Urolithiasis causes and symptoms. Urolithiasis: features of the course of the disease in women and methods of its treatment

Medium-sized stones are more likely to form in the kidneys. When they are fixed at the site of formation, there may not be any symptoms. However, when the stone moves along the ureter in places of greatest narrowing, the stone clogs the ureter - symptoms of renal colic appear.

Symptoms of renal colic

• paroxysmal pain - periodically aggravated
• Possible increase in body temperature

• Salts in the urine
• erythrocytes in urine
• cloudy urine

Symptoms of stones of various localization

Symptoms of stones in the calyx

More often, calyx stones are small and are excreted in the urine. With abundant urination (with heavy drinking, drinking alcohol, taking diuretics). Perhaps exacerbation of pain due to the active promotion of stones.
The nature of the pain:

• Pain is paroxysmal
• Localized pain in the lumbar region in the lower abdomen or in the groin.
• The pain is exacerbated by shaking, active movements.

Symptoms of stones in the renal pelvis

medium sized stones most often cause a serious condition - blockage of the ureter and an attack of renal colic.
Symptoms of renal colic:
General symptoms:

• paroxysmal pain - periodically aggravated,
• Pain occurs suddenly, often with movement, shaking, heavy fluid intake or alcohol. Changing position does not relieve pain.
• Possible increase in body temperature
• Pain can be given to the lumbar region, to the lower abdomen, to the inguinal region (depending on the level of ureteral obstruction).

Stones in the ureters

Localization of the stone in the upper third of the ureter

• Pain in the lumbar region
• The pain is acute, periodically subsides (but not completely), with periods of intensification
• Change in body position does not affect the intensity of pain
• Pain may radiate to the side of the abdomen

• The pain is localized in the lateral projection of the abdomen - along the lower costal edge
• Gives to the iliac and inguinal region
• Changing the position of the body does not affect the intensity of pain.

• Localization of pain - lower abdomen, groin area
• Pain radiates to the scrotum/external labia
• Feeling full Bladder
• Frequent urge to urinate
• Urination itself is painful, does not lead to a feeling of emptying the bladder

Stones in the bladder

• Periodic pain in the lower abdomen
• Pain can be given to the perineum, external genitalia
• Pain gets worse or comes on with movement
• When urinating, the stream of urine may suddenly break off, with a change in body position, urine discharge may resume.

Reasons for the formation of stones

• Climate (dry, leading to frequent dehydration)
• Soil structure - affects the electrolyte composition of food
• The chemical composition of water - the excess presence of salts in the water can contribute to an increase in their concentration in the urine. The acidity of the water is also of great importance for stone formation in the urinary organs.
• Mode and amount of fluid intake - insufficient fluid intake increases the risk of stone formation.
• Daily regime - sedentary image life contributes to the formation of stones
• The composition of daily food intake is excessive consumption of meat products, products with a high content of purine bases (peas, sorrel, spinach, etc.).

• Urinary tract infections: cystitis, urethritis, prostatitis, pyelonephritis
• Infectious diseases of other organs (tonsillitis, furunculosis, osteomyelitis)
• Diseases of the digestive tract: colitis, pancreatitis, cholelithiasis, hepatitis
• Anomalies in the development of the kidneys, ureters, bladder.

Diagnosis of urolithiasis

The diagnosis of urolithiasis is made on the basis of the following data:

Symptoms of the disease

1. intermittent sharp pains (like colic) in the lumbar region, lower abdomen or groin)
2. incomplete emptying of the bladder
3. burning sensation in the urethra when urinating

Data of examination and physical examination of the patient

1. palpation of the abdomen - allows you to exclude many acute inflammatory diseases of the abdominal organs (pancreatitis, adnexitis, appendicitis, cholecystitis). These diseases, by their external signs and symptoms, can be similar to an attack of renal colic.
2. tapping the abdomen and lumbar region - allows you to exclude or identify signs of diseases such as: sciatica, lumbago, pyelonephritis.
3. external examination of the patient - the forced posture of the patient (in which he feels a decrease in pain), the presence of edema, skin color may indicate many diseases of the urinary system.

CT diagnostic data this examination allows you to accurately diagnose urolithiasis and identify the shape, size and localization of stones.

X-ray diagnostic data - this method is used for a more detailed study of the flow of urine through the urinary tract, allows you to identify at what level there is a blockage of the urinary tract.

Data from a general urinalysis study- The following data may indicate the presence of urolithiasis:

1. Increased density of urine
2. The presence of unchanged red blood cells
3. The presence of a high concentration of salts
4. Detection of sand in the urine

Treatment of kidney stones with medicines

**Purpose medicines, the determination of the dosage and time of admission is carried out only by the attending physician.

Dissolution of stones with medicines

Treatment of urinary stones folk remedies

Physiotherapy for urolithiasis

Treatment of urolithiasis in a sanatorium

Methods for crushing stones in the kidneys and ureters(lithotripsy)

Operations for urolithiasis

Indications for surgery for urolithiasis:

• large stones when they cannot be crushed and removed without surgery;
• significant impairment of kidney function, despite the fact that other methods of treatment in this case are contraindicated;
• the position of the stone: if it is inside the kidney, then it is very difficult to crush it and bring it out;
• complication in the form of a purulent process in the kidneys (purulent pyelonephritis).

Pyelolithotomy. Removal of a urinary stone from the renal pelvis through an incision. Often, such an intervention is resorted to in the presence of large stones, coral-like stones.

Nephrolithotomy. A complex surgical intervention, which is performed with especially large sizes of stones that cannot be removed through the renal pelvis. In such situations, the incision is made directly through the tissue of the kidney.

Ureterolithotomy. An operation that is currently performed very rarely. This is the removal of a ureteral stone through an incision in the wall of the ureter. In most cases, the removal of such stones can be performed using endoscopic techniques, without an incision.

Help with renal colic

If the pain bothers you on the left, then you can apply a hot heating pad to the kidney area, take antispasmodics (No-shpa, Drotaverine, Papaverine).

First aid is provided by the ambulance team on the spot and in the emergency department of the hospital where the patient is taken. A combination is introduced medicines.

Composition of the mixture:

• analgin (or baralgin) - pain reliever;
• papaverine - antispasmodic (eliminates spasm of the ureters);
• dibazol - antispasmodic, lowers blood pressure.

• after the drugs are administered, acute pain does not go away;
• fever, vomiting;
• lack of urine as a result of blockage of the lumen of the ureter by a stone;
• an attack of renal colic is bilateral;
• The patient has only one kidney.

Diet for urolithiasis

How are kidney stones formed?

• genetic predisposition;
• Bad ecology;
• Features of nutrition;
• Region of residence - in some areas the water is hard and contains a lot of salts;
• Hormonal imbalance, especially disorders of the parathyroid gland;
• Metabolic disorders, in particular mineral metabolism;
• Anatomical features of the structure of the kidneys and urinary tract (weakness of the ligaments that support the kidney);
• Deficiency of substances that slow down crystallization (citrate, pyrophosphate, nephrocalcin, uropontin);
• Inflammation in the renal pelvis;
• Reception of sulfonamides and tetracyclines, nitrofuran together with ascorbic and other acids.

