What is the time of urolithiasis. Urolithiasis: symptoms and methods of treatment at home. Urolithiasis laser surgery

Urolithiasis is characterized by the presence of sand and stones in the kidneys and urinary tract. Treatment of urolithiasis with folk remedies in this case is considered almost the main method of therapy. Traditional healers' recipes can work wonders in dissolving kidney stones in just a few months of home use. What are the most effective folk remedies for treating urolithiasis?

What you need to know in the treatment of urolithiasis at home?

It is not always allowed to remove stones from the kidneys and other organs at home. Therapeutic measures can be carried out only under such conditions:

• If the presence of stones is confirmed by a diagnostic study.
• Independently allowed to remove stones up to 5 mm in size. Larger stones can become lodged in the narrow passage of the ureter.
• The diagnostician named the type of stones that are localized in the organ. Some may be acidic, others alkaline. Treatment of each type of stones has differences and is selected individually.

Herbal treatment

Treatment of urolithiasis with herbs is considered very effective. It works gently and quite effectively. The outcome of such therapy is always favorable: the stones slowly dissolve and, together with the sand, are removed from the urinary tract to the outside. The main thing is to be patient and follow the course of folk healing. Various diuretic herbs are used for urolithiasis of the kidneys: yarrow, chamomile, knotweed, horsetail, birch buds, etc.

oxalate stones

Oxalate stones are the acidic type of masses that form in the kidneys. Oxalic acid is a common cause of their occurrence. It is found in foods such as sorrel, spinach, beans, nuts, etc. Therefore, the use of these foods should be limited during treatment. It is recommended to eat foods rich in calcium and magnesium. Cottage cheese, fish, buckwheat, peas are products that should be on the menu every day. Treatment with herbs is simple and painless. Traditional medicine suggests using herbal infusions and decoctions to get rid of oxalate stones.

Recipe for healing infusion:

• Take 10 g of corn stigmas, knotweed and St. John's wort.
• Mix the ingredients, add 1 liter of boiling water.
• Set aside for insisting for a quarter of an hour.
• Reception lead three times a day, drinking 100 ml of infusion.

Recipe for a drug from madder dye:

• Take 10 g of the dried root of the plant.
• It is poured into a jar of 0.5 liters.
• The container is filled with boiling water to the very brim.
• The tool is infused for about half an hour.
• The medicine is drunk during the day.
• Treatment is carried out daily for three weeks.

Phosphate

They belong to the alkaline type of stones. The main sign of the presence of solid masses in the organs of the urinary tract is the presence of white. Along with therapy, it is necessary to follow a diet that will be effective when eating a large amount of acidic foods. Pumpkin, cabbage, corn, and other foods with high alkalinity are limited.

The herbs used for urolithiasis have good diuretic, cleansing properties that allow you to heal the whole body. Herbal treatment of phosphate stones helps to avoid many health problems. Plants with healing properties will eliminate unpleasant symptoms and save a person from torment. Herbal infusions are prepared from inflorescences, stems and roots of medicinal plants used to split stones.

Cooking recipe number 1:

• We take 10 g of several varieties of herbs: dandelion inflorescences, comfrey root, yarrow.
• We mix the components and pour 1 liter of boiling water.
• We stand the infusion for 60 minutes, then filter.
• We drink ½ cup in the morning and in the evening before or after meals.

Preparing recipe number 2 includes the following procedure:

• Take pre-dried rosehip roots in the amount of 50 g.
• Grind the roots with a meat grinder.
• Put the raw materials in a jar of 0.5 liters.
• Add boiled cold water.
• Put on the stove and bring to a boil.
• After 30 minutes, decant the infused liquid.
• Drink 250 ml twice a day before meals.

Struvite

Stones formed due to the alkaline properties of the food consumed. They are found mainly in women. For the duration of therapy, such products are completely excluded: all types of cabbage, pineapples, tangerines, etc. The ability to “acidify” urine is inherent in cereal dishes, meat products, citrus fruits. Struvite stones are soft and crumble easily. They can be successfully treated with the help of medicinal herbs.

Collection Recipe #1

The collection consists of herbal ingredients:

• 10 g stems or currant leaves;
• 10 g aniseed;
• 20 g of rowan berries;
• 20 g dried hops.

