Urolithiasis among all urological diseases ranks second after inflammatory diseases of the kidneys and urinary tract.

Urolithiasis disease- This is a chronic disease that is caused by a metabolic disorder and is accompanied by the formation of stones in the kidneys and urinary tract, which are formed from the constituent parts of urine. Its most common form is nephrolithiasis(kidney disease).

This common disease has been around for a long time. The stones were found on ancient Egyptian mummies buried several thousand years ago. The disease is widespread in all countries of the world. In Russia, it is most often found in the Caucasus, the Volga region, the Urals, and in the Arctic. It is also distributed in the republics of Central Asia and Transcaucasia.

Most often, people of working age from 20 to 50 years old are affected. The share of urolithiasis accounts for up to 30-40% of patients in urological hospitals.

Causes of the disease

Among the reasons called insufficient intake of vitamin A in the body - hypo- or beriberi.

Damage to the tubules of the kidneys, leading to the formation of stones, is also observed with a lack of vitamin D, which, apparently, can explain the prevalence of urolithiasis in the Arctic, where there is a significant lack of vitamin D. vitamin D, that is, long-term administration of large doses, the appearance of stones is possible. It has been established that the occurrence of urinary calculi, consisting of calcium salts of oxalic acid, is also affected by a lack in the diet, and, accordingly, in the body of vitamin B 6 .

Another factor that has a toxic effect and leads to stone formation is primary hyperparathyroidism - a disease of the parathyroid glands, caused by excessive production of parathyroid hormone and characterized by a pronounced violation of calcium and phosphorus metabolism. In the occurrence of urolithiasis, hereditary genetic factors also play a significant role, causing the so-called urolithiasis diathesis - uric acid, oxalic acid, phosphate, that is, in other words, the presence of large amounts of salts in the urine.

Primary pyelonephritis (kidney inflammation) often precedes stone formation. With the re-formation of stones, the role of inflammation in the kidneys plays a decisive role. However, one reason for the formation of calculi is still not enough, most often this requires a combination of several reasons and the presence of predisposing factors, the main of which is a violation of the outflow of urine.

In this way , the process of formation of urinary stones is complex and multi-stage, and it is individual for each patient. Against the background of metabolic disorders, general and local predisposing moments are of great importance.

Types of kidney stones

Kidney stones can be single or multiple, their size varies from 0.1 to 10-15 cm or more, and the mass is from fractions of a gram to 2.5 kg or more. Their shape is diverse, sometimes the stone fills the entire cavity of the kidney in the form of a cast, resembles a coral in shape and is called coral.

ureteral stones- these are, as a rule, calculi displaced from the kidneys, have a variety of shapes, usually round or oblong, small in size, with a smooth or spiny surface, more often single, and sometimes there are several at once. When advancing, they can linger in places of physiological narrowing of the ureters.

Bladder stones are more common in men, since they are more likely than women to have diseases that cause a violation of the outflow of urine from the bladder, especially in old age. Such diseases include adenoma and prostate cancer, narrowing of the urethra (urethra), some diseases and injuries of the bladder and urethra, foreign bodies.

Stones can form either directly in the bladder itself or descend from the ureter. Usually manifested in the form of a sudden interruption of the urine stream, the appearance of pain in the bladder, dysuria, blood in the urine during movement of the body and decrease at rest.

Symptoms of urolithiasis

The main symptoms of urolithiasis are pain, admixture of blood in the urine, impaired urination, discharge of stones, very rarely the absence of urine in the bladder with a bilateral block of the ureters. With inflammation of the kidneys, there is an increase in temperature, but the most common symptom of urolithiasis is pain. Depending on the size, location, shape and mobility of the stone, the pain can be acute and dull, constant and intermittent. A large immobile kidney calculus usually does not cause pain, or it is insignificant.

The most striking manifestation of a kidney or ureteral stone is renal colic - an attack of acute pain. Pain may be caused by the movement of a small calculus or urinary salt crystals. Its occurrence can be sudden, without precursors, against the background of full health.

Such unbearable pain is remembered for a lifetime. The patient rushes about, cannot find a place for himself, behaves restlessly, neither lying down nor sitting, the pain does not decrease, he is ready to climb the wall. Usually localized in the right or left lumbar region, gives to the iliac, inguinal region, external genitalia. The duration of pain varies from several minutes to a day or more, may be accompanied by nausea, vomiting, bloating, when an infection is attached, the temperature rises, and chills appear. However, renal colic can be a symptom of other diseases.

An absolute sign of urolithiasis is the excretion of stones in the urine. The ability of a stone to pass depends on its size, location, tone of the urinary tract. The admixture of blood in the urine can be microscopic, that is, visible only under a microscope and macroscopic, visible to the eye and is usually caused by stone damage to the mucous membrane of the kidneys, ureters, as well as due to venous stasis in the kidneys and inflammation.

As a complication of urolithiasis, inflammation in the kidneys and bladder is considered. Diagnosis of ICD is based on the patient's complaints, examination by a doctor, laboratory, ultrasound, instrumental and radiological data. The condition of patients in the absence of complications can be satisfactory.

We must always remember that urolithiasis is a chronic disease, and there is always a risk of relapse, that is, re-formation of the stone, so each patient should be under the supervision of a doctor.

Treatment of urolithiasis

In most cases, the treatment of urolithiasis is carried out with the use of extracorporeal shock wave lithotripsy ( DLT).

The use of drugs is also mandatory and is aimed at eliminating metabolic disorders and preventing re-stone formation after the EBLT procedure.

• In the treatment of urolithiasis, phyto-preparations are widely used to promote the rapid removal of stones and sand: Cyston, Fitolizin, Uralit.
• With the development of renal colic, analgesics and antispasmodics are used: Drotaverine, Baralgin; intramuscular injection of diclofenac.
• Non-steroidal anti-inflammatory drugs during the first few days after EBRT.
• Essentiale, Lipostabil.
• Vitamin complexes: vitamin A and E.
• Antibacterial treatment is prescribed by a doctor after an examination (urine culture for microflora). Such drugs can be used: Furadonin, Palin, Norfloxacin, Sulfonamides.

Urolithiasis disease(other names: urolithiasis, nephrolithiasis, nephrolithiasis disease) occurs in approximately 12 percent of men and 5 percent of women 70 years of age. Fortunately, most cases of urolithiasis respond well to treatment. In addition, there are measures to prevent the recurrence of this disease, available to each patient.

Urolithiasis: symptoms, diagnosis and treatment

Causes of urolithiasis (how kidney stones form)

The occurrence of stones (calculi) in the kidneys can occur both with increased and normal levels of calcium, oxalic acid compounds (oxalates), cystine, and uric acid in the urine. All these substances form crystals that are fixed in the structures of the kidney and gradually increase in size, forming stones.

In a typical case, such a stone begins to move along the urinary tract and is excreted from the body in the urine. But, getting stuck in the urinary tract and preventing the outflow of urine, the stone can cause pain. Large stones do not always go away spontaneously, and in some cases surgical intervention is required to remove them.

Symptoms of urolithiasis

Pain- The most common symptom of urolithiasis is pain, which can range from mild, barely perceptible, to intense, difficult to bear and requiring medical attention. As a rule, the pain intensifies, then subsides, but does not completely go away. Typically, pulses of severe pain, known as renal colic, last 20 to 60 minutes. Pain can be localized in the side (in the iliac and lateral regions) or in the lower abdomen.

Blood in the urine- Most patients have blood in the urine ( hematuria). Urine may be pink, reddish, but sometimes blood can only be detected using a rapid urine test (test strips - urine dipstick testing) or microscopy.

Sand in urine- In the urine of patients there may be "sand" or small stones.

Other symptoms- Other signs of urolithiasis include nausea and vomiting, pain when urinating, or a sudden urge to urinate.

Asymptomatic urolithiasis- Often, urolithiasis occurs without obvious symptoms. In such cases, stones in the kidneys or urinary tract are detected by chance, during examination for another reason using imaging methods of instrumental diagnostics (ultrasound, X-ray, computed tomography). Stones can stay in the kidneys for many years without causing any symptoms.

Diagnosis of urolithiasis

Typically, kidney and urinary tract stones are detected based on the patient's symptoms, physical examination, and imaging tests.

Computed tomography (CT)- With the help of computed tomography, a three-dimensional image of the internal structures of the body is obtained. Often, if urolithiasis is suspected, an imaging method such as non-contrast spiral computed tomography (non-contrast helical CT).

Ultrasound- Ultrasound can also be used to detect stones, although it is difficult to diagnose small calculi and ureteral stones. However, ultrasound ultrasound) is highly recommended for those patients who are contraindicated in radiation exposure, such as pregnant women.