The process of stone formation begins with the fact that the concentration of salts in the urine increases, and they become insoluble. Salts crystallize around a colloidal "core" - a large organic molecule that is the basis of a kidney stone. Subsequently, new crystals form and grow on this matrix.

Recent studies have found that almost all stones (97%) contain nanobacteria so named because of their small size. These atypical Gram-negative (not Gram-staining) organisms produce apatite (calcium carbonate) during their vital activity. This mineral is deposited on the walls of the kidney cells, promoting the growth of crystals. Nanobacteria infect the epithelium of the collecting ducts and the zone of the papillae of the kidneys, creating foci of calcium phosphate crystallization around them, and thereby contribute to the growth of the stone.

What stones are formed in the kidneys with urolithiasis?

In 30% of women who suffered from urolithiasis before pregnancy, exacerbations occur, especially in the third trimester. This is due to a change in the drinking regimen and thickening of the mucous walls of the ureters. In addition, hormonal and anatomical changes in the body of a pregnant woman contribute to the development of inflammation around the stone, which leads to pyelonephritis.

Causes of the appearance and exacerbation of KSD in pregnant women.

• Violation of salt metabolism. During the period of bearing a child, phosphorus-calcium metabolism and reabsorption (reverse absorption from primary urine) of uric and oxalic acids are disturbed. Therefore, phosphate, urate and oxalate stones are predominantly formed.
• Decreased tone and expansion of the renal calyces and pelvis . Their volume increases by 2 times compared with the period before pregnancy. A decrease in tone leads to the fact that the sand is not removed from the kidney, but is overgrown with new crystals.
• Frequent urinary infections in pregnant women in which mucus, pus and epithelial cells take part in the formation of the core of the stone. The infection rises from the bladder with vesicoureteral reflux (reverse reflux of urine), penetrates the lymphogenous route with constipation or hematogenous with inflammatory bacterial diseases.
• The effect of the hormone progesterone on urinary tract receptors. Under its influence, the processes of formation and excretion of urine slow down. A decrease in the tone of the ureter from the 3rd to the 8th month causes stagnation of urine in the pelvis.
• Pathological mobility of the kidney can cause torsion of the ureter and obstruct the flow of urine. It develops due to the fact that the ligaments in pregnant women become more elastic and weakened.
• Uterine pressure. In the second half of pregnancy, the uterus deviates to the right and compresses the ureter, worsening the dynamics of urine. In this regard, in pregnant women, a predominantly right-sided lesion occurs.

Pain occurs in the upper part of the lower back, can be given to the stomach, genitals, leg. The woman is trying to take a forced position to alleviate the condition: on a healthy side, knee-elbow.

As the stone progresses, the condition may improve, but dull pain in the lower back remains. It should be noted that attacks of renal colic in pregnant women are more easily tolerated than in other patients. Perhaps this is due to the increased elasticity of tissues during the period of bearing a child.

Small stones depart almost asymptomatically and they are indicated only by traces of blood found in a general urine test. The passage of stones occurs mainly before 34 weeks, then the enlarged uterus compresses the ureters and the risk of renal colic increases.

If severe pain occurs, you should immediately call an ambulance or take the pregnant woman to the emergency room of the hospital. Although the attack of colic itself does not pose a threat to the life of the mother or fetus, pain and arousal can cause spontaneous abortion or premature birth, especially in the later stages.

Diagnostics

How to prevent urolithiasis?

Particular attention to prevention should be paid to people whose relatives suffer from urolithiasis. Since there is a high probability that the tendency to form stones is inherited.

Can kidney stones dissolve?

Drugs can dissolve:

• Urate stones;
• cystine stones;
• struvite stones;
• Phosphate stones.

• Small diameter - stones less than 4 mm dissolve well. A stone larger than 2 cm should preferably be crushed into smaller fragments by remote or contact endoscopic crushing.
• Sour urine reaction. Acid stones are looser and more susceptible to lysis.

Dissolution of urate stones. For dissolution are used:

Dissolution of cystine stones

• Thiopronin is a complexing agent that binds cystine. Provides dissolution of cystine stones. When taking it (800-1000 mg per day), it is necessary to consume a sufficient amount of liquid - 2.5-3 liters. The dose is divided into 2-3 parts, taken after meals.
• Penicillamine has a similar effect, but differs in a large number side effects compared to thiopronin. Take 500 mg 4 times a day, one hour before meals. The last evening dose should be increased. Before going to bed, you need to take an additional 0.5 liters of water.
• Captopril binds cysteine ​​in the urine and removes it from the kidneys, preventing it from being converted to cystine. Gradually dissolves stones. Assign 20-50 mg 3 times a day, on an empty stomach.
• Drinking plenty of water normalizes the acidity of urine and reduces the concentration of salts.

• Lithostat (acetohydroxamic acid). Blocks urease, an enzyme produced by bacteria that is a component of struvite stones. Softens stones and causes them to be crushed and excreted in the urine. Take 250 mg 3-4 times a day.

• Methionine 500 mg 3-6 times a day increases the acidity of the urine.
• Ammonium chloride 70-300 mg 3 times a day orally after meals prevents precipitation in alkaline urine.
• Acetohydroxamic acid - 250 mg 3-4 times a day, after meals. Assign for the oxidation of urine with the ineffectiveness of methionine and ammonium chloride.
• Cranberry extract 2 tablets 3 times a day increases the acidity of the urine and promotes the dissolution of phosphates.

To dissolve stones, it is extremely important to follow a diet and avoid foods that increase stone formation.

In medicine, urolithiasis is also referred to as urolithiasis and is abbreviated as ICD. This pathology is a serious disease with negative consequences, up to the occurrence of renal failure. Below is information about kidney stones, symptoms, and treatment in women.

Description of pathology

Urolithiasis is a disease in which stones are formed in the urinary organs, consisting of salts. Calculi can occur in any kidney or in two at the same time. This diagnosis in the fair sex is determined less frequently than in men. A feature of urolithiasis in women is the formation of staghorn calculi, completely covering the renal pelvis system. In rare cases, it may be necessary to remove part of the organ surgically.

Stones can be single or multiple, their weight varies from a few grams to a kilogram.

Reasons for development

The considered disease of the urinary system develops over a long time. It is formed due to the negative impact of several factors on the human body.

The main causes of urolithiasis:

• decreased physical activity;
• genetic predisposition;
• hormonal imbalance;
• the presence of harmful compounds in the body;
• diseases of the urinary system of infectious origin;
• unbalanced diet with a predominance of fatty, spicy, fried foods, as well as pickles and foods containing purines;
• pathology of the digestive tract in a chronic form;
• elevated levels of uric acid in the blood;
• metabolic disorder;
• environmental pollution;
• the use of low-quality water;
• congenital diseases of the bladder and kidneys;
• deviations from the normal level of acidity of urine;

Also, this pathology can be formed due to prolonged immobility during a serious illness.