Cooking:

• From the collection you need to take 1 tbsp. l. mixtures.
• Pour into a 1 liter jar.
• Pour in boiling water.
• Put in the refrigerator for 3-4 days.
• Drink the medicine 1/3 cup three times a day before meals.
• The therapeutic course is long - at least 4 months.

Collection Recipe #2

The main component of the healing agent is grass - corn stigmas. You need to take 40 g of stigmas, 1 tsp each. bearberry and oat straw; mix the ingredients and pour boiling water (1 l); infuse the drug for 50 minutes; express liquid and take 200 ml in the morning and evening, regardless of food. The therapeutic course will be 30 days. Make yourself a week break and repeat the treatment.

urate stones

Such stones are formed with an acid reaction of urine. Their increase occurs when a large amount of meat, fish products, offal, protein foods is used in food. The diet involves eating foods that are rich in magnesium, calcium, and vitamin B6. Urate is highly soluble in water, therefore, you need to drink more fluids during therapy. Therapy with folk remedies will allow you to get an excellent result. Herbal infusion used for therapeutic purposes is prepared as follows: Quite rare in men and women, unlike other types of kidney stones. The cause of the appearance of such masses is a hereditary metabolic disorder (cystinuria). Treatment of this type of stones is not considered effective, however, there are exceptions. During the therapeutic course, it is necessary to drink more fluids, limit the intake of foods containing sodium.

Herbal collection for the treatment of cystine stones:

• 10 g of dried herbs are taken - bearberry, chamomile, dandelion stems.
• Mix ingredients.
• Pour into a container.
• Pour 1 liter of water brought to 60 degrees.
• Insist on a couple of quarter of an hour.
• Strain the resulting liquid.
• Drink 250 ml three times a day after meals.
• The treatment course will be 1 month.

Strong charges for getting rid of stones

Herbal collection No. 1

Successfully used strong herbal preparations for urolithiasis. The kidney collection consists of the following ingredients:

• 10 g bearberry;
• 10 g St. John's wort;
• 20 g of string;
• 20 g dried parsley roots.

Medicine preparation:

• Mix the ingredients well.
• Pour the composition with boiling water (1.5 l).
• Set aside to infuse for 50 minutes.
• Strain the resulting liquid.
• Take ½ cup 2 times a day.

Fast passage:

Urolithiasis - urolithiasis- a disease characterized by the formation of calculi (stones) in the kidneys and / or urinary tract. This is one of the most common urological diseases. It should be noted that residents of Central Asia, the Caucasus, the Volga region, the Far North, Australia, Brazil, Turkey, India, and the eastern regions of the United States suffer more often. This geographical feature of urolithiasis indicates the influence of environmental factors on the occurrence of this pathology.

The reasons:

• hereditary predisposition.
• Congenital predisposition (congenital enzymopathies).
• Violations of colloid-chemical and biochemical processes:
  • According to the theory of catarrh of the pelvis, the organic matter formed as a result of inflammation of the pelvis and desquamation of the epithelium becomes the core of stone formation (matrix).
  • According to the crystalloid theory, supersaturation of the urine with crystalloids beyond the solubility limits leads to their precipitation and stone formation.
  • According to the colloidal theory of stone formation, urine is a complex solution supersaturated with dissolved mineral salts (crystalloids) and consisting of finely dispersed protein substances (colloids). The latter, being in a chemical relationship with crystalloids, keep them in the urine of a healthy person in a dissolved form, i.e., a colloid-crystalloid equilibrium is created. In violation of the quantitative and qualitative ratios between colloids and crystalloids in the urine, pathological crystallization and stone formation can occur.
  • One of the significant factors of stone formation is the reaction of urine (pH). It determines the optimum activity of proteolytic enzymes and the sedimentation of urinary salts.)
• Violation of urodynamics (violation of the outflow of urine). Difficulty in the outflow of urine from leads to impaired excretion and resorption of the constituent elements of urine, precipitation (crystallization) of salt sediment, and also creates conditions for the development of the inflammatory process. Conditions in which the outflow of urine is often disturbed:
  • primary and secondary stenosis (narrowing) of the ureteropelvic segment,
  • urinary tract anomalies
  • (kidney prolapse)
  • (reverse flow of urine from to),
• Endogenous factors:
  • hypercalciuria (increased levels of calcium in the urine),
  • A-avitaminosis,
  • D-avitaminosis or an overdose of vitamin D,
  • hyperparathyroidism,
  • bacterial intoxication with common infections and,
  • the use of large amounts of certain chemicals (sulfonamides, tetracyclines, antacids, acetylsalicylic acid, glucocorticoids, etc.),
  • prolonged or complete immobilization, etc.

