteta liječenja ovisi o nekoliko faktora: veličina kamenca, smještaj, broj i njegov kemijski sastav. Unatoč veće tehničke zahtjevnosti, ESWL nudi mogućnost efikasnog i sigurnog uklanjanja kamenaca, uz rijetke komplikacije te mogućnosti višestrukog ponavljanja postupka.Urolithiasis is a disease that leads to urinary stone formation in the urinary system. It is quite common, but the actual incidence can not be accurately determined, because a part of the stones are asymptomatic and part of them are of transient nature. It is believed that 5- 10% of the general population will have one or more urinary stones during their lifetime. Urolithiasis has a family and hereditary tendency, and an important factor in the emergence of urinary stones is lifestyle and nutrition. A patient with urolithiasis can be treated medically or surgically. Surgical treatment of urinary stones includes a classical, open operation, used only when other features are excluded, and minimal invasive procedures involving nephrolithrotripsy, ureterorenoscopy and extracorporeal shock wave therapy. Extracorporeal shock wave therapy is a relatively newer therapeutic method for treating urolithiasis. It is based on shock waves generated in the generator, focusing and pointing on the urinary stone in the body of the patient. The use of ESWL as a modality of treatment depends on several factors: the position of the stone, the size, the number of stones and the chemical composition of the stones. Despite the greater technical difficulty, ESWL offers the possibility of efficient and safe removal of stones, with rare complications and multiple repeatability of the procedure