Urolithiasis is characterized by the formation of stones (concrements) in the organs of the urinary system. Another name for the pathology is urolithiasis. According to statistics, this disease is so widespread that it affects to one degree or another every fifth adult.
Urolithiasis - causes
Solid stone-like formations in the kidney, ureter, or bladder begin to appear often in people 20-45 years old, but sometimes - and in childhood. The mechanism of their formation is diverse, so it is difficult to single out any one provoking factor. In general, the causes of urolithiasis are associated with a violation of metabolic processes in the body, in connection with which the formation of urinary tracts of crystallizing compounds.
Predisposing factors for the development of the disease are:
- heredity;
- use of water containing a large number of certain minerals;
- insufficient drinking regimen;
- sedentary lifestyle;
- infectious and inflammatory diseases of the urinary tract;
- chronic disorders of the digestive system;
- prevalence of acute, acidic, salty foods in the diet;
- excessive use of certain certain products (herbs, meat, dairy products, strong tea, etc.);
- congenital or acquired abnormalities of the kidneys, ureters (constrictions, additional vessels);
- systemic metabolic diseases ( gout , hyperparathyroidism );
- taking certain medications, etc.
Urolithiasis - types of stones
Urolithiasis can be diagnosed with single or multiple stones, having a different size - from 1 mm to 10 cm or more. In the presence of many small moving stones they are called sand. According to the form, urinary stones can be flat, rounded, with sharp edges and spines. A concrement is called coral, if it is located in the kidney and occupies almost the entire cavity of it, forming a "mold" of the calyx-pelvis system.
The stones are crystals of urinary salts, bound with different protein compounds. Many of them have a mixed chemical composition, but often they are dominated by certain compounds. Urolithiasis (urolithiasis) in the chemical structure of concrements is divided into the following main types:
- oxalate;
- urate;
- phosphate;
- struvite.
Oxalate Urolithiasis
Classification of stones in urolithiasis is important for the purpose of proper treatment. In many patients (approximately 70%) oxalate formations consisting of calcium oxalate and oxalate ammonium salts are detected. Their features are high density, low solubility, spiny surface. When moving, such stones easily injure the mucous tissues of the urinary system, and the resulting blood helps to stain them in a dark brown, almost black color.
One of the reasons for the formation of concrements of this type is a food ration in which ascorbic acid, oxalic acid is present in large amounts, there is a deficiency of magnesium and vitamin B6. In addition, they are provoked by the appearance of inflammatory diseases of the kidneys, operations on the gastrointestinal tract, endocrine dysfunction.
Phosphate urolithiasis
Describing what stones are in case of urolithiasis, experts note that phosphate stones are very common, and in most cases - in women. They consist of phosphoric acid and calcium salt and are soft, porous formations of a grayish or whitish hue. Such stones can grow very quickly, occupying the entire renal cavity, i.e. forming coral structures.
In many cases, infectious processes in the urinary system, leading to alkalinization of urine, become the starting point for the development of phosphates. Another common cause is the hyperfunction of the parathyroid glands, which leads to a disruption of the phosphate metabolism. Dietary habits play a role, in which large amounts of strong tea and coffee are consumed, vitamin A, E, D deficiency is observed.
Struvitous urolithiasis
Struvitic stones in urolithiasis are diagnosed in about 15% of patients. These stones have a soft texture, they can grow quickly. In composition, these compounds are ammonium and magnesium phosphate, as well as carbonate apatite. A predisposing factor to their appearance is infection of the urogenital tract, the causative agents of which are enzymatically cleavable urea bacteria. Pathogens are found on the stones themselves.
Quite often, the formation of struvite concrements is facilitated by low mobility, incomplete emptying of the bladder, causing urine stagnation. In the risk group - patients with diabetes mellitus and injured pelvic area with forced long-term immobilization. The food factor can serve as an abundance of protein foods in the diet (mainly meat).
Urartic urolithiasis
About a third of patients with urolithiasis form urate stones - yellowish-brown or brick-brown stones with a hard-loose structure and a relatively smooth surface. By chemical composition are salts of uric acid. These formations can accumulate in the kidneys, bladder, urinary tubes.
In women, this form of urolithiasis is diagnosed somewhat less often, which is probably due to one of its main reasons - frequent consumption of food rich in purines. These substances are found in large quantities in the meat of young animals, in broths, cold, legumes, etc. In addition, the disease can be formed due to metabolic disorders with a marked increase in the concentration of uric acid in the body.
Urolithiasis - symptoms
The most common signs of urolithiasis are:
- periodic pain in the lumbar region (on the one hand, on both sides) or in the groin zone of an acute and blunt, pulling character;
- frequent urge to urinate ;
- pain, burning sensation when urinating;
- blurred urine, the appearance of blood in it;
- swelling of the face, limbs.
