{"id":3138,"date":"2026-11-07T08:01:07","date_gmt":"2026-11-07T08:01:07","guid":{"rendered":"https:\/\/bookinghospital.org\/?p=3138"},"modified":"2026-11-07T08:04:13","modified_gmt":"2026-11-07T08:04:13","slug":"kidney-stone-surgery-who-needs-it","status":"publish","type":"post","link":"https:\/\/bookinghospital.org\/ro\/operatia-pentru-pietre-la-rinichi-cine-are-nevoie-de-ea\/","title":{"rendered":"Vi s-a spus c\u0103 litiaza renal\u0103 trebuie operat\u0103?"},"content":{"rendered":"<div data-elementor-type=\"wp-post\" data-elementor-id=\"3138\" class=\"elementor elementor-3138\">\n\t\t\t\t<div class=\"elementor-element elementor-element-dac12dc e-con-full e-flex e-con e-parent\" data-id=\"dac12dc\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1970ab5 elementor-widget elementor-widget-html\" data-id=\"1970ab5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"bh\">\n\n<section class=\"hero\">\n  <div class=\"in\">\n    <p class=\"eyebrow\">Urologie \u00b7 Calculi renali<\/p>\n    <h1>Vi s-a spus c\u0103 litiaza renal\u0103 trebuie operat\u0103?<\/h1>\n    <p class=\"lead\">Mul\u021bi calculi nu necesit\u0103 niciodat\u0103 o opera\u021bie. Pentru cei care o necesit\u0103, opera\u021bia potrivit\u0103 depinde de dou\u0103 lucruri: c\u00e2t de mare este calculul \u0219i unde se afl\u0103. Iat\u0103 ce spun de fapt ghidurile europene \u0219i americane de urologie \u2014 \u0219i ce trebuie s\u0103 organizeze un pacient care vine din str\u0103in\u0103tate \u00eenainte de a rezerva ceva.<\/p>\n    <p class=\"meta\">Pe baza <b style=\"color:#fff\">EAU 2025<\/b> \u0219i\n       <b style=\"color:#fff\">AUA 2025<\/b> privind litiaza urinar\u0103<\/p>\n  <\/div>\n<\/section>\n\n<section class=\"wrap\">\n\n  <div class=\"ozet\">\n    <h2>R\u0103spunsul scurt<\/h2>\n    <ul>\n      <li><b>Calculii mici se elimin\u0103 adesea singuri.<\/b> Calculii ureterali de 5\u201310 mm se elimin\u0103 f\u0103r\u0103 opera\u021bie \u00een aproximativ <b>25\u201353%<\/b> dintre cazuri.<\/li>\n      <li><b>Dimensiunea decide opera\u021bia.<\/b> Sub 10 mm: litotri\u021bie extracorporeal\u0103 cu unde de \u0219oc sau endoscopie flexibil\u0103. 10\u201320 mm: oricare dintre ele. Peste 20 mm: opera\u021bie minim invaziv\u0103 prin spate (PCNL).<\/li>\n      <li><b>Un rinichi blocat \u0219i infectat este o urgen\u021b\u0103<\/b> \u2014 se trateaz\u0103 acolo unde v\u0103 afla\u021bi, nu \u00eentr-o c\u0103l\u0103torie planificat\u0103 \u00een str\u0103in\u0103tate.<\/li>\n      <li><b>Despre stent li se spune pacien\u021bilor cel mai pu\u021bin.<\/b> Dac\u0103 zbura\u021bi acas\u0103 cu un stent, scoaterea lui trebuie organizat\u0103 \u00eenainte de plecare.<\/li>\n    <\/ul>\n  <\/div>\n\n  <h2>C\u00e2nd un calcul nu necesit\u0103 opera\u021bie<\/h2>\n\n  <p>Dac\u0103 calculul este mic, rinichiul nu este blocat, nu exist\u0103 infec\u021bie \u0219i durerea este controlabil\u0103, a\u0219teptarea este un tratament legitim. Ghidurile sus\u021bin observa\u021bia cu analgezice \u0219i, la pacien\u021bi selecta\u021bi, un medicament care relaxeaz\u0103 ureterul (un alfa-blocant) pentru a ajuta eliminarea calculului.<\/p>\n\n  <p>Acest medicament nu face minuni, dar efectul este real: \u00een analizele cumulate, pacien\u021bii care au primit un alfa-blocant au avut o \u0219ans\u0103 cu aproximativ <b>50% mai mare<\/b> de a elimina calculul dec\u00e2t cei care nu l-au primit (risc relativ 1,54; I\u00ce 95% 1,29\u20131,85). Beneficiul este cel mai clar pentru calculii din ureterul inferior mai mari de 5 mm.