The choice of treatment technology depends both on the size and location of the stones, and on the nature of the pain and the patient's ability to take fluid. If the most likely outcome is spontaneous passage of stones, the patient can eat and drink on his own, and the pain is tolerable for him, then he can be treated at home.

However, when the patient experiences severe pain or nausea, effective pain medication and intravenous fluids are needed, which can be provided in a specialized medical institution.

Treatment of urolithiasis at home- During the passage of the calculus, the patient may take over-the-counter pain medications: non-steroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin) or naproxen (Aleve). The recommended doses of these drugs are indicated on the package.

Other medications may also be prescribed, such as nifedipine (Procardia®) or tamsulosin (Flomax®), accelerating the process of stone passage.

The patient may be asked to filter a sample of their urine in order to obtain stone samples for analysis in a laboratory, where the chemical composition of the stone (eg, calcium, uric acid, etc.) will be determined. The idea of ​​what type of calculi are important for planning subsequent preventive treatment.

If the stones do not move away spontaneously- Stones larger than 9 or 10 millimeters rarely go away on their own. As a rule, special procedures are required to destroy or remove such a calculus. There are a number of available technologies for such treatment.

Shock wave lithotripsy, SWL (shock waves lithotripsy , SWL ) — Lithotripsy is the treatment of choice for many patients who require medical attention to pass stones. In particular, lithotripsy is recommended for patients with stones located in the kidney or proximal (upper) ureter.

Lithotripsy is not always effective in the presence of large or heavy stones. It may be necessary to use sleeping pills or pain medication during the procedure, although this depends on the type of equipment (lithotripter model) used for lithotripsy.

Lithotripsy is performed by focusing a high energy shock wave on a kidney stone. This "shock" wave, passing through the skin and tissues, releases its destructive energy at the surface of the calculus, leading to its fragmentation into fragments capable of easier discharge through the urinary tract.

Percutaneous (percutaneous) nephrolithotomy (percutaneous nephrolithotomy , PNL ) — For the removal of extremely large or compound calculi, as well as stones resistant to shock wave lithotripsy, minimally invasive endoscopic surgery, percutaneous nephrolithotomy, may be required. During this procedure, small instruments are sequentially introduced into the kidney through a small puncture in the skin to create and widen the nephrostomy canal, fragment and remove stones.

Urethroscopy (URS) Urethroscopy is a procedure that uses a thin tube passed through the urethra (urethra) and bladder into the ureter and kidney. This tube is ureteroscope- contains a camera and other tools that allow the doctor to see the stones, remove them, crush them into small pieces that can relatively easily pass through the urinary tract. Urethroscopy is often used to remove stones blocking the ureter and, in some cases, for kidney stones.

Treatment of urolithiasis that is asymptomatic- If a patient has urolithiasis that occurs without pronounced symptoms, he should decide on the advisability of treating this disease. In this case, one should take into account both the size and localization of stones, and the possibility of emergency contact with a medical institution in case of acute development of symptoms.

Regardless of what the patient's decision will be - to be treated or not - it is required to assess the state of his health for the presence of diseases that increase the risk of developing urolithiasis.

Prevention of urolithiasis

If you have kidney or urinary tract stones, blood and urine tests should be done to look for possible health problems that may be contributing to the development of urolithiasis.

Stones that have passed away should be analyzed to determine their type. Based on the results of this study, some of the following recommendations can be made:

• You may be prescribed a drug to reduce your risk of future stone formation.
• If you want to reduce the likelihood of other stones, drink more fluids to increase the amount of urine flowing through the kidneys and reduce the concentration of substances that stimulate stone formation. There is a recommendation - to drink enough fluid per day so that the volume of urine excreted is about 2 liters per day.
• Depending on the type of stones found, you may be advised to make certain dietary changes.

Summary

• The occurrence of kidney and urinary tract stones can occur with both increased and normal levels in the urine of certain substances that can form crystals. Crystals are fixed in the kidney and gradually increase in size, forming a stone (calculus).
• As a rule, over time, this stone moves along the urinary tract and is excreted in the urine. Otherwise, it remains in the urinary tract, obstructing the flow of urine, which can cause pain.
• Some diseases, lifestyle habits and a number of other factors increase the risk of developing urolithiasis in a particular person. Such risk factors include a history of urolithiasis in the patient or members of his family, some features of the usual diet, concomitant diseases, taking certain medications, and dehydration.
• The most common symptom of kidney stones is pain. Other symptoms include hematuria (blood in the urine), passing small stones, nausea, vomiting, pain when urinating, and an irresistible urge to urinate. Some patients have no symptoms.
• Investigations are usually required to diagnose urolithiasis. Computed tomography (CT) is the diagnostic method of choice for most patients.
• Treatment of urolithiasis usually consists of relieving pain and increasing fluid intake (drinking) until the stones pass. Over-the-counter pain relievers (such as ibuprofen, Advil, Motrin). Severe, uncontrollable pain may require a more effective medication (such as one of the narcotic analgesics).
• Small stones (less than 5 millimeters) usually pass in the urine on their own without treatment. Larger stones (over 9 millimeters) less often depart spontaneously; in such cases, as a rule, treatment is carried out in a medical institution.
• Patients who have repeatedly developed urolithiasis during their lives are recommended to have an additional examination to determine whether the formation of kidney stones is associated with some kind of disease. Medications may be prescribed to prevent future stone formation. In some cases, drinking plenty of fluids and changing your usual diet helps prevent further stone formation.

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Treatment of urolithiasis

Causes of urolithiasis

Urolithiasis belongs to the category of polyetiological diseases, the causes of which vary from case to case. Pathology implies the development of congestion in the urinary tract, which is typically combined with damage to the buffer systems that filter urine from free crystals at the stage from its formation in the distal tubules of the nephron to excretion from the body. Thus, the risks of replenishing the saturated salt solution with the resulting crystals are formed. A pathology in which stones are still contained in the kidneys, and from there they enter the bladder and urinary tract, is called nephrolithiasis.

Causes of urolithiasis are reduced to internal and external factors. Internal factors are predominantly enzymopathies, which are metabolic disorders in the proximal and distal tubules due to a lack or destructurization of cellular enzymes that provide digestive processes. Enzymopathies or, as they are otherwise called, tubulopathies are certainly accompanied by an accumulation in the kidney of substances that form the basis for the construction of stones. The most popular enzymopathies are:

• aminoaciduria, manifested by increased urinary excretion of one or more amino acids, as well as the presence in the urine of intermediate products of their metabolism;
• oxaluria, manifested by increased urinary excretion and precipitation of calcium oxalate crystals;
• cystinuria, manifested by the excretion of the amino acid cystine in the urine, and the kidney stones that form against this background differ in the content of cystine;
• galactosemia, which is a violation of the metabolism of galactose into glucose, which is usually a congenital genetic disease that manifests itself even at the stage of maternal milk intolerance;
• fructosemia is a metabolic disorder leading to the accumulation of unsplit enzyme fructose-1-phosphate and its increased excretion in the urine.

How progressive the formation of stones will be with this kind of metabolic disorders depends on external factors:

• climatic conditions, such as high temperature and humidity;
• geochemical conditions, for example, the composition of drinking water and its saturation with mineral salts;
• nutritional features - vegetable and dairy foods contribute to the alkalization of urine, and meat leads to its oxidation; excess in food canned food, salt, freeze-dried and reconstituted foods, lack of vitamins A and C, excess vitamin D.

Stone formation, among other things, is caused by endogenous factors:

Diseases accompanied by prolonged bed rest can contribute to stone formation in the kidneys. It is noteworthy that hyperfunction of the parathyroid glands, or rather, primary and secondary hyperparathyroidism, also contributes to the development of nephrolithiasis. The mechanism of development of pathology is based on the toxic effect of phosphorus retained in the body on the epithelium of the proximal convoluted tubules. In the blood and urine, the level of neutral mucopolysaccharides rises, they form polysaccharide cylinders and become the core of the calculus.

