La litiasis urinaria o mal de piedra, es una afección que afecta a la humanidad desde los más remotos tiempos.

En concreto, la formación de piedras o cálculos en el riñón y su posible expulsión a lo largo de las vías urinarias, el cólico renal,  se puede convertir en una de las peores experiencias dolorosa que podemos sufrir.

La litiasis renal es una causa muy frecuente de morbilidad del aparato urinario. Su incidencia se encuentra actualmente en aumento,  estimándose un riesgo de 12% en hombres y 6% en mujeres de sufrir un episodio durante el largo de su vida. La tasa de volver a sufrir un nuevo ataque varía entre 30-50% de los pacientes  a los 10 años, incrementándose el riesgo de sufrir la enfermedad con la edad.

En las modernas sociedades occidentales el 80% de las litiasis están compuestas de oxalato y/o fosfato de calcio, siendo los otros tipos principales de ácido úrico (ligado a la dieta), fosfatoamonicomagnesico, (ligado a las infecciones urinarias) y las menos frecuentes de cistina.

La evaluación médica del paciente con cálculo renal está centrada en las alteraciones dietéticas y metabólicas que conducen a la litiasis. Una vez que se han identificado estos factores, se puede planear una terapia preventiva específica y eficaz.

Actualmente las litiasis no expulsables, es decir que permanecen localizadas en cualquier lugar del todo el aparato urinario, son tributarias de los modernos métodos quirúrgicos mínimamente invasivos.

Hoy en día la combinación de las últimas tecnologías con el láser Holmium y el ureterorrenoscopio flexible, permite abordar la litiasis renal en cualquier localización tridimensional y a menudo sin incisiones.

Se trata de un tratamiento integral que permite tratar la concreción litiasica en cualquier localización. Además el acceso a través de la uretra evita en muchos casos el minimalista acceso lumbar percutáneo.

Es importante remarcar que  la moderna tecnología permite la extracción de los fragmentos pulverizados con la energía laser, a diferencia de otras técnicas como la litotricia extracorpórea por ondas de choque que fragmentaba los cálculos pero que el paciente tenía que expulsar en la micción, lo que podía ocasionar nuevas obstrucciones de la vía urinaria, cólicos renales, infecciones de orina….

A todas estas ventajas que facilitan  la realización de tratamientos cuasi ambulatorios o de dar el alta a las 24 h., hay que añadir que la combinación de estas técnica s permite tratar simultáneamente  o no, otras patologías como las neoplasias urinarias.

En definitiva, un nuevo paradigma terapeútico del ancestral mal de piedra de las vías urinarias gracias a una tecnología disruptiva basada en el uso del láser y de los resolutivos ureterorrenoscopios flexibles que logran el acceso a todos los rincones dentro del riñón, elevando la calidad de vida de los pacientes que tengan que pasar por este “ mal trago “.

 

Dr. Joaquim Gironella Coll

 

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