<\/p>\n\n  <div class=\"box\">\n    <span class=\"etiket\">Nu mai a\u0219tepta\u021bi \u0219i solicita\u021bi imediat ajutor medical dac\u0103 apar<\/span>\n    <ul>\n      <li><b>Febr\u0103 sau frisoane<\/b> \u00eempreun\u0103 cu durerea \u2014 un rinichi blocat \u0219i infectat poate pune via\u021ba \u00een pericol \u00een c\u00e2teva ore<\/li>\n      <li>Durere care nu r\u0103spunde la analgezice<\/li>\n      <li>V\u0103rs\u0103turi care v\u0103 \u00eempiedic\u0103 s\u0103 be\u021bi<\/li>\n      <li>Func\u021bie renal\u0103 care se \u00eenr\u0103ut\u0103\u021be\u0219te sau un singur rinichi func\u021bional<\/li>\n    <\/ul>\n    <p>Ghidurile sunt explicite: tratamentul conservator se opre\u0219te dac\u0103 apare oricare dintre acestea.<\/p>\n  <\/div>\n\n  <h2>C\u00e2nd opera\u021bia este r\u0103spunsul corect<\/h2>\n\n  <ul>\n    <li>Calculul este <b>prea mare pentru a se elimina singur<\/b> \u2014 ca regul\u0103 general\u0103, peste 10 mm \u0219ansele scad puternic<\/li>\n    <li>Calculul <b>blocheaz\u0103 rinichiul<\/b>sau rinichiul \u00ee\u0219i pierde deja func\u021bia<\/li>\n    <li>Exist\u0103 <b>o infec\u021bie<\/b> \u00een spatele obstruc\u021biei<\/li>\n    <li>Calculul nu s-a mi\u0219cat dup\u0103 o perioad\u0103 rezonabil\u0103 de a\u0219teptare<\/li>\n    <li>Ave\u021bi <b>un singur rinichi<\/b>sau calculi \u00een ambii rinichi<\/li>\n    <li>Meseria sau \u021bara dumneavoastr\u0103 face inacceptabil\u0103 o urgen\u021b\u0103 neplanificat\u0103 \u2014 de exemplu, pilo\u021bii \u0219i navigatorii sunt adesea trata\u021bi \u00een loc s\u0103 fie urm\u0103ri\u021bi<\/li>\n  <\/ul>\n\n  <h2>Ce opera\u021bie \u0219i de ce<\/h2>\n\n  <div class=\"tblwrap\">\n    <table>\n      <thead>\n        <tr><th>Calcul<\/th><th>Prima alegere uzual\u0103<\/th><th>\u00cen ce const\u0103<\/th><\/tr>\n      <\/thead>\n      <tbody>\n        <tr><td><b>Sub 10 mm, \u00een rinichi<\/b><\/td><td>Litotri\u021bie cu unde de \u0219oc (ESWL) <i>sau<\/i> endoscopie flexibil\u0103 (RIRS)<\/td><td>ESWL: f\u0103r\u0103 incizie, undele sonore sparg calculul; fragmentele trebuie totu\u0219i eliminate. RIRS: un endoscop sub\u021bire pe calea natural\u0103, laserul sparge calculul<\/td><\/tr>\n        <tr><td><b>10\u201320 mm<\/b><\/td><td>ESWL, RIRS sau opera\u021bie minim invaziv\u0103 \u2014 alege echipa<\/td><td>Duritatea calculului, anatomia rinichiului \u0219i preferin\u021ba dumneavoastr\u0103 conteaz\u0103 aici<\/td><\/tr>\n        <tr><td><b>Peste 20 mm<\/b><\/td><td><b>PCNL<\/b> (minim invaziv\u0103, prin spate)<\/td><td>Un mic tunel p\u00e2n\u0103 \u00een rinichi; cea mai eficient\u0103 op\u021biune pentru calculii mari \u0219i cea cu cea mai mare rat\u0103 de complica\u021bii<\/td><\/tr>\n        <tr><td><b>Calculi coraliformi<\/b> (care umplu sistemul colector)<\/td><td>PCNL, uneori combinat\u0103 cu RIRS<\/td><td>Adesea mai mult de o \u0219edin\u021b\u0103; eliminarea \u00eentregului calcul conteaz\u0103 mai mult dec\u00e2t viteza<\/td><\/tr>\n      <\/tbody>\n    <\/table>\n  <\/div>\n\n  <p>Nicio metod\u0103 nu elimin\u0103 to\u021bi calculii dintr-o dat\u0103. S\u0103 \u00eentreba\u021bi un centru despre <b>rata de pacien\u021bi f\u0103r\u0103 calculi pentru calculi ca ai dumneavoastr\u0103<\/b> \u2014 \u0219i c\u00e2t de des este necesar\u0103 o a doua \u0219edin\u021b\u0103 \u2014 v\u0103 spune mai mult dec\u00e2t orice cifr\u0103 din reclam\u0103.