Symptoms of urolithiasis differ in variety, differ depending on the stage of stone formation, its localization, size, concomitant pathologies. The formation of a stone is often asymptomatic, which can no longer be said about the following stages of the disorder: obturation of the urinary tract with a stone, and violations of the urodynamics of the upper urinary tract, and traumatization of the urothelium of the cups, pelvis and ureter with a calculus, and the addition of pyelonephritis, chronic renal failure are distinguished by a vivid clinical picture. Symptoms typical for this disease today include pain like renal colic, total macrohematuria, pollakiuria, and discharge of calculi. The symptom complex during the diagnosis is assessed holistically:

• pain - is determined by the localization, mobility, size and shape of the stone, if it is motionless, it may be completely absent; may be dull or aching, constant or aggravated by movement or physical exertion; the most characteristic is renal colic, acute pain in the lumbar region, the cause of which is a sharp violation of the outflow of urine due to spasm of the urinary tract; there is irradiation to the inguinal region, external genital organs, the inner surface of the thigh;
• nausea, vomiting, intestinal paresis, unilateral tension of the lumbar muscles and muscles of the anterior abdominal wall are companions of renal colic; the attack forces the patient to rush about in search of the most comfortable position of the body, often colic is accompanied by oliguria, anuria, chills, bradycardia;
• dysuria - a violation of urination due to blockage of the urethra with a stone; urination is either extremely difficult, or the stream becomes intermittent, weakens; with bladder stones, it develops against the background of irritation of the mucous membrane or secondary cystitis;
• pollakiuria - frequent and painful urination, a feeling of incomplete emptying of the bladder may be an alternative symptom of dysuria; excessively frequent urination that occurs at night and interferes with normal sleep is referred to as nocturia;
• hematuria - blood impurities in the urine, which is caused by damage to the mucous membranes by advancing calculus or rupture of thin-walled veins of the fornic plexuses against the background of a rapid recovery of urine outflow after a sudden increase in intrapelvic pressure, which becomes a natural development of renal colic;

The most obvious sign of urolithiasis is the passage of stones. Usually the stones move away naturally, this is preceded by renal colic, but in every fifth patient this process is painless. Departure of the stone is determined by its size, as well as the urodynamics of the urinary tract. When the stone moves along the ureter, it can linger in the juxtavesical or intramural section, then due to reflex influences, patients may experience dysuria or even acute urinary retention. Stones up to one centimeter in size are excreted in the urine.

How to treat urolithiasis?

Treatment of urolithiasis- a very diverse process, determined by the characteristics of a particular case. These are the composition of the stone, and its size, shape and localization, structural features of the cavitary system of the kidney and ureter, the functional state of the kidneys and the degree of violation of uroid dynamics, the functional activity of nephrons and urinary microflora.

Similar can only be general fundamental principles, the adherence to which is equally observed:

• dissolution or other destruction of stone
• removal or removal of stones from the urinary tract
• restoration of optimal patency of the urinary tract
• elimination of the identified causes of stone formation
• sanitation of the urinary system using various medications.

Used today for treatment of urolithiasis methods are presented as follows:

• conservative methods of treatment, entailing the natural process of stone discharge;
• symptomatic treatment relevant for renal colic;
• surgical removal of a stone or removal of a kidney containing a stone;
• medicinal litholysis;
• "local" litholysis;
• percutaneous nephrostomy;
• instrumental removal of stones descending into the ureter;
• percutaneous removal of kidney stones by extraction or litholapaxy (aspiration suction of a previously destroyed calculus);
• contact ureteroscopic destruction of stones;
• remote shock wave lithotripsy - the use of a stone-focused shock wave created outside the body.

In relation to patients suffering from bladder stones, two methods that are popular in the treatment of urolithiasis are used:

• cystolithotripsy - crushing stones using a bladder lithotripter, which is inserted into the bladder through the urethra, captures and destroys the stone into small fragments, which are then washed off with an aspirator;
• cystolithotomy - a surgical operation to remove a calculus from the bladder, temporary drainage of the bladder occurs in the postoperative period and ends with the installation of a urethral catheter.

In this case, they justify themselves surgical methods, according to statistics, 60% of surgical interventions on the kidney fall on the share of this disease. Absolute indications for surgery are such complications of nephrolithiasis as anuria, renal bleeding, obstructive pyelonephritis; relative - frequent renal colic with normal functional activity of the kidney, chronic calculous pyelonephritis and increasing dilatation of the cavitary system of the kidney. The surgical technique used during treatment is called pyelolithotomy, it can be anterior, inferior, posterior and superior, depending on the dissected pelvic wall. The posterior pyelolithotomy is the most popular. It is noteworthy that even such a radical method is fraught with complications, re-stone formation, and the treatment of recurrent stones is much more difficult than that of the first formed ones. Conducting a second operation is extremely contraindicated due to the high probability of death.

Conservative treatment seems to be the ideal way to eliminate stones, involves their dissolution and excretion from the body after taking medication. However, this direction is not fully developed, and medicines rather perform the function of pain relief, sanitation of the urinary tract, prevention of inflammatory processes, and disinfection.

Progressive method of removing stones are endoscopic methods, they are characterized by low invasiveness:

• nephroscopic - through percutaneous puncture and dilatation, a nephroscope is inserted, the stone is crushed and removed;
• ureteroscopic - by means of preliminary dilatation, a ureteroscope is inserted, retrogradely penetrates into the renal pelvis, destroying and removing stones;
• remote shock wave lithotripsy (ESWL) - a shock wave is created outside the body, which remotely destroys the stone in the urinary tract, on which its short pulses are focused; distinguish between electrohydraulic, electromagnetic and piezoelectric types of shock wave generation by lithotriptors; accompanied by intravenous or intramuscular administration of narcotic anesthetics; to accelerate the discharge of fragments, it is recommended to drink plenty of fluids, active movements, and stimulation of the upper urinary tract.

A favorable prognosis for urolithiasis can be ensured only with the timely treatment of the patient to a specialized urological medical institution, where the expediency of popular lithotripsy or pyelolithotomy will be determined by a professional.

What diseases can be associated

Urolithiasis refers to those diseases that rarely occur regardless of other disorders in the body. There are diseases that doctors refer to the group provoking stone formation, while others are considered to be its consequence.

Diseases considered to be the cause of urolithiasis:

• provoking stagnation of urine in the bladder -, neurogenic dysfunction of the bladder, or;

• metabolic disorders that determine the composition of urine -, fructosemia,;
• provoking urinary tract obstruction - acute nephropathy;
• inflammatory lesions of the kidneys and urinary tract -,.

Diseases that develop as a result of urolithiasis:

• - progressive expansion of the pelvicalyceal system, which is due to stenosis of the pelvic-ureteral segment and impaired urine outflow;
• - the process of increasing blood pressure, affecting the renal parenchyma, renal glomeruli and intrarenal vessels;
• and - inflammatory process in the renal parenchyma and pelvicalyceal system;
• and - Gradually progressive impairment of renal function, culminating in uremic intoxication.

Pyelonephritis, which is a frequent companion of urolithiasis, is defined as calculous - it develops when the pelvis or ureter is obstructed by a stone, while the serous phase of inflammation quickly turns into a purulent one, if the outflow of urine from the kidney is not restored as soon as possible. The patient's condition deteriorates rapidly, body temperature rises, chills appear, pain in the lumbar region becomes permanent, and the painful kidney increases so much that it is easily palpated. Chronic calculous pyelonephritis manifests itself depending on the phase of activity of the inflammatory process in the kidney (active, latent, remission). Body temperature rises only in the active phase of the disease, leukocyturia can be moderate, and absent in the remission phase.

The most dangerous complication of nephrolithiasis is acute renal failure. It is most likely if stone formation affects both kidneys or obstruction of both ureters occurs. Another risk is stones in one kidney and obstruction of one ureter, provided that the second kidney is missing. The first signs of impending danger are pronounced oliguria, anuria, irresistible thirst, dry mouth, nausea, and vomiting. Help should be immediate, consisting mainly in the drainage of the kidney. Chronic renal failure in urolithiasis develops as a result of impaired outflow of urine, against the background of the addition of pyelonephritis and is a wrinkling of the kidney.

Treatment of urolithiasis at home

Treatment of urolithiasis at home is carried out in agreement with the doctor, usually such measures are a continuation of work with the patient in a hospital setting. In this way, prescriptions regarding the diet, recommendations for undergoing sanitary-resort treatment and measures to prevent complications can be considered.

The diet for urolithiasis is determined by the type of stones and metabolic processes leading to them, but in general it comes down to the exclusion of meat broths, coffee, cocoa, fried and spicy foods, reduced consumption of salts, chocolate, animal proteins. Useful consumption, vegetables, fruits, dried fruits, dairy and cereal products. With normal glomerular filtration, it is recommended to take at least 1.5 liters of fluid per day.

The doctor also makes a decision about spa treatment on the basis of studies of metabolic disorders in a particular patient. Mineral waters increase diuresis, have an anti-inflammatory effect, allow you to change the pH of urine, its electrolyte composition and the acid-base state of the blood, which is advisable after the destruction of the stone or its removal by surgery. This may be the appointment of alkaline, slightly acidic, slightly mineralized waters.

