Clinic of Urology, Medical University, Sofia, Bulgaria
The application of contemporary minimally invasive methods for treatment of urolithiasis in Bulgaria started on 20-th March 1985, when the first percutaneous nephrolithotomy was performed. On 3-rd April 1986 was fulfilled the first ESWL for kidney stone with Dornier HM3 in the Clinic of Urology, Medical University, Sofia. At the end of 1986 started the initiation of rigid ureterorenoscopy in our country
Urolithiasis usually has an endemic character. In Europe it is diagnosed in 3 – 4% of the population – more often in Scandinavia, West England and Western Europe. Its incidence in Bulgaria is similar.
Several minimally invasive approaches are possible for stone treatment in kidney and ureter such as percutaneous nephrolithotomy, ureteroscopy and ESWL. Every endoscopic method has different indications, contraindications and complications. Their effectiveness is also compared.
Percutaneous nephrolithotomy is applied in simple kidney stones, staghhorn stones, stones in lower kidney pole etc. Ureteroscopy is applied for stone removal with different location – upper, middle and lower part of ureter. A combination of all endoscopic methods is recommended in complex stones.
The advantages and disadvantages of PNL, ureteroscopy and ESWL are compared in stones above 10 mm in pyelo-ureteral segment.
In conclusion today we have high opportunity to apply less invasive endoscopic procedures – PNL and URS. In addition we are trying to decrease operation time and hospital stay. Our opinion is that all endoscopic procedures should move to stone centers and become out patient treatment.