In St. Petersburg, urolithiasis is treated with a unique Russian-made thulium laser. The doctors of the hospital of St. Luke told Fontanka how it differs from other lasers and why its use is the very technological independence that the country needs.
Better and more efficient
The thulium laser can crush stones of any density in the kidneys and urinary tract, helping people get rid of deposits in a non-surgical or minimally invasive way. It is actively used in the treatment of urolithiasis. How exactly thulium differs from other lasers – only physicists can understand exactly. But briefly: thulium has a fundamentally different radiation and different pulse modulation. Thanks to this, Russian development works more efficiently and is cheaper to use than foreign ones. In addition, all related materials that are needed for such treatment are also produced in Russia.
Before the advent of thulium urological medical lasers, there was simply no domestic production.
“We were dependent on imports of equipment and consumables. Today, the situation has changed radically,” explains Igor Orlov, Deputy Chief Physician for Medical Affairs, Candidate of Medical Sciences, urologist-surgeon.
Urolithiasis (UCD) is a very common disease. On average, according to Orlov’s calculations, about 30% of all urologist patients suffer from stones. Suffering is not an exaggeration. When a stone enters the urinary tract, renal colic occurs. The pain from it is considered in medicine almost the strongest. Only the tooth is worse – and that is not always the case. But in addition to pain, the patient experiences severe intoxication. If help is not provided, the person may die.
“But not every person with stones in the urinary tract ends up in a hospital,” says Igor Orlov. – The ICD may not manifest itself in any way, and the person does not even know that he has stones. Unless he passes a special examination.
Urologists see people whose stones have already moved and blocked the ureter.
well forgotten old
Petersburg is not the leader in the number of cases of KSD, but in the clinic of St. Luke alone, stones are crushed annually in about 3000 patients. The operation lasts from 15 minutes (in mild cases) to several hours.
“Our city in terms of the number of people suffering from urolithiasis is about in the middle, when compared with other regions. Of course, there are more cases in the south,” explains Igor Orlov. “Where it’s hotter and people sweat more. Accordingly, their kidneys work out less, are washed out worse and are at risk of salt accumulation.”
At the same time, urolithiasis occurs even in young people. For example, recently Igor Orlov had a chance to treat an 18-year-old Petersburger, whose stone filled almost the entire kidney.
The thulium laser is a Russian development and quite old. The first version of this device was created back in the Soviet years. But then it was impossible to use it: there was not enough endoscopic equipment. In any case, patients had to be operated on – and the incisions were about 20-30 centimeters (and if the person is full, then longer) to get to the ureter. The extracted stones sometimes reached a diameter of a whole centimeter.
“Now there are less traumatic ways,” explains Igor Orlov. – We either make an incision very small, or do without it at all, working through the natural urinary tract. We crush the stone and it comes out.”
When endoscopes appeared in the daily practice of urologists, scientists returned to the development of the thulium laser. He was the first to appear in St. Petersburg at the doctors of the clinic of St. Luke – three years ago. The device has already passed three stages of improvement, the fourth is on the way. In the coming days, an improved model will be brought to St. Petersburg doctors.
By the way, doctors transfer all the stones extracted from patients to the laboratory for examination. Thus, doctors carry out the prevention of relapses – after all, if you accurately understand the cause of the disease, its recurrence can be avoided.
Stones in the human body are of different types: phosphate, oxalate, urate, xanthine and cystine.
“But, as a rule, stones have a mixed composition. And, of course, the reasons for their formation are also different, – explains Ivan Pazin, a urologist-surgeon at the hospital of St. Luke. – Special dietary recommendations have been developed for certain stones of the urinary system. For example, with oxalate, foods with a high content of vitamin C and oxalic acid are prohibited (parsley, sorrel, currants, rose hips, etc.), flour and dairy products are limited, and vegetables and fruits are allowed (strawberries, potatoes, cucumbers, eggplants and etc.), tea, coffee with milk, some medicinal and table mineral waters.
Even seemingly harmless foods, if overdone, can cause the formation of stones in the body. These include, for example, tomato juice and tofu cheese.
Everything for the comfort of the surgeon
Another novelty of the St. Luke Hospital is the so-called “smart operating rooms”. These are rooms equipped with modern electronics. For example, technologies make it possible to assess the parameters of a patient’s vital activity under anesthesia or to obtain the results of computed tomography or magnetic resonance imaging directly in the operating room. You can control the temperature from the panel.
“All this creates optimal conditions for the work of the surgeon and the entire team of doctors. If the doctor is comfortable operating, it also affects the patient,” says Igor Orlov. “The operation is going better.”
Such operating rooms in the clinic of St. Luke appeared earlier than in other hospitals in the city. Now there are already 7 of them in the hospital, and 12 are planned.