Carrying out the prevention of nephrolithiasis is considered problematic, if only because healthy people do not consider it necessary to follow a very strict preventive diet and proper drinking regimen until calculi are observed in their urinary tract. Therefore, the object of influence is predominantly a patient whose calculus has already passed or a urinary stone has been removed or destroyed. This shows measures to prevent the recurrence of urolithiasis, that is, the treatment of diseases leading to stone formation of metabolic disorders and kidney diseases.

What drugs to treat urolithiasis?

Magurlit - citrate mixtures for alkalization of urine; it is important to strictly adhere to the dosages indicated by the doctor and regularly measure the acidity of the urine, according to which the dosage may vary;

Baralgin - drugs that have antispasmodic and analgesic effects to relieve renal colic; administered intravenously or intramuscularly, outside the attack - orally; alternatives may be (subcutaneous), (subcutaneous), (orally), (intramuscularly);

Oolimetin, - antispasmodics for symptomatic treatment;

Uricuretic to lower blood uric acid.

Treatment of urolithiasis with folk methods

Taking medicinal decoctions for urolithiasis is very advisable, but must certainly be agreed with the attending physician. The reckless use of medicinal plant extracts can worsen the course of the disease, since the choice of one plant or another is determined, for example, by the type of metabolic disorder:

• from phosphate and calcium stones - combine in equal proportions the greens of madder dye, parsley, cranberries, rue, St. John's wort, bearberry, burdock, calamus; 2 tbsp brew the mixture with a liter of boiling water, leave for 2-3 hours, strain; take three times a day, 20 ml;

• from oxalate stones - combine dill seeds, knotweed, strawberries, horsetail, peppermint and corn stigmas in equal proportions; 2 tbsp brew the mixture with a liter of boiling water, leave for 2-3 hours, strain; take three times a day, 20 ml.

With your doctor, you can discuss the use of the following alternative recipes:

• when sand and stones leave, combine in equal parts a leaf of drooping birch, goose cinquefoil grass, common juniper fruits, field harrow root, large celandine grass; 4 tbsp. brew spoons of the collection with a liter of boiling water, cover with a napkin, strain when it cools down; take three times a day;
• for a diuretic effect - 1 tsp. stigmas of corn (which must be stored in a dry place) pour a glass of water and boil over low heat for 2-3 minutes; take half a glass every two hours.

Treatment of urolithiasis during pregnancy

The development of urolithiasis may be due to what happens quite rarely. The probability of metabolic disorders during pregnancy depends on hormonal, metabolic, functional, anatomical changes in the woman's body. Compliance with a healthy lifestyle, the use of preventive measures and constant cooperation with your doctor reduces the likelihood of such a complex and very long developing pathology.

If the disease could not be avoided, it is recommended to entrust the determination of therapy to the urologist in cooperation with gynecologists and obstetricians. Medical personnel evaluate the feasibility of immediate action, weighing the risks of the violation and its treatment for the health of the woman and the unborn child. Among all examination methods, preference is given to ultrasound and in no case to X-ray methods, radical interventions in the body tend to be postponed for the postpartum period, if this does not threaten the course of pregnancy and childbirth.

Which doctors to contact if you have urolithiasis

Of great importance is not only the determination of the features of the course of urolithiasis (presence, localization, size, shape of calculi), but also the risks of complicating the process of inflammatory processes, the morphological and functional state of the kidneys. Diagnosis of nephrolithiasis involves the complexity:

• complaints of the patient and the collection of anamnesis of the disease;
• physical examination - palpation of the kidney, tapping on the lower back, determination of muscle tension during colic;
• laboratory methods - blood and urine analysis; the latter is examined for the amount of protein, leukocytes, erythrocytes, salts, bacteria
• ultrasound methods - ultrasound of the kidneys (inferior in terms of informational content to X-ray, but in certain cases it turns out to be indispensable)
• instrumental methods - cystoscopy, chromocysistoscopy
• X-ray methods - survey urography, excretory urography, tomography, retrograde pneumopyelography; the shadow of the stone is clearly visible on the overview picture;
• radionuclide research methods - dynamic nephroscintigraphy allows you to establish the degree of preservation of the function of each kidney, evaluate its secretory and evacuation abilities; radioisotope renography characterizes the functional state of the tubular and glomerular apparatus of the kidney, which determines the method of treatment;

The information is for educational purposes only. Do not self-medicate; For all questions regarding the definition of the disease and how to treat it, contact your doctor. EUROLAB is not responsible for the consequences caused by the use of the information posted on the portal.

A metabolic disease caused by various causes, often of a hereditary nature, characterized by the formation of stones in the urinary system (kidneys, ureters, bladder or urethra). Stones can form at any level of the urinary tract, ranging from the renal parenchyma, in the ureters, in the bladder to the urethra.

The disease can be asymptomatic, manifested by pain of varying intensity in the lumbar region or renal colic.

The history of the names of urinary stones is very fascinating. For example, struvite (or tripyelophosphate) is named after the Russian diplomat and naturalist G. H. von Struve (1772-1851). Previously, these stones were called guanites, because they were often found on bats.

Calcium oxalate dihydrate (oxalate) stones are often referred to as weddelites because the same stones are found in rock samples taken from the bottom of the Weddell Sea in Antarctica.

The prevalence of urolithiasis

Urolithiasis is widespread, and in many countries of the world there is an upward trend in the incidence.

In the CIS countries, there are areas where this disease occurs especially often:

• Ural;
• the Volga region;
• Don and Kama basins;
• Transcaucasia.

Among foreign regions, it is more common in such areas as:

• Asia Minor;
• Northern Australia;
• North East Africa;
• Southern regions of North America.

In Europe, urolithiasis is widespread in:

• Scandinavian countries;
• England;
• the Netherlands;
• South East of France;
• South of Spain;
• Italy;
• Southern regions of Germany and Austria;
• Hungary;
• Throughout Southeast Europe.

In many countries of the world, including Russia, urolithiasis is diagnosed in 32-40% of cases of all urological diseases, and ranks second after infectious and inflammatory diseases.

Urolithiasis is detected at any age, most often in working age (20-55 years). In childhood and old age, cases of primary detection are very rare. Men get sick 3 times more often than women, but staghorn stones are most often found in women (up to 70%). In most cases, stones form in one of the kidneys, but in 9-17% of cases, urolithiasis is bilateral.

Kidney stones are single and multiple (up to 5000 stones). The size of the stones is very different - from 1 mm to giant ones - more than 10 cm and weighing up to 1000 g.

Causes of urolithiasis

Currently, there is no unified theory of the causes of urolithiasis. Urolithiasis is a multifactorial disease, has complex diverse mechanisms of development and various chemical forms.

The main mechanism of the disease is considered to be congenital - a slight metabolic disorder, which leads to the formation of insoluble salts that form into stones. According to the chemical structure, different stones are distinguished - urates, phosphates, oxalates, etc. However, even if there is an innate predisposition to urolithiasis, it will not develop if there are no predisposing factors.

The basis of the formation of urinary stones are the following metabolic disorders:

• hyperuricemia (increased levels of uric acid in the blood);
• hyperuricuria (increased levels of uric acid in the urine);
• hyperoxaluria (increased levels of oxalate salts in the urine);
• hypercalciuria (increased levels of calcium salts in the urine);
• hyperphosphaturia (increased levels of phosphate salts in the urine);
• change in the acidity of urine.

In the occurrence of these metabolic shifts, some authors prefer the effects of the external environment (exogenous factors), others prefer endogenous causes, although their interaction is often observed.

Exogenous causes of urolithiasis:

• climate;
• geological structure of the soil;
• chemical composition of water and flora;
• food and drinking regimen;
• living conditions (monotonous, sedentary lifestyle and recreation);
• working conditions (harmful production, hot shops, heavy physical labor, etc.).

The dietary and drinking regimes of the population - the total calorie content of food, the abuse of animal protein, salt, foods containing large amounts of calcium, oxalic and ascorbic acids, the lack of vitamins A and group B in the body - play a significant role in the development of KSD.

Endogenous causes of urolithiasis:

• infections of both the urinary tract and outside the urinary system (tonsillitis, furunculosis, osteomyelitis, salpingo-oophoritis);
• metabolic diseases (gout, hyperparathyroidism);
• deficiency, absence or hyperactivity of a number of enzymes;
• severe injuries or diseases associated with prolonged immobilization of the patient;
• diseases of the digestive tract, liver and biliary tract;
• hereditary predisposition to urolithiasis.

A certain role in the genesis of urolithiasis is played by such factors as gender and age: men get sick 3 times more often than women.

Along with the general causes of endogenous and exogenous nature in the formation of urinary stones, local changes in the urinary tract (developmental abnormalities, additional vessels, narrowing, etc.) that cause a violation of their function are of undeniable importance.