Symptoms

The presence of urolithiasis in women may indicate the appearance of the following signs:

1. The occurrence of pain in the lumbar region, which can periodically intensify. In the event that there is a complete blockage of the ureter with a stone, unbearable pain may develop.
2. Vomiting.
3. Frequent urination or lack of it.
4. Blood blotches in the urine, which in most cases can only be detected in a laboratory study.
5. Deterioration of well-being, possibly an increase in body temperature up to 38 degrees, the occurrence of chills.
6. Interruption of the urination process, while the urge remains.

Urolithiasis in women can have serious complications, for example, against its background, kidney failure develops, flowing into a chronic form.

Diagnostic methods

If some of the above signs of the development of the disease appear, it is necessary to make an appointment with the therapist, who should conduct an initial examination of the patient. If stones are found in the bladder, the doctor, as a rule, refers the patient to a urologist, if the formations are localized in the kidneys, to a nephrologist. In addition, the treatment of urolithiasis takes place with the participation of a nutritionist. In some cases, surgery is required.

Diagnosis of the considered pathology consists in:

• questioning the patient for the manifestation of signs that indicate the development of pathology;
• general and biochemical blood and urine tests;
• ultrasound examination of the kidneys and bladder;
• excretory urography;
• retrograde pyelography (in rare cases);
• determination of blood pH;
• computed tomography of organs.

Video: Urolithiasis disease

Treatment

If a woman is aware that the colic that has arisen is associated with the passage of a stone, then thermal procedures are necessary, for example, taking a hot bath. This will help relax smooth muscles, dilate the ureter, and reduce or eliminate the pain of urolithiasis in women. However, with intestinal obstruction or appendicitis, the symptoms of which are similar, the use of heat is prohibited.

Medical

The traditional treatment of urolithiasis in women consists in the intramuscular use of antispasmodic drugs (No-shpy and Baralgin), the use of painkillers and anti-inflammatory drugs (Ketanov and Xefocam), as well as herbal medicines (Fitolysin).

Also, treatment is carried out aimed at dissolving stones. The doctor prescribes medications based on the type of stones. If phosphate formations are detected, it is advisable to take methionine to acidify the urine, and to prevent the absorption of phosphates in the intestine - aluminum hydroxide.

With urate stones, such medications like Magurlit, Uralit-U, Blemaren. In the event that the stones consist of oxalates, surgical therapy is prescribed, since this type of formation is almost impossible to dissolve.

Surgical

Surgical treatment is prescribed when the urinary tract is completely blocked by large stones. In rare cases, part of the kidneys is removed. There are several types of surgery to remove stones from the urinary system:

• endoscopy;
• laparoscopy;
• lithotripsy.

The first two methods are the most common and least traumatic. The third method (lithotripsy) consists in crushing stones with the help of ultrasonic waves.

Folk remedies

In addition to the main treatment (to increase its effectiveness), it is recommended to resort to alternative therapy. Below are the most effective traditional medicine methods that can help in dissolving stones, as well as in relieving the pain that has arisen.

Method number 1

It is necessary to prepare an infusion, for the manufacture of which you will need the following components:

• 50 g of yarrow;
• 250 ml of vodka.

Actions:

1. Raw materials must be washed and crushed, then poured with vodka.
2. Place the resulting mixture in a dark, cool place for a week to infuse. The blank for the medicine should be in a closed glass container.
3. After 7 days, the drug must be filtered.

Healing liquid take 3 rubles / day. 20 ml before a meal.

Method number 2

It consists in the use of two decoctions. To prepare the first one you will need:

• 50 g crushed dried rosehip roots;
• 700 ml clean water.

Actions:

• Raw materials must be filled with water and put on the stove.
• Boil for a quarter of an hour with minimal heat.

Necessary ingredients for the preparation of the second decoction:

• 30 g bearberry;
• 300 ml of boiling water.

Actions:

1. Pour fresh or dried raw materials with boiling water.
2. Leave the resulting mixture for a couple of hours to infuse.

The first healing agent to use 3 rubles / day. 300 ml after eating, the second - after 25 minutes. after taking the first 100 ml.

Method number 3

Consists of 2 stages.

First you need to prepare a medicine with the addition of honey. Of the ingredients you will need:

• 10 g of crushed dry calamus rhizome;
• a glass of natural honey;

Actions:

1. Mix the ingredients and put in a water bath.
2. Melt honey, stirring, for 10 minutes.
3. When ready, mix the medicine thoroughly.

Then you need to prepare a medicinal infusion, for the manufacture of which you will need:

• 70 ml of natural honey;
• 70 g black radish;
• 70 ml of vodka.

The prepared components must be thoroughly mixed and left for 3 days to infuse in a darkened room. The treatment regimen is similar to the second method.

Other

In addition to using the above methods of therapy, it is necessary to adhere to diet food and control drinking regimen.

With stones consisting of urates, it is strongly recommended to refuse to use the liver, legumes, aged cheeses, and red wine. If available, it is advisable to increase the number of meat, fish dishes, pasta, butter in your diet. It is also recommended to use sauerkraut, honey, lemon juice, but it is worth limiting the consumption of eggs, fruits, milk and sour cream.

When oxalates are contraindicated: carrots, beets, onions, sorrel, rhubarb, spinach, tomatoes, parsley and celery. It is recommended to limit the consumption of milk and cottage cheese. Sweet fruits, cucumbers and cabbage are shown.

Prevention

If the following preventive measures are observed, the formation of urolithiasis can be prevented:

1. It is recommended to lead an active and healthy lifestyle.
2. Avoid hypothermia.
3. Drink plenty of clean water daily (up to 2 liters per day).
4. Stick to a balanced diet.

In the presence of any changes in urination, it is necessary to visit a urologist. Urolithiasis is quite dangerous for women, it can provoke severe consequences for the kidneys, as well as infertility. Self-medication in this case is unacceptable.

Video: Urolithiasis: symptoms and treatment

Urolithiasis (urolithiasis) is a disease that occurs as a result of a metabolic disorder, in which an insoluble precipitate forms in the urine in the form of sand (up to 1 mm in diameter) or stones (from 1 mm to 25 mm or more). Stones settle in the urinary tract, which disrupts the normal outflow of urine and causes renal colic and inflammation.

According to medical statistics, urolithiasis ranks second in frequency among all urological diseases, and third among urological diseases leading to death. Urolithiasis affects people of all ages, including children, but the main age group is people between the ages of 25 and 45. The disease is more common in men than in women, but women are more likely to be diagnosed with severe forms of the disease. It is also known that stones are more often formed in the right kidney than in the left, and in approximately 20% of cases both kidneys are involved in the pathological process.

