Urolithiasis

The reasons

Symptoms of urolithiasis

Diagnostics

Treatment of urolithiasis

Complications

Urolithiasis develops due to a metabolic disorder and is manifested by the formation of stones in the organs of the urinary system.

The condition when stones are formed in the kidneys is called nephrolithiasis; ureterolithiasis in the ureters; in the bladder – cistolithiasis.

The reasons

All causes leading to the formation of stones in the urinary system are divided into exogenous (external) and endogenous (internal).

To exogenous include the following:

  • long drinking hard water;
  • living in climatic zones where there is a lack of ultraviolet rays;
  • large use of sour, salty, spicy foods;
  • insufficient water intake during the day;
  • sedentary lifestyle.

To endogenous include the following:

  • renal dysfunction due to chronic diseases;
  • genetic predisposition to stone formation;
  • infectious diseases accompanied by dehydration;
  • severe diseases in which the patient requires prolonged immobilization;
  • pathology of the gastrointestinal tract (due to a violation of the processes of digestion and absorption);
  • metabolic disorders (hyperparathyroidism, gout);
  • congenital anomalies of the structure of the kidneys and urinary tract.

The most common in urolithiasis are inflammatory diseases of the kidneys (pyelonephritis, glomerulonephritis), gout, hyperparathyroidism, gallstone disease, cystitis, prostatitis, pancreatitis, colitis.

There are 5 types of stones:

  • urate, appear in disorders of uric acid metabolism (with gout);
  • oxalate, appear with an increased content of oxalate salts;
  • phosphate, appear when phosphorus metabolism is impaired;
  • cystine, they appear in hereditary pathology;
  • mixed, a combination of several types of exchange disorders.

Symptoms of urolithiasis

In men, this pathology is detected three times more often than in women. The clinical manifestations of urolithiasis in men and women are the same.

The severity of symptoms depends on the size of the stones and where they are located.

In the presence of small stones, the disease is asymptomatic, or after severe physical exertion discomfort may appear in the lumbar region. At this stage, concrements are most often diagnosed by chance during examinations.

Localization of pain in urolithiasis

The most inherent symptom is – pain.

The pain may be permanent or paroxysmal; whining or sharp character; the severity of pain depends on the size of the stone and its location.

Pain with kidney stones

When finding kidney stones or upper ureter, pain occurs in the lumbar region and is aching in nature.

However, if the stone causes obstruction (blockage) of the ureter, the flow of urine is disturbed and the pain is significantly increased. The patient develops   renal colic . It is characterized by severe pain, does not go away with a change in body position. Pain can last from a few minutes to several days. Patients rush about, there are frequent urge to urinate.

The pain is most often unilateral, rarely can be bilateral.

As the stone moves along the urinary tract, the pain subsides.

Pain in the lower abdomen in men can spread to the external genital organs, the scrotum. The pains resemble prostatitis, testicular torsion.

In women, pain in the lower abdomen is given to the labia, vulva.

Difficult urination, it becomes frequent and painful.

Pain in bladder stones

When finding stones in the bladder, pain is localized in the suprapubic area, with small stones, the pain is aching. Irradiation of pain is also in the region of the external genital organs.

Blood in the urine and sand

The second most common symptom is   hematuria   (appearance of blood in the urine).

Hematuria occurs when the stone moves along the urinary tract, due to damage to the mucous membranes. With the passage of small stones, blood can be detected only in the study of urine. And with the passage of large stones, the patient himself may note pink urine staining.

Also, the patient can see small stones (sand) in the urine sediment.

Diagnostics

If there are signs of urolithiasis, it is necessary to consult a urologist or a nephrologist and undergo the necessary examination.

General urine analysis:

  • Allows to detect hematuria – appearance in urine   red blood cells . In the presence of inflammation in the urinary system is detected   increased number of leukocytes,   increase urine density . In the urine sediment detected salts (oxalates, phosphates, urates).
  • If there are stones in the urine sediment, their research is carried out. Sets the character of the stone.

Biochemical blood test:

  • Aimed at identifying abnormalities in metabolism. The level of uric acid, phosphate, oxalate, and kidney function (creatinine, urea, glomerular filtration rate) are evaluated.

General blood analysis.

  • You can detect anemia ( decrease in hemoglobin ) with prolonged blood loss; boost   white blood cell counts and erythrocyte sedimentation rate   ESR with the inflammatory process.