Symptoms of urolithiasis

The most characteristic symptoms of urolithiasis are:

• pain in the lumbar region- can be constant or intermittent, dull or acute. The intensity, localization and irradiation of pain depend on the location and size of the stone, the degree and severity of the obstruction, as well as the individual structural features of the urinary tract.

Large pelvic stones and staghorn kidney stones are inactive and cause dull pain, often permanent, in the lumbar region. For urolithiasis, pain is associated with movement, shaking, driving, and heavy physical exertion.

For small stones, attacks of renal colic are most characteristic, which is associated with their migration and a sharp violation of the outflow of urine from the calyx or pelvis. Pain in the lumbar region often radiates along the ureter, into the iliac region. When the stones move into the lower third of the ureter, the irradiation of pain changes, they begin to spread lower to the inguinal region, to the testicle, the glans penis in men and the labia in women. There are imperative urge to urinate, frequent urination, dysuria.

• renal colic- paroxysmal pain caused by a stone, occurs suddenly after driving, shaking, drinking plenty of fluids, alcohol. Patients constantly change position, do not find a place for themselves, often groan and even scream. This characteristic behavior of the patient often makes it possible to establish a diagnosis "at a distance". Pain sometimes lasts for several hours and even days, periodically subsiding. The cause of renal colic is a sudden obstruction of the outflow of urine from the calyces or pelvis, caused by occlusion (of the upper urinary tract) by a stone. Quite often, an attack of renal colic can be accompanied by chills, fever, leukocytosis.
• nausea, vomiting, bloating, abdominal muscle tension, hematuria, pyuria, dysuria- symptoms often associated with renal colic.
• independent stone passage
• rarely - obstructive anuria(with a single kidney and bilateral ureteral stones)

In children, none of these symptoms are typical for urolithiasis.

Stones of the renal calyx

Calyx stones can be the cause of obstruction and renal colic.

With small stones, pain usually occurs intermittently at the time of transient obstruction. The pain is dull in nature, of varying intensity, and is felt deep in the lower back. It can be aggravated after heavy drinking. In addition to obstruction, the cause of pain may be inflammation of the renal calyx due to infection or the accumulation of tiny crystals of calcium salts.

Calyx stones are usually multiple, but small, so they should pass spontaneously. If the stone remains in the calyx despite the flow of urine, then the likelihood of obstruction is very high.

Pain caused by small calyx stones usually disappears after extracorporeal lithotripsy.

Stones of the renal pelvis

Stones of the renal pelvis with a diameter of more than 10 mm. usually cause obstruction of the ureteropelvic segment. In this case, there is severe pain in the costovertebral angle below the XII rib. The nature of the pain is different from dull to excruciatingly acute, its intensity is usually constant. The pain often radiates to the side of the abdomen and hypochondrium. It is often accompanied by nausea and vomiting.

A staghorn stone occupying all or part of the renal pelvis does not always cause urinary tract obstruction. Clinical manifestations are often poor. Only mild back pain is possible. In this regard, staghorn stones are a finding when examining recurrent urinary tract infections. Left untreated, they can lead to serious complications.

Upper and middle ureteral stones

Stones in the upper or middle third of the ureter often cause severe, sharp pain in the lower back.

If the stone moves along the ureter, periodically causing obstruction, the pain is intermittent, but more intense.

If the stone is immobile, the pain is less intense, especially with partial obstruction. With immobile stones that cause severe obstruction, compensatory mechanisms are activated that reduce pressure on the kidney, thereby reducing pain.

With a stone in the upper third of the ureter, pain radiates to the lateral parts of the abdomen, with a stone in the middle third - in the iliac region, in the direction from the lower edge of the ribs to the inguinal ligament.

Stones in the lower ureter

Pain with a stone in the lower third of the ureter often radiates to the scrotum or vulva. The clinical picture may resemble testicular torsion or acute epididymitis.

A stone located in the intramural ureter (at the level of the entrance to the bladder) in clinical manifestations resembles acute cystitis, acute urethritis or acute prostatitis, since it can cause pain in the suprapubic region, frequent, painful and difficult urination, imperative urges, gross hematuria, and in men - pain in the area of ​​the external opening of the urethra.

Bladder stones

Bladder stones are mainly manifested by pain in the lower abdomen and suprapubic region, which can radiate to the perineum, genitals. Pain occurs when moving and when urinating.

Another manifestation of bladder stones is frequent urination. Sharp causeless urges appear when walking, shaking, physical activity. During urination, the so-called "stuffing" symptom may be noted - suddenly the urine stream is interrupted, although the patient feels that the bladder is not completely emptied, and urination resumes only after a change in body position.

In severe cases, with very large stones, patients can only urinate while lying down.

Signs of urolithiasis

Manifestations of urolithiasis may resemble symptoms of other diseases of the abdominal cavity and retroperitoneal space. That is why the urologist first of all needs to exclude such manifestations of an acute abdomen as acute appendicitis, uterine and ectopic pregnancy, cholelithiasis, peptic ulcer, etc., which sometimes needs to be done together with doctors of other specialties. Based on this, determining the diagnosis of KSD can be both difficult and lengthy, and includes the following procedures:

1. Examination by a urologist, clarification of a detailed anamnesis in order to maximize the understanding of the etiopathogenesis of the disease and the correction of metabolic and other disorders for the prevention of the disease and metaphylaxis of relapses. The important points of this stage are clarification:

• type of activity;
• time of onset and nature of the course of urolithiasis;
• previous treatment;
• family history;
• food style;
• a history of Crohn's disease, bowel surgery, or metabolic disorders;
• drug history;
• the presence of sarcoidosis;
• the presence and nature of the course of urinary infection;
• the presence of anomalies of the genitourinary organs and operations on the urinary tract;
• history of trauma and immobilization.

2. Stone visualization:

• performance of survey and excretory urography or spiral computed tomography.

3. Clinical Analysis blood, urine, urine pH. Biochemical study of blood and urine.
4. Urine culture on microflora and determination of its sensitivity to antibiotics.
5. If necessary, performed calcium stress test(differential diagnosis of hypercalciuria) and ammonium chloride (diagnosis of renal tubular acidosis), study of parathyroid hormone.
6. Stone analysis(if available).
7. Biochemical and radioisotope renal function tests.
8. Retrograde ureteropyelography, ureteropyeloscopy, pneumopyelography.
9. Examination of stones by tomographic density(used to predict the effectiveness of lithotripsy and prevent possible complications).

Treatment of urolithiasis

How to get rid of stones

Due to the fact that the causes of urolithiasis have not been fully elucidated, the removal of a stone from the kidney by surgery does not yet mean the patient's recovery.

Treatment of persons suffering from urolithiasis can be both conservative and operative.

General principles for the treatment of urolithiasis include 2 main areas: the destruction and / or elimination of the calculus and the correction of metabolic disorders. Additional methods of treatment include: improvement of microcirculation in the kidneys, adequate drinking regimen, sanitation of the urinary tract from an existing infection and residual stones, diet therapy, physiotherapy and spa treatment.

After establishing the diagnosis, determining the size of the calculus, its localization, assessing the state of urinary tract patency and kidney function, as well as taking into account concomitant diseases and previous treatment, you can begin to choose the optimal treatment method to rid the patient of the existing stone.

Calculus elimination methods:

1. various conservative methods of treatment that promote stone expulsion with small stones;
2. symptomatic treatment, which is most often used for renal colic;
3. surgical removal of a stone or removal of a kidney with a stone;
4. medicinal litholysis;
5. "local" litholysis;
6. instrumental removal of stones descending into the ureter;
7. percutaneous removal of kidney stones by extraction (litholapoxia) or contact lithotripsy;
8. ureterolitholapoxia, contact ureterolithotripsy;
9. remote lithotripsy (DLT);

All of the above methods of treating urolithiasis are not competitive and do not exclude each other, and in some cases are complementary. However, it can be said that the development and implementation of external lithotripsy (EBLT), the creation of high-quality endoscopic equipment and equipment were revolutionary events in urology at the end of the 20th century. It was thanks to these epoch-making events that the beginning of minimally invasive and less traumatic urology was laid, which today is developing with great success in all areas of medicine and has reached its peak associated with the creation and widespread introduction of robotics and telecommunication systems.

The emerging minimally invasive and less traumatic methods of treating urolithiasis radically changed the mentality of a whole generation of urologists, a distinctive feature of the current essence of which is that, regardless of the size and location of the stone, as well as its “behavior”, the patient must and can be rid of it! And this is correct, since even small, asymptomatic stones located in the cups must be eliminated, since there is always a risk of their growth and the development of chronic pyelonephritis.

Currently, for the treatment of urolithiasis, the most widely used is extracorporeal lithotripsy (ESL), percutaneous nephrolithotripsy (-lapaxia) (PNL), ureterorenoscopy (URS), due to which the number of open operations is reduced to a minimum, and in most clinics in Western Europe - to zero.