Causes of urolithiasis

Many factors play a role in the occurrence of urolithiasis, while the mechanism of stone formation and its causes have not been fully elucidated. It is known that the leading role is given to the structural features of the tubular system of the kidneys, when the anatomical structure of the kidney itself contributes to the occurrence of congestion. At the same time, the formation of stones also requires the influence of external factors, mainly diet, as well as the conditions of the drinking regime. Also, in the development of urolithiasis, diseases of the genitourinary system, endocrine pathologies (especially diseases of the parathyroid glands that directly affect metabolic processes involving calcium), long-term use of certain drugs (sulfonamides, tetracyclines, glucocorticoids, aspirin, etc.) play a role.

Types of urolithiasis

Various metabolic disorders cause the formation of stones that differ in their chemical composition. The chemical composition of the stones is important, since the medical tactics in the treatment of urolithiasis, as well as the correction of the diet to prevent relapses, depend on this.

The following stones are formed in the urinary tract:

• Stones based on calcium compounds (oxalates, phosphates, carbonates);
• Stones based on uric acid salts (urates);
• Stones formed by magnesium salts;
• Protein stones (cystine, xanthine, cholesterol).

The main share falls on calcium compounds (about 2/3 of all stones), protein stones are the least common. Urates are the only group that can be dissolved. These stones are more common in older people. Stones consisting of magnesium salts are most often accompanied by inflammation.

Stones in urolithiasis can form in any part of the urinary tract. Depending on where they are located, the following forms of the disease are distinguished:

• Nephrolithiasis - in the kidneys;
• Ureterolithiasis - in the ureters;
• Cystolithiasis - in the bladder.

Urolithiasis is initially asymptomatic. The first signs of urolithiasis are detected either by chance, during the examination, or with a sudden onset of renal colic. Renal colic - a severe pain attack, often the main symptom of urolithiasis, and sometimes the only one, occurs as a result of a spasm of the urinary duct, or its obstruction by a stone.

The attack begins acutely, with a sharp pain, the localization of which depends on the localization of the stone. The pain is intense, can radiate to the groin, lower abdomen, lower back. Urination becomes painful and rapid, blood (hematuria) is found in the urine. There is nausea, sometimes vomiting. The patient rushes about in search of a position that would bring relief, but does not find such a position. An attack of renal colic can take place with a subsidence and exacerbation of pain, and end with either the removal of a stone, or subsidence of colic, or a developed complication.

It should be noted that the severity of signs of urolithiasis is not always associated with the size of the stones. Sometimes stones of small size, not exceeding 2 mm, can cause severe colic, while there are cases of severe kidney damage, when multiple stones fused into coral-like formations do not lead to colic, but are discovered by chance or when complications of urolithiasis begin.

Diagnosis of urolithiasis

Diagnosis of urolithiasis occurs on the basis of the characteristic clinical picture of renal colic and ultrasound data. Computed tomography and magnetic resonance urography are also informative. A detailed analysis of urine is carried out, using functional tests (according to Zimnitsky, Nechiporenko, etc.). Mandatory bacteriological examination of urine. Radiography has now lost its leading place in the diagnosis of urolithiasis, but is still used as an additional method.

Treatment of urolithiasis

An attack of renal colic is removed with the help of antispasmodic and analgesic drugs. The main treatment of urolithiasis is carried out in the absence of acute manifestations.

Urolithiasis is considered a surgical disease, but urolithiasis caused by urate formation can be treated with drugs that dissolve these stones. Other types of stones require mechanical removal.

Treatment of urolithiasis is carried out using two main methods: lithotripsy and surgery. External shock wave lithotripsy is an effective method of treating urolithiasis, in which stones in the urinary tract are broken up with a shock wave and then excreted in the urine. The method has proved to be excellent, thanks to it, the indications for surgical intervention in the treatment of urolithiasis have significantly narrowed.

Operations with which the treatment of urolithiasis is carried out are divided into open and endoscopic, as well as organ-preserving and radical. A radical operation is the removal of a kidney if it has lost its function. Choice preference method surgical treatment urolithiasis are endoscopic techniques that allow the removal of stones without making an incision in the abdominal cavity.

Prevention of urolithiasis

Prevention of kidney stones is necessary condition complete cure, since without it relapses are inevitable. The basis for the prevention of urolithiasis is a diet that normalizes metabolism and the biochemical composition of urine, as well as compliance with the drinking regimen. Diet for urolithiasis is produced depending on chemical composition stones. So, with oxalates, dairy products, chocolate are excluded from the diet, and with urate stones, eating meat is limited. An extremely important condition is the intake of a sufficient amount of water - 1.5 - 2 liters per day.

Video from YouTube on the topic of the article:

Urolithiasis (UCD) is a term that is familiar to a huge number of people. This disease is characterized by the appearance of various kinds of stones in the organs of the urinary system. Most often, the disease occurs in people of working age - from 22 to 55 years. In the absence of timely treatment, 6% of patients suffering from it are at risk of getting a disability of the 2nd degree.

Scientists believe that the presence of stones in the genitourinary system is a manifestation of imbalance throughout the body. It is impossible to say that only one factor led to the appearance of this disease.

Factors provoking the development of kidney stones in women and men can be very diverse. There are reasons that contribute to the appearance of stones in the organs of the genitourinary system, and mechanisms that directly result in the appearance of stones.

The reasons contributing to the development of urolithiasis include:

1) congenital anomalies in the structure of the kidneys. In most cases, stones appear in the kidneys and from there descend into the ureters, bladder, and urethra. Congenital anatomical narrowing of these organs contributes to the appearance of stones;

2) violation of metabolism in the body. Congenital or acquired failures in the metabolic system most often lead to the appearance of the disease. These include: oxaluria, galactosuria, uraturia, cystinuria, aminoaciduria. With all these pathologies, an excessive amount of oxalates, urates, galactose, cysteine ​​is produced, which are deposited in the renal tubules. They are the basis of future kidney stones;

3) genetic predisposition. According to the patients of our medical center in St. Petersburg, whose relatives suffered from urolithiasis and had many stones or single staghorn stones, this disease can indeed be inherited;

4) exogenous factors, or factors that are outside the body. These include gender, age, geographical location and climate in the region. So, middle-aged people with sedentary work, living in a hot climate, suffer from a violation of the outflow of urine and urolithiasis three times more often than people leading an active lifestyle and living in a cool climate. Such an effect on the body is quite simple to explain - in a hot climate, with a passive position of the body, there is stagnation of urine in the genitourinary organs. The high concentration of salts, which occurs due to the characteristics of the climate, leads to the formation of the disease.

There are also general and local processes within the body that contribute to the development of KSD. Common factors include:

• violation of the metabolism of vitamins A and D;
• prolonged immobilization of injured limbs with a plaster cast (more than 3 months);
• excessive amount of calcium salts in the body;
• the presence of a bacterial infection in the body, including bacterial pyelonephritis;
• long-term use of certain drugs (antacids for chronic gastritis and ulcers, tetracyclines for bacterial diseases, sulfonamides for autoimmune diseases, ascorbic acid for beriberi, glucocorticoids after transplants, with multiple sclerosis and a number of other diseases), can also cause the development of urolithiasis.