Ultrasound examination of the kidneys, bladder.

  • Allows you to identify the presence of stones, signs of inflammation.

To detect stones in the ureter, clarify their location and the degree of obstruction of the urinary tract – conduct excretory   urography. The study is conducted by introducing a radiopaque substance and then evaluating its elimination rate.

In case of obstruction in the lower parts of the urinary tract, retrograde ureteropyelography is performed. Contrast is not injected into the kidneys, but from the bottom up – along the ureters.

Also to clarify the diagnosis can be assigned   computed tomography . It allows you to specify the size of the stone, its position.

Treatment of urolithiasis

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In the presence of small stones, the treatment is carried out on an outpatient basis. Appointed therapy by a nephrologist or urologist.

If the stones are large or the patient develops renal colic, the treatment is inpatient. The duration of hospitalization depends on the treatment carried out, an average of 10-14 days.

Treatment of urolithiasis is aimed at removing stones and correcting metabolic processes to prevent their re-formation.

Methods for removing stones depend on the size of the stone and its location.

Small stones can independently go through the urinary tract.

To relieve the condition, reduce pain to the patient (in the event of renal colic), antispasmodics and painkillers are prescribed.

  • Drotaverine;
  • Papaverine;
  • Duspatalin;
  • Analgin.

Dissolving stones with drugs

In the presence of urats apply:

  • Allopurinol;
  • Etamide;
  • Ugly.

In the presence of phosphate stones are assigned:

  • Cyston;
  • Marelin;

When oxalate stones are used:

  • Blamaren;
  • Spilled;
  • Pyridoxine.

When cystine stones are used:

  • Penicillamine;
  • Potassium citrate;
  • Uralit.

Crushing stones with their subsequent removal

Shock wave lithotripsy.

  • With the help of a shock wave, the stone is crushed and then discharged along the urinary tract. The method is not suitable in the presence of large concretions.

Also, stones destroy and with the help of ultrasonic waves, a laser.

Percutaneous nephrolithotomy.

  • Endoscopic intervention using tools that destroy the stone, with the subsequent removal of parts of the stone from the kidney.

Litolapaxia.

  • This is an endoscopic removal of stones from the bladder.

Also, when urolithiasis is used physiotherapy treatment:

  • diadynamic amplipulse therapy – used to relieve pain;
  • inductothermy – used as an antispasmodic therapy and pain relief;
  • exposure to sinusoidal currents – used to relieve swelling of the mucous membranes of the ureter and spasms. Used in remission.
  • Magnetic Therapy – used to relieve pain.

Diet

Read more about the diet for kidney stones in our   separate article .

For patients with urolithiasis, it is recommended to follow the following dietary recommendations:

Be sure to drink during the day about two liters of liquid;

When uratnyh stones must be limited to:

  • meat; fish;
  • mushrooms;
  • legumes;
  • beer.

With oxalate stones:

  • chocolate, cocoa;
  • beets, lettuce, spinach;
  • foods rich in oxalic acid;

With phosphate stones:

  • salt;
  • carbonated drinks;
  • alcohol;
  • currant, cranberry;
  • milk products.

Prevention of stones

The main focus in the prevention of urolithiasis is the normalization of metabolism.

If you do not normalize the metabolic processes, the recurrence of the disease is inevitable.

The following preventive measures are recommended:

  • daily exercise;
  • alcohol rejection;
  • maintain a normal weight;
  • drink about 2 liters of fluid per day;
  • reduce salt intake;
  • when establishing the type of stones to comply with dietary recommendations.
  • timely treat inflammatory diseases of the urinary organs.
  • regularly examined by a urologist or nephrologist.

Complications

With incorrect treatment of urolithiasis, the following are the most common complications:

The development of the inflammatory process in the kidney, ureter or bladder. This is the most common complication. Caused by the stagnation of urine and damage to the mucous membranes.

The inflammatory process can spread to the renal cellulose (perinephritis). It develops without treatment.   pyelonephritis   or illiterate treatment of jade.

Due to the prolonged inflammatory process (chronic pyelonephritis) develops  chronic renal failure.

With complete blockage of the urinary tract on both sides, which is extremely rare, may develop  acute renal failure.

With timely diagnosis, proper treatment and compliance with further recommendations for the prevention of the disease, the prognosis is favorable. Compliance with preventive measures will avoid the recurrence of stone formation.

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