Types of urinary stones:

• Urates - stones consisting of salts of uric acid, yellow-brown, sometimes brick in color with a smooth or slightly rough surface, rather dense. Formed when urine is acidic.
• Phosphates - calculi, consisting of salts of phosphoric acid, grayish or white, fragile, easily broken, often combined with infection. Formed in alkaline urine.
• Oxalates - consist of calcium salts of oxalic acid, usually dark in color, almost black with a spiky surface, very dense. Formed in alkaline urine.
• Rarely there are cystine, xanthine, cholesterol calculi.
• Mixed stones are the most common type of stones.

Symptoms of urolithiasis

The main clinical manifestations of KSD are associated with impaired urodynamics (impaired urine outflow) and/or an inflammatory process. In the early stages, the disease may be asymptomatic. Moreover, the size of the calculus is not always comparable with the severity of complaints: the largest calculi (coral stone) may not bother a person for a long time, while a relatively small calculus in the ureter leads to renal colic with severe pain manifestations. Thus, clinical manifestations depend primarily on the localization of the stone and the presence or absence of an inflammatory process.

Here are the main symptoms of urolithiasis:

• may be acute (renal colic) or dull, aching in nature. The cause of renal colic is a sudden violation of the outflow of urine from the kidney, as a result of obstruction of the ureter by a stone. The pain is sudden, with periods of relief and repeated attacks. The pain is localized in the region of the kidney or along the ureter and has a typical irradiation down to the iliac, inguinal region. Patients behave uneasily, not finding the position of the body in which pain would decrease. Dull, aching nature of pain is characteristic of the inflammatory process against the background of ICD.
• Hematuria (blood in the urine) with urolithiasis occurs as a result of a sharp increase in intrapelvic pressure (with renal colic) with the formation of pyelovenous reflux (urine reflux into the venous bed), which is manifested by total macrohematuria after the relief of renal colic. Also, when a calculus passes through the ureter, it is possible to injure the latter.
• Dysuria (impaired urination), in the form, is usually formed when a calculus is located in the lower third of the ureter, or when a large calculus is present in the bladder. For this reason, erroneous overdiagnosis of and is possible. or interruption of urination may occur with stones in the bladder and urethra.
• : an increase in the number of leukocytes in the urine - indicates the addition of a urinary tract infection.
• : lack of urine due to a violation of the outflow of urine - possible in the presence of stones in both ureters or in the presence of a stone in the ureter of a single kidney. Postrenal anuria requires urgent therapeutic measures.

Diagnostics

• . Usually, with urolithiasis, changes in the parameters of the general blood test are not observed. However, if renal colic occurs or pyelonephritis is formed, it may be noted,.
• :
  • Minor, microhematuria (the presence of red blood cells in the urine) may be observed.
  • In the presence of calculous pyelonephritis, leukocyturia and usually join. However, with renal colic, urine values ​​\u200b\u200bmay be normal, since the calculus can completely block the passage of urine from this kidney.
  • . can be detected episodic and often depend on the nature of nutrition and. Uric acid crystals with urine pH less than 6.0 are characteristic of urate nephrolithiasis and uric acid diathesis; phosphate crystals of calcium and magnesium at a urine pH of 7.0 and above - for phosphate urolithiasis and phosphaturia; calcium oxalates - for calcium oxalate urolithiasis or oxaluric diathesis.
• and urine includes the determination of the content, calcium, magnesium, inorganic phosphorus, etc.:
  • Hyperuricemia (increased levels of uric acid in the blood) and hyperuricuria (increased levels of uric acid in the urine) indicate impaired synthesis of uric acid, which occurs with uric acid diathesis, gout, and can lead to the formation of urate stones.
  • Hyperphosphaturia (increased levels of phosphorus in the urine) may be a manifestation of phosphate diathesis, congenital or acquired due to primary diseases of the stomach or central nervous system. More often, phosphaturia is false (pH 7.0 and higher), which depends on alkali-forming bacteria (Proteus).
• The study of the level of hormones (calcitonin and parathyroid hormone) is carried out in the diagnosis of hyperparathyroidism, especially in patients with staghorn, bilateral and recurrent stones with elevated serum calcium levels. An increase in the level of calcium (hypercalcemia), a decrease in the level of phosphorus and magnesium in the blood serum are signs of impaired metabolism, which are considered as risk factors for recurrent stone formation and require the exclusion of the renal form of primary hyperparathyroidism.
• Bacteriological examination (sowing) of urine allows you to identify the microflora of urine and determine the titer (number) of bacteria. Bacteriological urine cultures with the determination of the sensitivity of microflora to antibacterial drugs allow for the etiotropic treatment of pyelonephritis, which is one of the causes of recurrence of stone formation.