Local factors include various diseases and conditions of the genitourinary system:

• anatomical structural disorders;
• long-term presence of catheters in the bladder and urinary tract;
• insufficient blood supply to the urinary organs;
• vesicoureteral reflux;
• spinal cord injury, which leads to a violation of the outflow of urine;
• nephroptosis, or prolapse of the kidney.

The presence or absence of one or more factors does not mean the onset of the disease. Only the individual characteristics of the organism and the way of life of a person determine the development of this disease.

Formation and types of stones in MKb

2) pure oxalate. Most often found in the urinary tract. These include varieties such as wavellite and weddellite. Such stones are formed due to prolonged dehydration of the body - these can be chronic infectious diseases, autoimmune diseases, alcoholism.

3) urate. They are formed due to an excessive amount of uric acid salts in the body. They are often found in people suffering from gout and obesity.

4) phosphate. These are hydroxyapatite, struvite, carbonate apatite. The formation of these stones is associated with substances that bacteria secrete. That is why it is extremely important to treat bacterial diseases in time.

5) cystine. Observed in the body in violation of the exchange of the amino acid cysteine. These stones are quite rare.

6) the most rare in patients with urolithiasis is the appearance of cholesterol stones. As a rule, they have a high percentage of oxalates and phosphates. In addition to the variety of morphological structure, each stone has its own color and shape. So, oxalates are dark in color with a spiny surface, phosphates are light gray and almost smooth. Urats are yellowish in color with an uneven surface.

The symptomatology of the disease depends on the shape, size, localization of stones, quantity and their mobility. Fixed small stones can form in the kidneys for years without causing any inconvenience to a person. At the same time, one stone with an uneven surface can pass into the ureters, where it will irritate the membranes and nerve receptors, disrupt the outflow of urine, thereby causing severe pain.

There are three main symptoms that characterize the presence of urolithiasis in humans:

• pain;
• hematuria (the appearance of blood in the urine - determined by urinalysis or visually);
• excretion of stones or their fragments in the urine.

In most cases, the first two symptoms occur. The third is typical for small stones that can pass through the genitourinary tract. The main symptom of urolithiasis is pain. Its appearance, character, intensity, localization depend on the location of the stone and its passage through the genitourinary tract. So, stones that are in the kidneys most often cause pain in the lumbar region. If the stone is in the ureter, it can be either in the corresponding part of the back or in the abdomen. When small stones enter the ureter, sometimes there is a complete overlap of its lumen. This causes pain of characteristic intensity and duration, which is called "renal colic".

Symptoms of manifestation in patients with KSD of extrarenal localization

Stones that are in the lower parts of the ureters appear a little differently. In particular, pain will be localized to the side of the midline of the abdomen on the right or left, depending on the affected ureter. The level of pain will depend on the localization of the stone - above the navel when the stone is in the upper third of the ureter, on the side of the bunch if there is a stone in the middle third, below the navel - in the lower third.

Pain in the pubic and suprapubic areas may indicate the presence of a stone in the bladder or urinary tract. As a rule, the presence of a stone in the bladder is accompanied by the development of a severe pain syndrome, the intensity of which increases during urination. In this case, drops of blood may be released during or after urination. Scarlet blood before and during urination is a diagnostic indicator of the presence of a stone in the bladder or lower parts of the ureter.

Laboratory Criteria

It is not too difficult to identify urolithiasis if a person has ever had renal colic or a feeling of discomfort in the lumbar region. Objective signs of the disease, together with the data of laboratory and instrumental analyzes, help the doctor to make the correct diagnosis and proceed to the treatment of the disease.

To diagnose a disease great importance has a urine test. It allows you to determine the nature of the stones and, accordingly, choose the right ways of treatment. Of great importance is such an indicator as urine pH. If it is equal to 6.0, then urate and calcium oxalate stones are likely to form. If the pH reaches a value of 7.1, there is a high probability of the formation of phosphate stones with the addition of magnesium. A urine pH value of 6.5 will indicate the formation of calcium phosphate stones. Urine pH values ​​ranging from 5.5 to 6.0 will indicate the possibility of uric acid stone formation.

This method is inaccurate and can only suggest what the mechanism of stone formation is. It must be used in complex diagnostics of the organism. Healthy people and for those who have previously been diagnosed with "Urolithiasis", it is recommended to take a urine test every three months.

When identifying a disease, it is also important to find the cause of this disease. Therefore, it is necessary to add tests for hormones and microelements to the general analyzes. So, it is necessary to check the activity of parathyroid hormone, thyroid hormones, vitamin D, catecholamines. It is also necessary to know the amount of calcium and sodium in the body. It is mandatory to analyze the amount of uric acid in urine and blood.

Instrumental diagnostic methods

Sufficiently relevant methods for diagnosing urolithiasis, which are used in our medical center in St. Petersburg, are ultrasound and excretory urography. Each of these methods has its own advantages and disadvantages. Ultrasound diagnostics can detect stones of any size, any morphological structure. This method can be used by pregnant women, it is also perfect for people who are allergic to contrast agents. The disadvantage of the study is the impossibility of examining the entire genitourinary tract, as a result of which it is possible simply not to find a stone. An ultrasound can accurately show the presence or absence of any bladder stones. This procedure is performed only with a full bladder.

Excretory urography is an X-ray method for detecting stones. Unfortunately, not all stones are visualized radiographically. So, oxallate stones will be clearly visible using this research method, and urate and cysteine ​​stones are not available for visualization. The essence of excretory urography is the administration of a special contrast agent. In this case, several pictures are taken that allow you to visualize the course of this substance through the genitourinary tract. Thus, you can see a narrowing in one of the sections of the genitourinary system, which will correspond to the location of the stone.

Excretory radiography has a number of its disadvantages and contraindications. So, it can be allergic reactions to the contrast agent. X-rays are also contraindicated in children and pregnant women due to exposure of the body. This procedure also cannot be performed during an attack of renal colic and some diseases of the genitourinary system. In the absence of contraindications, excretory urography is best combined with an ultrasound examination. This will allow with more likely find a stone and establish its exact location.

To detect stones in the bladder, cystography is used - an x-ray examination of the bladder. To do this, a catheter is inserted into the bladder, through which the bladder is filled with contrast. After the introduction of contrast, a picture is taken that shows the presence or absence of stones. An alternative to these methods is multislice magnetic resonance imaging. This method does not require the introduction of contrast, it can be used during an attack of renal colic and it does not irradiate the patient. At the same time, stones of various densities are perfectly visualized in the pictures. The disadvantages of this research method include the high cost of this procedure.

How to treat urolithiasis?

Treatment of urolithiasis has several principles. This is:

• elimination of pain syndrome (mainly with renal colic);
• restoration of the normal outflow of urine, which is disturbed due to blockage of the ureter or urethra by a stone;
• stone removal; prevention of stagnation of urine in the genitourinary organs and the development of infection.