Diet for urolithiasis

The diet of patients with urolithiasis includes:

• drinking at least 2 liters of fluid per day;
• depending on the identified metabolic disorders and the chemical composition of the stone, it is recommended to limit the intake of animal protein, table salt, products containing large amounts of calcium, purine bases, oxalic acid;
• The consumption of foods rich in fiber has a positive effect on the state of metabolism.

Physiotherapy for urolithiasis

The complex conservative treatment of patients with urolithiasis includes the appointment of various physiotherapeutic methods:

• sinusoidal modulated currents;
• dynamic amplipulse therapy;
• ultrasound;
• laser therapy;
• inductothermy.

In the case of the use of physiotherapy in patients with urolithiasis complicated by urinary tract infection, it is necessary to take into account the phases of the inflammatory process (shown in the latent course and in remission).

Sanatorium-resort treatment for urolithiasis

Sanatorium-resort treatment is indicated for urolithiasis both in the period of the absence of a stone (after its removal or independent discharge), and in the presence of a calculus. It is effective for kidney stones, the size and shape of which, as well as the condition of the urinary tract, allow us to hope for their independent discharge under the influence of the diuretic action of mineral waters.

Patients with uric acid and calcium oxalate urolithiasis are treated at resorts with low-mineralized alkaline mineral waters:

• Zheleznovodsk (Slavyanovskaya, Smirnovskaya);
• Essentuki (Essentuki No. 4, 17);
• Pyatigorsk, Kislovodsk (Narzan).

With calcium-oxalate urolithiasis, treatment can also be indicated at the Truskavets (Naftusya) resort, where mineral water is slightly acidic and low-mineralized.

Treatment at the resorts is possible at any time of the year. The use of similar bottled mineral waters does not replace a spa stay.

Reception of the above mineral waters, as well as mineral water "Tib-2" (North Ossetia) for therapeutic and prophylactic purposes is possible in an amount of not more than 0.5 l / day under strict laboratory control of indicators of the exchange of stone-forming substances.

Treatment of uric acid stones

• dissolution of stones (litholysis).

In the treatment of uric acid stones, the following drugs are used:

1. Allopurinol (Allupol, Purinol) - up to 1 month;
2. Blemaren - 1-3 months.

Treatment of calcium oxalate stones

With the medical treatment of urolithiasis, the doctor sets himself the following goals:

• prevention of recurrence of stone formation;
• prevention of the growth of the calculus itself (if it already exists);
• dissolution of stones (litholysis).

With urolithiasis, stepwise treatment is possible: if diet therapy is ineffective, it is necessary to additionally prescribe medications.

One course of treatment is usually 1 month. Depending on the results of the examination, treatment may be resumed.

The following drugs are used in the treatment of calcium oxalate stones:

1. Pyridoxine (vitamin B 6) - up to 1 month;
2. Hypothiazid - up to 1 month;
3. Blemaren - up to 1 month.

Treatment of calcium phosphate stones

With the medical treatment of urolithiasis, the doctor sets himself the following goals:

• prevention of recurrence of stone formation;
• prevention of the growth of the calculus itself (if it already exists);
• dissolution of stones (litholysis).

With urolithiasis, stepwise treatment is possible: if diet therapy is ineffective, it is necessary to additionally prescribe medications.

One course of treatment is usually 1 month. Depending on the results of the examination, treatment may be resumed.

In the treatment of calcium phosphate stones, the following drugs are used:

1. Antibacterial treatment - if there is an infection;
2. Magnesium oxide or asparaginate - up to 1 month;
3. Hypothiazid - up to 1 month;
4. Phytopreparations (plant extracts) - up to 1 month;
5. Boric acid - up to 1 month;
6. Methionine - up to 1 month.

Treatment of cystine stones

With the medical treatment of urolithiasis, the doctor sets himself the following goals:

• prevention of recurrence of stone formation;
• prevention of the growth of the calculus itself (if it already exists);
• dissolution of stones (litholysis).

With urolithiasis, stepwise treatment is possible: if diet therapy is ineffective, it is necessary to additionally prescribe medications.

One course of treatment is usually 1 month. Depending on the results of the examination, treatment may be resumed.

In the treatment of cystine stones, the following drugs are used:

1. Ascorbic acid (vitamin C) - up to 6 months;
2. Penicillamine - up to 6 months;
3. Blemaren - up to 6 months.

Complications of urolithiasis

Prolonged standing of a stone without a tendency to self-discharge leads to progressive inhibition of the function of the urinary tract and the kidney itself, up to its (kidney) death.

The most common complications of urolithiasis are:

• Chronic inflammatory process at the location of the stone and the kidney itself (pyelonephritis, cystitis), which, under adverse conditions (hypothermia, acute respiratory infections), can become aggravated (acute pyelonephritis, acute cystitis).
• In turn, acute pyelonephritis can be complicated by paranephritis, the formation of pustules in the kidney (apostematous pyelonephritis), carbuncle or kidney abscess, necrosis of the renal papillae and, as a result, sepsis (fever), which is an indication for surgical intervention.
• Pyonephrosis - represents the terminal stage of purulent-destructive pyelonephritis. The pyonephrotic kidney is an organ that has undergone purulent fusion, consisting of separate cavities filled with pus, urine and tissue decay products.
• Chronic pyelonephritis leads to rapidly progressive chronic renal failure and eventually to nephrosclerosis.
• Acute renal failure is extremely rare due to obstructive anuria with a single kidney or bilateral ureteral stones.
• Anemia due to chronic blood loss (hematuria) and impaired hematopoietic function of the kidneys.

Prevention of urolithiasis

Preventive therapy aimed at correcting metabolic disorders is prescribed according to indications based on the patient's examination data. The number of courses of treatment during the year is set individually under medical and laboratory control.

Without prophylaxis for 5 years, half of the patients who got rid of stones with one of the methods of treatment, urinary stones form again. It is best to start patient education and proper prevention immediately after spontaneous passage or surgical removal of the stone.

Lifestyle:

• fitness and sports (especially for professions with low physical activity), however, excessive exercise in untrained people should be avoided
• avoid drinking alcohol
• avoid emotional stress
• urolithiasis is often found in obese patients. Weight loss by reducing the intake of high-calorie foods reduces the risk of disease.

Increasing fluid intake:

• It is shown to all patients with urolithiasis. In patients with urine density less than 1.015 g/l. stones are formed much less frequently. Active diuresis promotes the discharge of small fragments and sand. Optimal diuresis is considered in the presence of 1.5 liters. urine per day, but in patients with urolithiasis, it should be more than 2 liters per day.

Calcium intake.

• Higher calcium intake reduces oxalate excretion.

The use of fiber.

• Indications: Calcium oxalate stones.
• You should eat vegetables, fruits, avoiding those that are rich in oxalate.

Oxalate retention.

• Low dietary calcium levels increase oxalate absorption. When dietary calcium levels increased to 15–20 mmol per day, urinary oxalate levels decreased. Ascorbic acid and vitamin D may contribute to increased oxalate excretion.
• Indications: hyperoxaluria (urine oxalate concentration more than 0.45 mmol/day).
• Reducing oxalate intake may be beneficial in patients with hyperoxaluria, but in these patients, oxalate retention should be combined with other treatments.
• Limiting the intake of oxalate-rich foods for calcium oxalate stones.

Foods rich in oxalates:

• Rhubarb 530 mg/100 g;
• Sorrel, spinach 570 mg/100 g;
• Cocoa 625 mg / 100 g;
• Tea leaves 375-1450 mg/100 g;
• Nuts.

Vitamin C intake:

• Vitamin C intake up to 4 g per day may occur without the risk of stone formation. Higher doses promote endogenous metabolism of ascorbic acid to oxalic acid. This increases the excretion of oxalic acid by the kidneys.

Reduced protein intake:

• Animal protein is considered one of the important risk factors for stone formation. Excessive intake may increase calcium and oxalate excretion and decrease citrate excretion and urinary pH.
• Indications: Calcium oxalate stones.
• It is recommended to take approximately 1g/kg. protein weight per day.

Thiazides:

• The indication for the appointment of thiazides is hypercalciuria.
• Drugs: hypothiazide, trichlorothiazide, indopamide.
• Side effects:

1. mask normocalcemic hyperparathyroidism;
2. development of diabetes and gout;
3. erectile dysfunction.

Orthophosphates:

• There are two types of orthophosphates: acidic and neutral. They reduce calcium absorption and calcium excretion as well as reduce bone reabsorption. In addition to this, they increase the excretion of pyrophosphate and citrate, which increases the inhibitory activity of urine. Indications: hypercalciuria.
• Complications:

1. diarrhea;
2. cramps in the abdomen;
3. nausea and vomiting.

