Interventionelle Therapie von Harnsteinen - Indikationen, Erfolgsraten und Komplikationen

Zusammenfassung

Bis vor etwa 30 Jahren war die offene Operation die häufigste Therapieform für Harnsteine, heute spielt sie dagegen kaum noch eine Rolle bei der Steinbehandlung. Einen maßgeblichen Anteil an dieser Entwicklung hat die 1980 erstmals klinisch eingesetzte extrakorporale Stoßwellenlithotripsie (ESWL), welche heute eine führende Rolle in der Harnsteinbehandlung eingenommen hat. Daneben wurden endoskopische Verfahren wie Ureterorenoskopie (URS) und perkutane Nephrolitholapaxie (PCNL) weiterentwickelt, die eine optimale, minimalinvasive Ergänzung zur ESWL darstellen. Dieser Artikel gibt eine Übersicht über den heutige Stand der interventionellen Harnsteintherapie und diskutiert die Indikationen, Erfolgsraten und Komplikationen der jeweiligen Verfahren.

Summary

Open surgery was the standard therapy for urinary calculi up to about 30 years ago. This changed upon introduction of extracorporeal shockwave lithotripsy (ESWL) in 1980, a procedure that is now the primary therapy for 70 % of the patients in western countries. Simultaneously, endourological procedures like ureterorenoscopy (URS) and percutaneous nephrolithotripsy (PCNL) have been improved, and now, modern small diameter and highly efficient instruments offer an ideal alternative to shockwave lithotripsy. Today, minimally-invasive stone treatment has replaced open stone surgery almost completely. This article introduces ESWL, URS and PCNL and discusses indications, outcomes and limitations.

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