There are medical methods for the treatment of urolithiasis, as well as surgery to remove stones from the urinary tract.

1) Conservative or drug therapy is aimed at eliminating the pain attack, destroying and removing stones. Antispasmodics are best for pain relief.

2) Stone expulsion therapy will be effective in 80% of cases in the presence of stones no larger than 6 mm in diameter. Together with drug therapy for the release of the stone, therapeutic exercises are actively used. It is aimed at changing the position of the body in space. Therapeutic gymnastics is aimed at accepting patients of special positions that contribute to the passage of the stone through the urinary system.

3) Drug destruction of stones is effective only in the presence of urate stones. Therapy is aimed at eliminating the cause of stones - removing excess uric acid from the body. Unfortunately, this method is more prophylactic - it prevents the appearance of new stones rather than destroys existing ones.

4) The most effective treatment for urolithiasis is surgery to remove the stones. During it, you can remove stones of any morphological structure, of any size and shape, of any localization.

Postoperative period

An important part of the treatment is metaphylaxis in the postoperative period. This is a set of measures that are aimed at removing stones that are invisible to the eye, with a diameter of up to 0.5 mm, and the remains of a crushed stone. Metaphylaxis includes a drinking regimen in the amount of fluid of at least 3 liters per day, with the control of daily diuresis in a volume of about 2 liters. At the same time, it is assigned special food with a decrease in the amount of salt in the diet to 4.5 g / day. The amount of animal protein should also be limited - 0.8 g per kilogram of the patient's body weight. In the postoperative period, it is recommended to consume easily digestible meat - it is boiled or steamed beef. Fried and fatty foods should be categorically excluded from the patient's diet.

Throughout the postoperative period, the patient should be actively engaged in physical therapy, which will also contribute to the release of residual stone fragments. Each patient is assigned an individual diet, which is selected depending on the morphological composition of the stone and the presence of changes according to the results of blood tests.

Effective treatment

Treatment of urolithiasis is a guarantee of obtaining highly qualified medical care. Modern methods diagnostics in the multidisciplinary medical center Union Clinic in St. Petersburg allow you to carry out all necessary types research. These are blood tests, urinalysis (including urinalysis according to Nechiporenko), as well as instrumental research methods.

For a complete diagnosis of the presence of silt and the absence of stones in the organs of the genitourinary system, the clinic has modern equipment that allows for ultrasound examination of the kidneys, ureters, and bladder. Patients also have access to radiological methods of examination, such as radiography of the abdominal cavity and small pelvis, excretory urography.

A complete examination of the patient allows a highly qualified medical staff more accurately assess the patient's condition and make a correct diagnosis. Moreover, preliminary studies inform the doctor about the size and shape of the stones, the functional state of the kidneys. This determines the scope of medical intervention.

To reduce the traumatism that, one way or another, the body is exposed to during the removal of stones, experts recommend the use of conservative treatment. However, the approach to each patient is always purely individual. And the amount of intervention depends on the state of the human body, the size, number and shape of stones, the presence or absence of complications.

Prevention of re-stone formation

• Prevention of urolithiasis is the best way to prevent the appearance of stones. It consists of fairly simple steps:
• treatment of chronic diseases of the body;
• treatment of diseases of the genitourinary system;
• sports 3 times a week;
• elimination of inactivity at work - changes in posture and walks during breaks;
• therapeutic exercises in the post-opration period;
• normalization of nutrition - elimination of fatty, excessively salty and sour foods from the diet;
• patients who have had urolithiasis must adhere to the diet prescribed by the attending physician;
• determining the level of calcium and vitamin D at least once a year;
• preventive visits to a urologist every six months - a year;
• passing urine and blood tests every three months;
• passing an ultrasound examination of the genitourinary organs for people who have had urolithiasis, once every six months.

Such simple actions help to significantly reduce the risk of stones in the organs of the genitourinary system and get rid of all the troubles of this disease.

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Urolithiasis disease- a common urological disease, manifested by the formation of stones in various parts of the urinary system, most often in the kidneys and bladder. Often there is a tendency to severe recurrent course of urolithiasis. Urolithiasis is diagnosed by clinical symptoms, X-ray results, ultrasound of the kidneys and bladder. The fundamental principles of the treatment of urolithiasis are: conservative stone-dissolving therapy with citrate mixtures, and if it is not effective, remote lithotripsy or surgical removal of stones.

Urolithiasis disease- a common urological disease, manifested by the formation of stones in various parts of the urinary system, most often in the kidneys and bladder. Often there is a tendency to severe recurrent course of urolithiasis.

Urolithiasis can occur at any age, but most often affects people 25-50 years old. Children and older patients with urolithiasis are more likely to form bladder stones, while middle-aged and young people mainly suffer from stones in the kidneys and ureters.

The disease is widespread. There is an increase in the frequency of urolithiasis, which is believed to be associated with an increase in the influence of adverse environmental factors. At present, the causes and mechanism of the development of urolithiasis have not yet been fully studied. Modern urology has many theories explaining the individual stages of stone formation, but so far it has not been possible to combine these theories and fill in the missing gaps in a single picture of the development of urolithiasis.

Predisposing factors

There are three groups of predisposing factors that increase the risk of developing urolithiasis.

• External factors

The likelihood of developing urolithiasis increases if a person leads a sedentary lifestyle, leading to a violation of phosphorus-calcium metabolism. The occurrence of urolithiasis can be provoked by nutritional features (excess protein, sour and spicy foods that increase the acidity of urine), water properties (water with a high content of calcium salts), lack of B vitamins and vitamin A, harmful working conditions, taking a number of drugs (large amounts ascorbic acid, sulfonamides).

• Local internal factors

Urolithiasis often occurs in the presence of anomalies in the development of the urinary system (a single kidney, narrowing of the urinary tract, horseshoe kidney), inflammatory diseases of the urinary tract.

• General internal factors

The risk of urolithiasis increases with chronic diseases of the gastrointestinal tract, prolonged immobility due to illness or injury, dehydration due to poisoning and infectious diseases, metabolic disorders due to a deficiency of certain enzymes.

Men are more likely to develop urolithiasis, but women are more likely to develop severe forms of urolithiasis with the formation of staghorn stones that can occupy the entire cavity of the kidney.

Classification of stones in urolithiasis

Stones of one type form in about half of patients with urolithiasis. In this case, in 70-80% of cases, stones are formed, consisting of inorganic calcium compounds (carbonates, phosphates, oxalates). 5-10% of stones contain magnesium salts. About 15% of stones in urolithiasis are formed by uric acid derivatives. Protein stones are formed in 0.4-0.6% of cases (in violation of the metabolism of certain amino acids in the body). The remaining patients with urolithiasis form polymineral stones.

Etiology and pathogenesis of urolithiasis

So far, researchers are only studying various groups of factors, their interaction and role in the occurrence of urolithiasis. It is believed that there are a number of permanent predisposing factors. At a certain point, an additional factor joins the constant factors, which becomes an impetus for the formation of stones and the development of urolithiasis. Having influenced the patient's body, this factor may subsequently disappear.