• Orthophosphates can be used as an alternative to thiazides. Used for treatment in selected cases, but cannot be recommended as a first line remedy. They should not be prescribed for stones associated with urinary tract infection.

Alkaline citrate:

• Mechanism of action:

1. reduces supersaturation of calcium oxalate and calcium phosphate;
2. inhibits the process of crystallization, growth and aggregation of the stone;
3. reduces supersaturation of uric acid.

• Indications: calcium stones, hypocitraturia.

Magnesium:

• Indications: Calcium oxalate stones with or without hypomagniuria.
• Side effects:

1. diarrhea;
2. CNS disorders;
3. fatigue;
4. drowsiness;

• You can not use magnesium salts without the use of citrate.

Glycosaminoglycans:

• The mechanism of action is calcium oxalate crystal growth inhibitors.
• Indications: calcium oxalate stones.

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.

What it is?

Urolithiasis is a chronic disease that is caused by a metabolic disorder and is accompanied by the formation of stones in the kidneys and urinary tract, which are formed from the constituent parts of urine.

Its most common form is nephrolithiasis (kidney stones).

Causes

Urolithiasis is provoked by various reasons:

• sedentary lifestyle leading to metabolic disorders;
• infectious and inflammatory diseases of the genitourinary system, which were caused by streptococcus, staphylococcus, Escherichia coli, Proteus vulgaris;
• other diseases of the kidneys and genitourinary system;
• unbalanced diet, disturbed regimen, too spicy, sour, salty foods in the diet;
• lack of vitamins A and B;
• the use of low-quality water with harmful chemical elements in the composition;
• some drugs can increase the acidity of urine and affect the functioning of the kidneys;
• unfavorable working conditions, accompanied by physically hard work or work in the cold;
• tumors in the bladder;
• chronic diseases of the gastrointestinal tract (pancreatitis, gastritis and others);
• chronic and protracted pathologies of the kidneys and urinary tract;
• osteoporosis and other diseases associated with bones;
• genetic predisposition.

As for women, pregnancy also affects the development of urolithiasis. In women who are carrying a child, the outflow of urine is often disturbed in the later stages. The uterus enlarges, pressing on the kidneys. For this reason, urine can stagnate, provoking the development of infectious diseases.

Classification

Basically, the pathogenesis of urolithiasis develops against the background of metabolic disorders in humans. This leads to the fact that some products and substances are poorly processed and cannot completely leave the body. They accumulate as insoluble particles and result in sand or stones in the urine. Stones are classified according to their chemical composition. They are of several types:

1. Based on calcium (phosphates, carbonates). They are the most common (more than 60% of all stones).
2. Containing uric acid salts (urates). They are dissolvable and occur mainly in elderly patients.
3. Based on magnesium salts. Such stones provoke inflammation in the places of their localization.
4. Protein stones (cystine, cholesterol). These protein stones are very rare.

The study of stones for their chemical composition is of great importance in the treatment of the disease, the appointment of a diet.

Symptoms of urolithiasis

There are symptoms of urolithiasis in men only at the time of the movement of the formed stone along the urethra. The pathological condition is characterized by a triad of clinical manifestations:

• pain sensations of varying severity;
• changes in the urinary sediment (the appearance of blood, pus and other components);
• violation of the process of excretion of urine, up to complete anuria (obstructive genesis).

The pain syndrome can be constant or coming, the degree of its severity varies from aching and pulling pains to unbearable renal colic, which requires emergency hospitalization of the patient in a hospital.

Complaints of a dysuric nature join the pain symptoms: frequent and painful urination, violation of the processes of emptying the bladder. Patients complain of general weakness, decreased performance, feeling of nausea and vomiting at the peak of pain (it does not bring any relief).

The severity of symptoms of urolithiasis, depending on the localization of the calculus, is as follows:

1. The presence of a calculus in the lumen of the bladder is accompanied by pain in the lower abdomen, while the pain radiates to the genitals, perineum or rectum. There are typical dysuric disorders: frequent and painful urination, which can be interrupted suddenly (symptom of "interruption of the jet").
2. With the localization of the calculus at different levels of the ureter, the pain shifts to the inguinal region, its irradiation to the surface of the thigh and genitals is characteristic. There are complaints of frequent and painful urination. When the stone completely blocks the lumen of one of the ureters, the pain syndrome becomes unbearable (renal colic).
3. If the stone is localized in the pyelocaliceal apparatus of the kidney, then the patient has aching pains in the lumbar region of the corresponding side. Pain is associated with a change in body position and movement of the patient. Often there are traces of blood in the urine.

Often, patients go to the doctor with a stone that has already passed away, which is an indisputable sign of urolithiasis.

Complications

The most common adverse outcomes of the disease are the following pathological processes:

• calculous pyonephrosis (most often, purulent cavities in the tissues of the kidney occur with a recurrent form of urolithiasis);
• inflammation of the affected kidney against the background of blockage of the urinary duct (obstructive form of pyelonephritis);
• rupture of the wall of the ureter, bladder or urethra with the development of a septic condition in the patient;
• acute renal failure (observed in patients with urolithiasis of a single kidney);
• cicatricial deformities of the lumen of the ureter and others.

Diagnostics

In order to exclude complications from urolithiasis, urologists recommend not to hesitate to visit a doctor and seek medical help at the first sign of illness. To recognize the disease, determine the localization of calculi, their size, evaluate the work of the organs of the genitourinary system, will help complex differential diagnosis of urolithiasis, which consists of the appointment of laboratory and instrumental methods of examination.

Instrumental diagnostics:

• Intravenous excretory diagnostics.
• X-ray - evaluates the kidneys, ureters and bladder, recognizes stones.
• CT or MRI of the kidneys is an informative diagnostic method that allows you to evaluate the work of the entire genitourinary system, to identify the slightest violations in its work.
• Ultrasound of the kidneys - visualizes all the structures of the organ, determines the number of stones and other visible disorders in the urinary system.

Laboratory diagnostics:

• Urinalysis - determines the pH of urine, the number of leukocytes. Urine tests for urolithiasis are carried out quite often, since they help to identify salt crystals and recognize their composition.
• Blood test - allows you to determine the presence of an inflammatory process, as evidenced by an increased ESR and the number of leukocytes.
• Daily urine analysis - allows you to assess the content of various salts in urine.

Treatment of urolithiasis

ICD is a group of serious diseases that, if not properly treated, can lead to death of a person. Self-medication for this disease is unacceptable, therefore, at the first signs of the disease, you need to seek medical help. Any form of urolithiasis is treated in a complex with the use of:

• medicines;
• dieting;
• herbal medicine;
• physiotherapy;
• the right way of life;
• crushing stones with ultrasound;
• removal of stones.

A conservative method of treating urolithiasis in men is carried out taking into account an integrated and systematic approach, involves taking certain medications.

Medications are prescribed depending on the composition of the stones:

1. Citrate suppositories, diuretics and vitamins (if the stones are of oxalate etiology);
2. Diuretic, anti-inflammatory and diphosphonates (if the stones found have a phosphate etiology). With this course of KSD, many doctors recommend home herbal treatment as an adjunct therapy;
3. Medicines that slow down the process of urea synthesis. Also, drugs are prescribed that change the degree of acidity of urine, which leads to the dissolution of stones (in the presence of stones of urate etiology).

Drugs for the treatment of urolithiasis are divided into the following groups:

1. Pain medication. Medication relieve pain during an attack of renal colic ("Tempalgin", "Baralgin" and others).
2. Antibiotics. Mandatory point of therapy. The antibiotic is selected individually by the urologist.
3. Medications to help pass the stone. Appointment depends on the size, composition, location ("Furosemide").
4. Antispasmodics. They remove the cause of the spasm, relax the walls of the ureter, facilitating the passage of the calculus (Papaverine, No-shpa, Diprofen).
5. Preparations that dissolve the stone. Selection of funds according to the composition of the calculus (“Fitolizin”, “Solimok”, “Urodan” and others, as well as dietary supplements - “Prolit”, “Litovit”).

The purpose of drug therapy is to prevent an exacerbation of urolithiasis, to alleviate the general condition of a person, to relax the muscles and walls of the ureter (kidney), to dissolve possible calculi and painless withdrawal.

Folk remedies

At home, in the absence of pain, as well as for the prevention of relapse, you can use alternative methods. With phosphate stones, the effect is noted with regular drinking of decoctions of wild rose or barberry.

Combined herbal preparations are also used, consisting of several herbs that have a moderate diuretic, antispasmodic and uroseptic effect.