Often, the pathology for a long time does not make itself felt, and the symptoms of urolithiasis for the first time can manifest itself in renal colic , when the stone enters the ureter and causes it to clog. In this case, the following symptoms occur:
- a sharp appearance of intense cramping pains in the lumbar region;
- occurrence of frequent urge to urinate, after which anuria can be observed;
- increased body temperature;
- chills;
- nausea;
- cold sweat;
- blanching, etc.
Urolithiasis - diagnosis
Urolithiasis can be determined by ultrasound of the kidneys, bladder and urinary tubes. The data of computed tomography and radiocontrast diagnostics make it possible to more accurately establish the shape, size and density of the stones, to investigate the urine flow, to determine the possible obstruction of the urinary ducts. If urolithiasis is suspected, urinalysis and blood tests will help establish the nature of metabolic disorders and reveal stone-forming substances.
Urolithiasis - treatment
There are a variety of methods for treating patients with stones in the urinary system, depending on the location of stones, their composition, size, the clinical manifestations of the disease, the degree of impaired renal function, etc. In addition to removing pathological formations from the body, correction of the revealed metabolic disorders, which served as causal factors, is required.
Treatment of urolithiasis with stones of small size is often performed by a medicamentous method with compulsory dietotherapy. In medium and large formations, there is a need either for their fragmentation (lithotripsy) or for rapid removal. Apply the following non-invasive types of crushing of stones:
- Remote lithotripsy - grinding stones by means of apparatus-generator of shock waves, supplied from the outside, followed by a natural excretion with a current of urine.
- Contact lithotripsy is a procedure performed by inserting an endoscope into the bladder, ureter or renal pelvis, through which ultrasonic waves, pneumatic impulses or laser radiation are applied to destroy the stones with further evacuation by aspiration or using endoscopic loops and forceps.
Urolithiasis - treatment (drugs)
To reduce pain during seizures, non-steroidal anti-inflammatory drugs (Diclofenac, Indomethacin ) and spasmolytics ( No-shpa , Atropine, Nifedipine) are prescribed. Spasmolytics are necessary to reduce the tone of the musculature of the urinary tract and facilitate the removal of small stones. In addition, there are many herbal preparations that have antispasmodic and anti-inflammatory effects (Kanefron, Cystenal, Olimetin).
Medicines for urolithiasis, which have a stone-breaking effect by changing the acidity of urine, can be used for almost all types of stones, except struvite. For this, the following drugs may be recommended:
- with oxalate urolithiasis - Piroxidine, Thiamin plus Asparcum, Magnesium oxide;
- at phosphate stones - Aluminum hydroxide, Tsiston;
- with urate concretions - Blemaren, Soluran, Magurlit, Allopurinol.
If urolithiasis is accompanied by the formation of struvite stones, antibacterial treatment is indicated, for which medications such as:
- Cefepime;
- Ofloxacin;
- Meropenem and others.
Urolithiasis - treatment with folk remedies
On how to treat urolithiasis, folk medicine knows a lot. In this case, none of the means can not be used independently, without agreement with the doctor, tk. It may be dangerous. In general, various herbal preparations are used, the type of which is selected depending on the chemical composition, size and location of the stones. The composition of medicinal fees may include the following medicinal plants:
- corn silk;
- burdock root;
- rose hips;
- three-color violet;
- dandelion roots;
- leaves of grapes;
- currant leaves, etc.
Diet with urolithiasis
Depending on the type of urinary formations and revealed metabolic disorders, the doctor prescribes nutrition for urolithiasis. In general, with different types of ailment, a diet with urolithiasis provides for:
- increase in fluid intake (at least 2 liters per day);
- reduction in the volume of portions;
- increase in diet rich in fiber;
- restriction of salt, spices;
- restriction of the use of food and drinks with stone-forming properties (animal protein, purines, oxalic acid, etc.).
Operation with urolithiasis
If corneal urolithiasis or large concrements are diagnosed, it is possible to use percutaneous lithotripsy - crushing stones by ultrasound, which is fed through the puncture in the skin and the inserted endoscope. In some cases, one can not do without surgery - with the long absence of the effect of conservative therapy, chronic obstruction of the urinary tract, a serious inflammatory process, etc. Such kinds of surgical interventions are used:
- pyelolithotomy;
- nephrolithotomy;
- ureterolithotomy.
Prevention of urolithiasis
Both primary and secondary prevention of urolithiasis include the following recommendations:
- sufficient drinking regime;
- a varied healthy nutritional diet;
- rejection of bad habits;
- increased physical activity;
- timely treatment of infections;
- regular medical examinations.