The Dr. Ibarluzea Gaspar Gonzalez, urologist Top Doctors, tell us about the extra- and intracorporeal lithotripsy.
The revolution began in the 80s of last century, to treat urinary stones via, has continued, especially in these last years, with an unstoppable evolution of the hand of technological development. The miniaturization of devices, the incredible advances in image we all know from our phones, video cameras and photos in constant evolution, new materials, 3D vision, robotics, and so. All this applied to medicine, in our case urology and especially in regard to the treatment of urolithiasis has allowed us to minimize the patient aggression unthinkable a few years ago so that sometimes the only option it was an extremely bloody and aggressive surgery. As a clarification for non urologists tell them we use indistinctly the terms: stone, rocks or load as synonyms.
Lithotripsy Extracorporeal shockwave
The Lithotripsy Extracorporeal was invented in the 80s. The first device so house development Dornier, a German company, realizing that a shockwaves which were produced in experiments that made them missiles and aircraft could approach and who produced tension forces they were able to break the calculations or stones rino. The first device consisted of a bowl of water in which the patient had to put the medium through which the wave is propagated was water, then why the method was popularized as the bathtub. They have not stopped evolving devices, this we have here is the seventh of generation of appliances Dornier brand is the Dornier Gemini, is the most sophisticated device on the market has a location systems and very advanced patient positioning, fully robotic. The main disadvantage of this method is that once broken stone in more or less large fragments should be removed in its natural route, so after a certain amount of stones, stones, we find the serious problem of obstruction urinary route.
The intracorporeal lithotripsy
The endoscopic techniques to treat bladder stones began early last century. We cause great admiration the skill of those urologists who had covered trouble with rudimentary means to our eyes but in his day was a huge step. This is a mechanical litrotictor my private museum that taught him to want to scare any patient. Was introduced through the urethra into the bladder and with very poor vision would be removing the calculation with these pliers.
Until the 80s we were not able to introduce under direct vision in the upper urinary route, ie, in the ureter and renal cavities. The set of endoscopic techniques to explore and act on the upper urinary tract are known by the term of Endourology. In the ureter and renal cavities we can introduce two major roads, the main hole, ie through the urethra and through the bladder to access one or the other ureter, this requires the use of very thin instruments and fragile and this is one of the areas of greatest evolution in the last decade
retrograde intra-renal surgery
The uretenorenoscopia flexible instruments than 3 mm in diameter with a television camera in High Definition and totally manageable tip allow us to navigate through the urethra and bladder into the ureter and penetrating up through the coming to innermost urinary via an exciting underwater journey.
Obviously this requires a miniaturized instruments to the fullest and a must as is the holmium laser with a 200 micron fiber, almost as a hair, allows us to cut coagulate and break stones.
percutaneous intra-renal surgery.
The technique of choice for treating large stones in the kidney is the renal cavities accessed by a path established from the skin of the lower back kidney. By puncture with a needle directed by ultrasound and X -ray guide a metal is introduced, after removing the needle expands on the guide to put a hole approximately the size of a pen that will communicate with the interior of the kidney where the outer tube introduce endoscopes, which in this case may be called nephroscopes both rigid and flexible.
The latest acquisition to our therapeutic arsenal is microperc is to perform surgery for puncture percutaneous but without enlarging the path because for the same needle can fit an optical system miniaturized to the maximum and fiber laser to break the calculation.
I do not know where we will lead all the way to the future for when I started the specialty, and over 30 years ago, this was unthinkable and even a science fiction author would have imagined. From what I am sure of is that while humans have to pee on the horizon does not provide otherwise, good urologists need to fix our pipes jams.