<\/p>\n\n  <div class=\"soru\">\n    <h3>Stentul: partea pe care n-o explic\u0103 nimeni<\/h3>\n\n    <p>Dup\u0103 opera\u021bia endoscopic\u0103 a calculilor, adesea se las\u0103 un tub moale de plastic (un stent JJ) \u00eentre rinichi \u0219i vezic\u0103, pentru ca umfl\u0103tura s\u0103 nu blocheze scurgerea urinei. Este normal, este temporar \u0219i poate fi nepl\u0103cut: nevoia urgent\u0103 de a urina, s\u00e2nge \u00een urin\u0103 \u0219i disconfort \u00een flanc la urinare sunt frecvente.<\/p>\n\n    <p>Exist\u0103 <b>p\u0103reri diferite despre momentul scoaterii: nu exist\u0103 o zi unanim acceptat\u0103<\/b>. Datele sugereaz\u0103 c\u0103 scoaterea foarte devreme (patru zile sau mai pu\u021bin, la pacien\u021bii f\u0103r\u0103 stent \u00eenainte de opera\u021bie) este asociat\u0103 cu mai multe prezent\u0103ri la urgen\u021b\u0103, \u00een timp ce men\u021binerea lui mai mult agraveaz\u0103 simptomele f\u0103r\u0103 a \u00eembun\u0103t\u0103\u021bi eliminarea calculului. \u00cen practic\u0103, majoritatea echipelor \u00eel scot \u00een una\u2013dou\u0103 s\u0103pt\u0103m\u00e2ni.<\/p>\n\n    <p><b>Dac\u0103 v\u0103 \u00eentoarce\u021bi acas\u0103 cu un stent, scoaterea lui trebuie organizat\u0103 \u00eenainte de zbor.<\/b> Un stent uitat luni de zile se poate \u00eencrusta \u0219i poate deveni o problem\u0103 serioas\u0103. Cere\u021bi data scoaterii \u00een scris \u0219i un raport pe baza c\u0103ruia urologul dumneavoastr\u0103 s\u0103 poat\u0103 ac\u021biona.<\/p>\n  <\/div>\n\n  <h2>Ce trebuie s\u0103 organizeze un pacient care vine din str\u0103in\u0103tate<\/h2>\n\n  <ul>\n    <li><b>O tomografie recent\u0103.<\/b> Planificarea tratamentului depinde de dimensiunea, pozi\u021bia \u0219i densitatea calculului. O investiga\u021bie mai veche de c\u00e2teva luni s-ar putea s\u0103 nu mai descrie corect calculul dumneavoastr\u0103.<\/li>\n    <li><b>Analiza calculului dup\u0103 opera\u021bie.<\/b> Compozi\u021bia calculului decide cum preveni\u021bi urm\u0103torul. Cere\u021bi ca fragmentele s\u0103 fie trimise la analiz\u0103 \u0219i ca rezultatul s\u0103 v\u0103 fie \u00eenm\u00e2nat.<\/li>\n    <li><b>Suport la domiciliu.<\/b> Litiaza este o boal\u0103 recurent\u0103, nu un eveniment unic. Analizele de s\u00e2nge \u0219i urin\u0103 \u0219i, la cei cu calculi repeta\u021bi, colectarea urinei pe 24 de ore se fac acolo unde locui\u021bi.<\/li>\n    <li><b>Un plan clar pentru stent<\/b>, dup\u0103 cum s-a ar\u0103tat mai sus.<\/li>\n  <\/ul>\n\n  <div class=\"box efsane\">\n    <span class=\"etiket\">Mitul<\/span>\n    <p><b>\u201eLaserul dizolv\u0103 calculul \u0219i gata.\u201d<\/b><\/p>\n    <p>Laserul sparge calculul \u00een fragmente; aceste fragmente trebuie totu\u0219i s\u0103 p\u0103r\u0103seasc\u0103 organismul, iar nu orice opera\u021bie elimin\u0103 tot. Uneori o a doua \u0219edin\u021b\u0103 este planificat\u0103 de la \u00eenceput. Un centru care promite vindecare garantat\u0103 \u00eentr-o singur\u0103 \u0219edin\u021b\u0103 promite ceva ce datele nu sus\u021bin.