Urinary infection exacerbates the course of urolithiasis and is one of the most important additional factors stimulating the development and recurrence of KSD, since a number of infectious agents in the process of life affect the composition of urine, contribute to its alkalization, the formation of crystals and the formation of stones.

Symptoms of urolithiasis

The disease progresses in different ways. In some patients, urolithiasis remains a single unpleasant episode, in others it takes on a relapsing character and consists of a number of exacerbations, in others there is a tendency to a protracted chronic course of urolithiasis.

Calculi in urolithiasis can be localized both in the right and in the left kidney. Bilateral stones are observed in 15-30% of patients. The clinic of urolithiasis is determined by the presence or absence of urodynamic disorders, changes in renal functions and an associated infectious process in the urinary tract.

With urolithiasis, pain appears, which can be acute or dull, intermittent or constant. Localization of pain depends on the location and size of the stone. Develops hematuria, pyuria (with the addition of infection), anuria (with obstruction). If there is no urinary tract obstruction, urolithiasis is sometimes asymptomatic (13% of patients). The first manifestation of urolithiasis is renal colic.

• Renal colic

When the ureter is blocked by a stone, the pressure in the renal pelvis rises sharply. Stretching the pelvis, in the wall of which there are a large number of pain receptors, causes severe pain. Stones smaller than 0.6 cm usually pass on their own. With narrowing of the urinary tract and large stones, the obstruction does not spontaneously resolve and can cause damage and death of the kidney.

A patient with urolithiasis suddenly develops severe pain in the lumbar region, independent of body position. If the stone is localized in the lower parts of the ureters, there are pains in the lower abdomen, radiating to the inguinal region. Patients are restless, trying to find the position of the body, in which the pain will be less intense. Possible frequent urination, nausea, vomiting, intestinal paresis, reflex anuria.

Physical examination reveals a positive symptom of Pasternatsky, pain in the lumbar region and along the ureter. Microhematuria, leukocyturia, mild proteinuria, increased ESR, leukocytosis with a shift to the left are determined in the laboratory.

If there is a simultaneous blockage of two ureters, a patient with urolithiasis develops acute renal failure.

• Hematuria

In 92% of patients with urolithiasis after renal colic, microhematuria is noted, which occurs as a result of damage to the veins of the fornic plexuses and is detected during laboratory tests.

• Urolithiasis and concomitant infectious process

Urolithiasis is complicated by infectious diseases of the urinary system in 60-70% of patients. Often there is a history of chronic pyelonephritis, which arose even before the onset of urolithiasis.

Streptococcus, staphylococcus, Escherichia coli, Proteus vulgaris act as an infectious agent in the development of complications of urolithiasis. characteristic pyuria. Pyelonephritis associated with urolithiasis is acute or chronic.

Acute pyelonephritis with renal colic can develop at lightning speed. Significant hyperthermia and intoxication are noted. If adequate treatment is not available, bacterial shock is possible.

• Coral nephrolithiasis

In some patients with urolithiasis, large stones form, almost completely occupying the pyelocaliceal system. This form of urolithiasis is called staghorn nephrolithiasis (KN). CI is prone to a persistent relapsing course, causes severe impairment of renal function and often causes the development of renal failure.

Renal colic for staghorn nephrolithiasis is uncharacteristic. Initially, the disease is almost asymptomatic. Patients may present non-specific complaints (fatigue, weakness). Possible mild pain in the lumbar region. In the future, all patients develop pyelonephritis. Gradually, renal function decreases, and renal failure progresses.

Diagnosis of urolithiasis

The diagnosis of KSD is based on anamnestic data (renal colic), urination disorders, characteristic pains, changes in urine (pyuria, hematuria), urinary stones, data from ultrasound, X-ray and instrumental studies.

In the process of diagnosing urolithiasis, X-ray diagnostic methods of research are widely used. Most of the stones are detected by survey urography. It should be borne in mind that soft protein and uric acid stones are X-ray negative and do not give a shadow on the survey pictures.

If urolithiasis is suspected, regardless of whether shadows of calculi were found on survey images, excretory urography is performed, which determines the localization of calculi, evaluates the functional ability of the kidneys and urinary tract. X-ray contrast study in urolithiasis makes it possible to identify X-ray negative stones, which are displayed as a filling defect.

If excretory urography does not allow assessing the anatomical changes in the kidneys and their functional state (with pyonephrosis, calculous hydronephrosis), isotope renography or retrograde pyelography is performed (strictly according to indications). Before surgical interventions, renal angiography is used to assess the functional state and angioarchitectonics of the kidney in staghorn nerolithiasis.

The use of ultrasound expands the possibilities of diagnosing urolithiasis. With the help of this research method, any X-ray positive and X-ray negative stones are detected, regardless of their size and location. Ultrasound of the kidneys allows you to assess the impact of urolithiasis on the state of the pelvicalyceal system. To identify stones in the underlying parts of the urinary system allows ultrasound of the bladder. Ultrasound is used after remote lithotripsy for dynamic monitoring of the course of litholytic therapy for urolithiasis with X-ray negative stones.

Differential diagnosis of urolithiasis

Modern techniques make it possible to detect any type of stones, so it is usually not required to differentiate urolithiasis from other diseases. The need for differential diagnosis may arise in an acute condition - renal colic.

Usually, the diagnosis of renal colic is not difficult. With an atypical course and right-sided localization of a stone that causes urinary tract obstruction, it is sometimes necessary to make a differential diagnosis of renal colic in urolithiasis with acute cholecystitis or acute appendicitis. The diagnosis is based on the characteristic localization of pain, the presence of dysuric phenomena and changes in urine, the absence of symptoms of peritoneal irritation.

Serious difficulties are possible in the differentiation of renal colic and kidney infarction. In both cases, there is hematuria and severe pain in the lumbar region. It should not be forgotten that kidney infarction is usually the result of cardiovascular diseases, which are characterized by rhythm disturbances (rheumatic heart disease, atherosclerosis). Dysuric phenomena in renal infarction are extremely rare, pain is less pronounced and almost never reaches the intensity that is characteristic of renal colic in urolithiasis.

Treatment of urolithiasis

General principles therapy for urolithiasis

Both surgical methods of treatment and conservative therapy are used. The tactics of treatment is determined by the urologist depending on age and general condition patient, stone location and size, clinical course of urolithiasis, presence of anatomical or physiological changes, and stage of renal failure.

As a rule, surgical treatment is necessary to remove stones in urolithiasis. The exception is stones formed by uric acid derivatives. Such stones can often be dissolved by conservative treatment of urolithiasis with citrate mixtures (blemaren, uralit U) for 2-3 months. Stones of a different composition are not amenable to dissolution.

