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Kidney stones (urolithiasis)

Kidney stones (urolithiasis)

Urolithiasis is a disease in which stones form in the organs of the urinary system, in most cases in the kidneys and bladder.

The main cause of the onset and development of urolithiasis is a metabolic disorder, which leads to the formation of insoluble salts that form stones. The number of stones and their location can be very different.

Young people most often have stones in the ureters and kidneys; bladder stones are more often diagnosed in the elderly and in children.

The main predisposing factors for the development of urolithiasis, urologists include:

  • anatomical malformations of the urinary tract
  • hereditary nephritis-like or nephrosis-like syndromes
  • chronic urogenital diseases (pyelonephritis, cystitis, urocystitis, inflammation of the prostate, etc.)
  • chronic diseases of the digestive system (gastritis, colitis, etc.)
  • certain composition of food and water, etc.

Coral stone in the kidney with urolithiasis, identified on CT scan of the abdominal organs.

 

Diagnosis of urolithiasis

When diagnosing urolithiasis, depending on the reasons for the formation and composition, stones are divided into three types stone formation:

  • calcium - up to 70% of patients
  • metabolic (uric acid) - up to 12%
  • infected - up to 15%
  • patients with cystine stones - up to 2 - 3%

Determination of the mineral composition of stones is necessary to prevent re-stone formation. For patients with recurrent stone formation in the case of urolithiasis, after clarifying the causes of stone formation, a set of measures (metaphylaxis) is prescribed to prevent recurrent stone formation.

Depending on the location of the stone, a patient with urolithiasis may complain of different symptoms, but the main ones for this disease are:

  • paroxysmal pain
  • blood in the urine
  • deterioration in general well-being

With a kidney stone, pain often occurs during physical exertion, other diseases of the genitourinary tract may worsen in patients. If the stone is in the bladder, then the patient with urolithiasis is disturbed by frequent painful urination, as well as painful sensations that appear when moving.

When a stone is placed in the ureters, a patient with urolithiasis experiences frequent urge to urinate, pain that passes from the lower back to the inner thigh, groin, and lower abdomen.

If the stone blocks the lumen of the ureter and urine has accumulated in the kidney, renal colic begins. A patient with urolithiasis experiences acute pain in the lower back, extending to the abdomen. Colic continues until the stone changes its position or leaves the ureter.

Multiple calculi (stones) in the kidney with urolithiasis, located in its pelvis and at the entrance to the ureter.

 

Treatment of urolithiasis

Treatment of urolithiasis is carried out under the constant supervision of a physician. Depending on the size of the stone, a medical or surgical method of treatment is chosen. Currently, many non-surgical methods allow you to achieve good results without surgery.

Treatment of urolithiasis should be comprehensive. For small stones of the pelvis or ureter, drugs that activate urodynamics are prescribed for the independent discharge of stones, antibacterial drugs, and drugs for dissolving stones. If the stone size is up to 0.5 cm, cystenal, artemizol, ennantin, and avisan are prescribed. For renal colic, thermal procedures (heating pad, bath), pain relievers, antispasmodics, novocaine blockade are used.

 

Surgical treatment of urolithiasis

If the stone is in the renal pelvis, a pyelolithotomy is performed. In this case, the pelvis is dissected, the stone is removed, and a suture is applied to the pelvis, and drainage is placed.

Sometimes, with a very large stone size, it cannot be removed through an incision in the pelvis. In this case, a nephrolithotomy is performed - an incision is made through the kidney tissue.

If the stone is in the ureter, the ureter is opened and the stone is removed. The operation is called ureterolithotomy.

Transurethral X-ray endoscopic surgery. Initially, the stone was destroyed into small pieces and removed through the cystoscope tube under the control of the surgeon's vision. Now, in connection with the creation of new endoscopic equipment (nephroscopes, ureteropyeloscopes), this method is one of the main methods for the treatment of urolithiasis and other diseases of the urinary tract. This method is used to remove stones from the bladder, ureters, and urethra.

Transurethral ureterolithotripsy (destruction of a stone in the ureter through the urethra) and lithoextraction (extraction of a stone) are performed in a specially equipped X-ray operating room. A ureteropyeloscope is inserted into the ureter, the ureter is examined and a decision is made on the method of destruction of the stone. If the stone is small, it is captured and removed. If the stone is larger, it is crushed and removed in parts.

Percutaneous X-ray endoscopic surgery. In this case, the nephroscope is inserted into the renal calyceal system through a puncture hole in the lumbar region. With this method of surgical intervention, stones are removed from the renal pyelocaliceal system.

 

Remote shock-wave lithotripsy in urolithiasis

It allows you to break the stone down into small particles, which then leave on their own in the urine. In this case, a special reflector is used, which transmits electro-hydraulic waves over a distance and destroys stones in the patient's body without direct contact with the stone.