<\/p>\n  <\/div>\n\n  <div class=\"yazar\">\n    <div class=\"rozet\">BV<\/div>\n    <div>\n      <h3>Revizuire medical\u0103: Conf. Dr. Bekir Voyvoda<\/h3>\n      <p>Medic urolog la Spitalul Florence Nightingale din Istanbul; conferen\u021biar din 2025. Acest ghid a fost preg\u0103tit de echipa medical\u0103 BookingHospital pe baza ghidurilor europene (EAU 2025) \u0219i americane (AUA 2025) actuale privind litiaza \u0219i a fost revizuit pentru acurate\u021be chirurgical\u0103. Tratamentul fiec\u0103rui pacient este planificat de urologul care opereaz\u0103, dup\u0103 evaluarea propriilor investiga\u021bii imagistice.<\/p>\n    <\/div>\n  <\/div>\n\n  <div class=\"cta\">\n    <h2>Trimite\u021bi-ne investiga\u021biile \u0219i v\u0103 spunem ce este realist<\/h2>\n    <p>Trimite\u021bi raportul tomografiei \u0219i analize recente de s\u00e2nge \u0219i urin\u0103. Un medic le va examina \u0219i v\u0103 va spune ce tratamente sunt rezonabile pentru calculul dumneavoastr\u0103 \u2014 inclusiv c\u00e2nd a\u0219teptarea este r\u0103spunsul mai bun.<\/p>\n    <div class=\"btns\">\n      <a class=\"btn btn-1\" href=\"https:\/\/bookinghospital.org\/ro\/medical-tourism\/\">Trimite\u021bi rapoartele medicale<\/a>\n    <\/div>\n  <\/div>\n\n  <div class=\"uyari\">\n    <p><b>Avertisment medical.<\/b> Acest articol este o informare general\u0103 bazat\u0103 pe ghiduri interna\u021bionale publicate. Nu este un sfat medical personal, nu stabile\u0219te o rela\u021bie medic\u2013pacient \u0219i nu \u00eenlocuie\u0219te evaluarea medicului care v\u0103 trateaz\u0103. Febra \u00eenso\u021bit\u0103 de durere \u00een flanc necesit\u0103 \u00eengrijire medical\u0103 urgent\u0103 acolo unde v\u0103 afla\u021bi.<\/p>\n  <\/div>\n\n  <div class=\"kaynak\">\n    <h3>Referin\u021be<\/h3>\n    <ol>\n      <li>European Association of Urology. EAU Guidelines on the Diagnosis and Treatment of Urolithiasis.\n        <i>European Urology<\/i> 2025.<\/li>\n      <li>American Urological Association. Surgical Management of Kidney and Ureteral Stones: AUA\n        Guideline, 2025.<\/li>\n      <li>Campschroer T, et al. Alpha-blockers as medical expulsive therapy for ureteral stones.\n        <i>Cochrane Database of Systematic Reviews<\/i>.<\/li>\n    <\/ol>\n  <\/div>\n\n<\/section>\n\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Urology \u00b7 Kidney stones Been told your kidney stone needs surgery? Many stones never need an operation. Of those that do, the right operation depends on two things: how big the stone is and where it sits. Here is what the European and American urology guidelines actually say \u2014 and what a patient travelling from [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"elementor_header_footer","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"_joinchat":[],"footnotes":""},"categories":[18],"tags":[],"class_list":["post-3138","post","type-post","status-publish","format-standard","hentry","category-urology-guide"],"_links":{"self":[{"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/posts\/3138","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/comments?post=3138"}],"version-history":[{"count":5,"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/posts\/3138\/revisions"}],"predecessor-version":[{"id":3143,"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/posts\/3138\/revisions\/3143"}],"wp:attachment":[{"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/media?parent=3138"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/categories?post=3138"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/tags?post=3138"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}