The passage of stones from the urinary tract or the surgical removal of stones from the bladder or kidney does not exclude the possibility of recurrence of urolithiasis, therefore, it is necessary to take preventive measures aimed at preventing recurrence. Patients with urolithiasis are shown a complex regulation of metabolic disorders, including care for maintaining water balance, diet therapy, herbal medicine, drug therapy, physiotherapy exercises, balneological and physiotherapeutic procedures, sanatorium treatment.

When choosing the tactics of treating staghorn nephrolithiasis, they are guided by a violation of renal functions. If the kidney function is preserved by 80% or more, conservative therapy is carried out, if the function is reduced by 20-50%, remote lithotripsy is necessary. With further loss of kidney function, kidney surgery is recommended to surgically remove kidney stones.

Conservative therapy of urolithiasis

Diet therapy for urolithiasis

The choice of diet depends on the composition of the detected and removed stones. General principles of diet therapy for urolithiasis:

In urolithiasis with calcium oxalate stones, it is necessary to reduce the use of strong tea, coffee, milk, chocolate, cottage cheese, cheese, citrus fruits, legumes, nuts, strawberries, black currants, lettuce, spinach and sorrel.

In case of urolithiasis with urate stones, it is necessary to limit the intake of protein foods, alcohol, coffee, chocolate, spicy and fatty foods, exclude meat foods and offal (liver sausages, pates) in the evening.

With urolithiasis with phosphorus-calcium stones, milk, spicy dishes, spices, alkaline mineral waters are excluded, the use of cheese, cheese, cottage cheese, green vegetables, berries, pumpkins, beans and potatoes is limited. Recommended sour cream, kefir, red currant cranberries, sauerkraut, vegetable fats, flour products, lard, pears, green apples, grapes, meat products.

Stone formation in urolithiasis largely depends on the pH of the urine (normal - 5.8-6.2). The intake of certain types of food changes the concentration of hydrogen ions in the urine, which allows you to independently regulate the pH of the urine. Vegetable and dairy foods alkalinize urine, while animal products acidify. You can control the level of urine acidity with the help of special paper indicator strips, which are freely sold in pharmacies.

If there are no stones on the ultrasound (the presence of small crystals - microlites is allowed), “water shocks” can be used to flush the kidney cavity. The patient takes on an empty stomach 0.5-1 liter of liquid (low-mineralized mineral water, tea with milk, decoction of dried fruits, fresh beer). In the absence of contraindications, the procedure is repeated every 7-10 days. In the case when there are contraindications, "water strokes" can be replaced by taking a potassium-sparing diuretic or a decoction of diuretic herbs.

Phytotherapy for urolithiasis

During the treatment of urolithiasis, a number of herbal medicines are used: rovatinex, cystenal, uralit, uroflux, nieron, phytolysin, cyston, phytolot, marelin, olimetin, avisan. Medicinal herbs are used to accelerate the removal of sand and stone fragments after remote lithotripsy, as well as a prophylactic agent to improve the condition of the urinary system and normalize metabolic processes. Some herbal preparations increase the concentration of protective colloids in the urine, which interfere with the process of salt crystallization and help prevent the recurrence of urolithiasis.

Treatment of infectious complications of urolithiasis

With concomitant pyelonephritis, antibiotics are prescribed. It should be remembered that the complete elimination of urinary infection in urolithiasis is possible only after the elimination of the root cause of this infection - a stone in the kidney or urinary tract. There is a good effect when prescribing nolicin (norfloxacin). When prescribing drugs to a patient with urolithiasis, it is necessary to take into account the functional state of the kidneys and the severity of renal failure.

Normalization of metabolic processes in urolithiasis

Metabolic disorders are the most important factor causing relapses of urolithiasis. Benzbromarone and allopurinol are used to lower uric acid levels. If the acidity of urine cannot be normalized by diet, the listed drugs are used in combination with citrate mixtures. In the prevention of oxalate stones, vitamins B1 and B6 are used to normalize oxalic acid metabolism, and magnesium oxide is used to prevent the crystallization of calcium oxalate.

Widely used antioxidants that stabilize the function of cell membranes - vitamins A and E. With an increase in the level of calcium in the urine, hypothiazide is prescribed in combination with preparations containing potassium (potassium orotate, panangin). In case of violations of the metabolism of phosphorus and calcium, long-term use of diphosphonates (ksidifon) is indicated. The dose and duration of taking all drugs is determined individually.

Therapy of urolithiasis in the presence of kidney stones

If there is a tendency to independent discharge of stones, patients with urolithiasis are prescribed medications from the group of terpenes (avisan, enatin, artemisole, cystenal), which have a bacteriostatic, sedative and antispasmodic effect.

Renal colic is stopped with antispasmodics (drotaverine, sodium metamizole) in combination with thermal procedures (hot water bottle, bath). With inefficiency, antispasmodics are prescribed in combination with painkillers.

Surgical treatment of urolithiasis

If the calculus in urolithiasis does not go away spontaneously or as a result of conservative therapy, surgical intervention is required. The indication for surgery for urolithiasis is severe pain, hematuria, attacks of pyelonephritis, hydronephrotic transformation. When choosing a method of surgical treatment of urolithiasis, preference should be given to the least traumatic technique.

Open surgical interventions for urolithiasis

In the past, open surgery was the only way to remove a stone from the urinary tract. Often, during such surgery, it became necessary to remove the kidney. Today, the list of indications for open surgery for urolithiasis has been significantly reduced, and improved surgical techniques and new surgical techniques almost always allow saving the kidney.

Indications for open surgery for urolithiasis:

The type of open surgical intervention for urolithiasis is determined by the localization of the stone.

Operation types:

X-ray endoscopic surgery for urolithiasis

The operation is performed using a cystoscope. Small stones are removed entirely. In the presence of large calculi, the operation is performed in two stages: crushing the stone (transurethral lithotripsy) and its extraction (lithoextraction). The stone is destroyed by pneumatic, electro-hydraulic, ultrasonic or laser methods.

A contraindication to this surgical intervention may be prostate adenoma (due to the inability to insert an endoscope), urinary tract infections and a number of diseases of the musculoskeletal system in which a patient with urolithiasis cannot be properly laid on the operating table.

In some cases (localization of calculi in the pyelocaliceal system and the presence of contraindications to other methods of treatment), percutaneous lithoextraction is used to treat urolithiasis.

Shock wave lithotripsy for urolithiasis

Crushing is carried out using a reflector that emits electro-hydraulic waves. Remote lithotripsy can reduce the percentage of postoperative complications and reduce the trauma of a patient suffering from urolithiasis. This intervention is contraindicated in pregnancy, blood clotting disorders, cardiac disorders (cardiopulmonary insufficiency, artificial pacemaker, atrial fibrillation), active pyelonephritis, overweight patient (over 120 kg), inability to bring the calculus into the focus of the shock wave.

After crushing, sand and stone fragments are excreted in the urine. In some cases, the process is accompanied by easily stopped renal colic.

No type of surgical treatment excludes the recurrence of urolithiasis. To prevent recurrence, it is necessary to carry out long-term, complex therapy. After removal of stones, patients with urolithiasis should be observed by a urologist for several years.

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