1. Combine the ingredients in the indicated quantities: garden parsley herb - 20 g, common bearberry leaves, common juniper fruits, field harrow root, medicinal dandelion root - 15 g each; common anise fruit, shepherd's purse herb - 10 g each. Pour 10 g of raw materials in an enamel bowl with 1 cup boiling water, close the lid and heat in a water bath for 30 minutes, leave for 10 minutes, strain, squeeze the thick. Bring the volume of the broth with boiled water to 200 ml. Take 1/2-1/3 cup warm 2-3 times a day.
2. Tricolor violet grass - 30 g, horsetail grass - 30 g, St. brew a tablespoon of the crushed mixture with a glass of boiling water, leave for 30 minutes, strain and take a glass 3 times a day with phosphate and carbonate stones.
3. This method of removing stones consists in taking two decoctions. The first decoction is prepared from the roots of wild rose. They need to be ground with a coffee grinder to end up with 50 g of dry powder. Then pour the powder into 700 ml of water and let it boil over the fire for 15 minutes. After that, prepare an infusion of bearberry. To do this, pour boiling water (300 ml) dried or fresh grass (about 30 g), leave for about 2 hours. Take the first remedy three times a day after meals, 300 ml. 25 minutes after its use, you should take a bearberry infusion of 100 ml.
4. Mix the ingredients in the indicated proportions: large celandine grass - 30 g, common oregano grass - 20 g, common barberry bark - 20 g; pour a tablespoon of the mixture with a glass of boiling water, leave for 30 minutes and take a glass 3 times a day with uric acid stones.
5. Mix the ingredients in the indicated proportions: nettle leaf and roots - 50 g, licorice root - 30 g; pour a tablespoon of the mixture with a glass of boiling water, insist until cool, strain and drink in 3 divided doses during the day for kidney stones with nephritis.
6. The dissolution of sand and stones in the urinary organs is facilitated by fresh onions and garlic, strawberries, a decoction of melon seed in milk, black radish juice with honey or sugar, infusions and decoctions of beans, peas, infusions of shepherd's purse leaves, black currants, fruits (fresh and dry) wild rose, fruits of mountain ash, dandelion roots, calamus rhizomes, corn stigmas, horsetail grass (contraindicated in nephritis). Recommended pumpkin, cabbage pickle and juice, barberry, strawberries, wild rose.

The list of traditional medicine recipes is large. It is worth remembering the contraindications of some herbs, therefore, when choosing a method of treatment with folk remedies, a doctor's consultation is required.

Surgical methods

Large urinary stones that are not amenable to dissolution are broken into small fragments, which are either passed out on their own or removed surgically. Stones are destroyed by lithotripsy, acting on them with a shock wave.

There are several types of lithotripsy:

1. Contact lithotripsy - an endoscopic apparatus is brought to the stone through the urethra and bladder, the active part of which comes into contact with the stone (therefore, the method is called contact). A shock wave is formed at the point of contact.
2. Percutaneous lithotripsy - in this technique, a lithotripter is inserted into the kidney through an incision in the lumbar region. It is used for crushing giant and coral-like stones.
3. ESWL - external shock wave lithotripsy - a non-invasive method in which the impact on the kidney stone is carried out without any skin incisions and other invasive techniques.

In the event that the stone cannot be crushed, a surgical operation is performed. Depending on the volume of the operation, the following types of operations for urolithiasis are distinguished:

1. Nephrolithotomy - an incision is made directly through the kidney. This operation is indicated for stones that cannot be removed by other methods and when lithotripsy is ineffective. It is the most difficult operation for the patient.
2. Pyelolithotomy - the calculus is removed from the kidney through a small incision in the renal pelvis.
3. Ureterolithotripsy is an operation to remove a stone from the ureter.

Nutrition rules

Diet and nutrition for urolithiasis depends on the pH and composition of the calculi. Depending on them, doctors have compiled a list of products, the use of which is contraindicated in one case or another.

If the stones are of urate origin, you can not take:

• alcoholic drinks;
• coffee;
• meat broths;
• fried and spicy dishes;
• offal;
• chocolate, cocoa;
• animal protein.

In the presence of phosphate stones, you can not use:

• vegetables with green skin and/or flesh;
• any spices;
• spicy dishes;
• pumpkin, including its seeds;
• legumes;
• potato;
• dairy products.

In the presence of oxalant stones, the following should be avoided:

• dairy products;
• citrus;
• strawberries and strawberries;
• lettuce leaves;
• spinach;
• legumes;
• cheeses of any kind;
• nuts;
• sorrel;
• cocoa, coffee and tea.

Compliance with a certain diet is an integral part of the therapeutic program, which allows you to stop the further formation of stones in the urinary system, as well as suppress the growth of existing stones.

Nutrition for urolithiasis is based on the following principles:

• Don't overeat. Food that enters the stomach in large volumes will only aggravate the situation.
• Systematic eating. Ideally, you should eat at about the same time. It is not recommended to skip meals, this can lead to increased stone formation and deterioration of well-being.
• Do not eat excessively high-calorie foods. The energy value of products should correspond to the energy costs that take place in reality.
• The diet should be enriched with foods rich in vitamins and amino acids.
• Drink about 2-3 liters of regular non-carbonated water per day. This will increase the amount of urine produced.

Prevention

With the diagnosis of "urolithiasis", prevention should be carried out much earlier than the first signs of the disease appear. People who are at risk or have chronic diseases associated with metabolism should pay special attention to their health.

Prevention of urolithiasis consists of observing the following recommendations:

1. Consume clean water. In some regions, the water contains a large amount of salts, which leads to an increase in their concentration in the urine and the formation of crystals. It is better to buy bottled water or use filters with a high degree of purification.
2. Observe the drinking regime. If there are no contraindications, a person should drink about 2 liters of fluid per day. The best option is clean drinking water. It is an ideal solvent and helps to dilute salts and prevent crystals and stones from forming. People living in a hot climate need to increase the volume to 3 liters.
3. Eat in a balanced way. Kidney stones form in both meat lovers who follow a protein diet and vegetarians who consume a lot of acidic vegetables and fruits. Therefore, nutrition should be varied and balanced in composition. It is recommended to eat 150-170 g of meat and 50 g of fish per day. It is not necessary to eat them every day, for example, you can fish 2 times a week for 300 g. Also, 300-400 g of vegetables and the same amount of fruit in any form are required daily. Groats and bread in total should be 300-400 g.
4. Don't get dehydrated. Infectious diseases, burns, hot weather, prolonged exercise and sports cause significant fluid loss. You must constantly replenish its reserves. To do this, it is advisable to drink often (every half an hour), you can drink in small portions of 100-150 ml. This will help reduce intoxication, remove harmful substances from the body and protect the kidneys.
5. Take vitamins. Deficiency of vitamins, especially E and group B, negatively affects the condition of the mucous membrane of the urogenital organs and the functioning of the kidneys, and also leads to disruption of metabolic processes. Therefore, it is recommended to drink vitamin complexes 2 times a year.
6. Don't oversalt food. For an adult, the daily salt intake is 5 g or one teaspoon. This amount includes all the salt in the dishes that you cook and in the products (mayonnaise, herring, chips). Excess salt makes it difficult for the kidneys to work.
7. Be outdoors. The lack of ultraviolet radiation is bad for the condition of the bones. Minerals are washed out of them, which can take part in stone formation.
8. Treat diseases of the urinary system in a timely manner. Any inflammation can provoke the formation of stones and exacerbation of urolithiasis. Therefore, at the first symptoms, seek qualified help, and do not self-medicate.
9. Lead an active lifestyle. Lack of physical activity contributes to stagnation of urine. And exercises aimed at strengthening the abdominal and lumbar muscles improve kidney function and eliminate congestion. The daily norm should be walking (30-40 minutes each) and a set of exercises lasting 15-20 minutes. The best option is to additionally visit the gym or pool 2-3 times a week.
10. Take herbal diuretics periodically. Suitable watermelon, pomegranate juice, concentrated decoction of dried apricots (100 g per 0.5 l of water). Some medicinal herbs have a diuretic and anti-inflammatory effect: bear's ears, corn stigmas, horsetail and bearberry. They “wash” the kidneys, prevent the salts from precipitating, and remove the already formed small stones and sand.
11. Take care of your digestive health. Deficiency of digestive enzymes in diseases of the gastrointestinal tract leads to the formation of calcium oxalate stones. So, ascorbic acid, in case of indigestion, turns into oxalate, which is deposited in the kidneys in the form of crystals.
12. Avoid hypothermia. Keep your legs and lower back warm. The receptors located in these areas have a reflex connection with the kidneys and bladder. Hypothermia can cause inflammation or spasm of the smooth muscles around the stone.

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.