What is the pathophysiology of pelvolithotomy?

Pelviolithotomy, or the surgical removal of a kidney stone from the pelvis, is performed when the stone is too large to pass through the ureter and causes obstruction or pain. The pathophysiology of pelviolithotomy involves the following steps:

Stone formation: Kidney stones, also known as renal calculi, form when certain substances in the urine, such as calcium, oxalate, uric acid, and cystine, crystallize and aggregate. The exact mechanisms of stone formation are not fully understood, but risk factors include dehydration, certain medical conditions, diet, and genetics.

Obstruction and pain: When a kidney stone grows large enough, it can obstruct the flow of urine from the kidney to the bladder. This obstruction leads to increased pressure within the kidney and the collecting system, causing pain. The pain is typically felt in the back or side and can be severe, colicky, and accompanied by nausea and vomiting.

Diagnosis: Pelviolithotomy is considered when conservative measures, such as hydration, pain management, and medical therapy, fail to relieve symptoms or prevent complications. Imaging studies, such as ultrasound, X-ray, or CT scan, are performed to confirm the presence, size, and location of the kidney stone.

Surgical intervention: Pelviolithotomy is a surgical procedure performed to remove the kidney stone directly from the pelvis. The procedure involves the following steps:

1. Anesthesia: General anesthesia is usually administered to ensure patient comfort and immobility during the surgery.

2. Positioning: The patient is placed in a supine position, and the surgical area is prepared and sterilized.

3. Access: A small incision is made in the lower abdomen, and a speculum is inserted to provide visualization and access to the kidney stone.

4. Stone removal: The kidney stone is located and extracted from the pelvis using various techniques, such as grasping forceps or laser lithotripsy. Laser lithotripsy involves the use of a laser to break the stone into smaller fragments that can be easily removed.

5. Closure: After removing the stone, the speculum is removed, and the incision is closed with sutures.

6. Post-operative care: Following the surgery, patients may experience some discomfort and may require pain medication. They may also need to stay in the hospital for a few days to monitor their recovery.

The pathophysiology of pelviolithotomy lies in the formation of kidney stones that cause obstruction and pain. Surgical intervention is necessary to directly remove the stone from the pelvis, aiming to alleviate symptoms, prevent complications, and restore normal urinary flow.