Radiation methods for diagnosing urolithiasis:

• Ultrasound diagnosis allows visualization of stones located in the kidneys, bladder, upper and lower thirds of the ureter. In this case, it is possible to determine the size of the calculus, its shape, location. Violation of the outflow of urine from the kidney caused by a calculus (stone) of the ureter on ultrasound is manifested by the expansion of the pyelocaliceal system.
• X-ray methods of research. Calculi (stones), from the point of view of X-ray examination, can be X-ray negative (not visible on a standard X-ray) and X-ray positive (visualized on a standard X-ray). X-ray negative calculi are calculi consisting of uric acid salts (urates). The remaining calculi, including mixed ones, are X-ray positive. In order to visualize radio-negative stones, excretory radiography (X-ray examination using a radiopaque substance administered intravenously) is used. There are also additional X-ray studies, which we will not dwell on.

Treatment of urolithiasis:

• Symptomatic treatment:
  • antispasmodic therapy;
  • anti-inflammatory agents.
• Litholytic therapy (dissolution of stones) - is based on the shift of the pH-urine in the direction opposite to that in which the concrete form of stones is formed.
• Temporary restoration of urine outflow:
  • installation of a ureteral catheter;
  • nephrostomy.
• Remote crushing of calculi (DLT).
• Operative excision of the calculus.

Prevention of urolithiasis

• Normalization of metabolic disorders.
• Increase the amount of fluid consumed (in the absence of contraindications).
• Urine pH adjustment.
• Diet correction.
• Correction of hormonal disorders.
• Vitamin prophylaxis and mineral prophylaxis of urolithiasis.

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

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

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

The reasons contributing to the development of urolithiasis include:

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

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

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

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

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

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

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

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

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

Formation and types of stones in MKb

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

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

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

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

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

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

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

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

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

Symptoms of manifestation in patients with KSD of extrarenal localization

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

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

Laboratory Criteria

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

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

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

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

Instrumental diagnostic methods

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

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

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

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

How to treat urolithiasis?

Treatment of urolithiasis has several principles. It:

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

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

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

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

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

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

Postoperative period

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

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

Effective treatment

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

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

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

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

Prevention of re-stone formation

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

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

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

General information

Urolithiasis is a common urological disease, manifested by the formation of stones in various parts of the urinary system, most often in the kidneys and bladder. Often there is a tendency to severe recurrent course of urolithiasis. Urolithiasis can occur at any age, but most often affects people 25-50 years old. In children and older patients with urolithiasis, bladder stones are more likely to form, while middle-aged and young people mainly suffer from kidney and ureteral stones. There is an increase in the frequency of urolithiasis, which is believed to be associated with an increase in the influence of adverse environmental factors.

The reasons

At present, the causes and mechanism of the development of urolithiasis have not yet been fully studied. Modern urology has many theories explaining the individual stages of stone formation, but so far it has not been possible to combine these theories and fill in the missing gaps in a single picture of the development of urolithiasis. There are three groups of predisposing factors that increase the risk of developing urolithiasis.

• External factors. The likelihood of developing urolithiasis increases if a person leads a sedentary lifestyle, leading to a violation of phosphorus-calcium metabolism. The occurrence of urolithiasis can be provoked by nutritional features (excess protein, sour and spicy foods that increase the acidity of urine), water properties (water with a high content of calcium salts), lack of B vitamins and vitamin A, harmful working conditions, taking a number of drugs (large amounts ascorbic acid, sulfonamides).
• local internal factors. Urolithiasis often occurs in the presence of anomalies in the development of the urinary system (a single kidney, narrowing of the urinary tract, horseshoe kidney), inflammatory diseases of the urinary tract.
• General internal factors. The risk of urolithiasis increases with chronic diseases of the gastrointestinal tract, prolonged immobility due to illness or injury, dehydration due to poisoning and infectious diseases, metabolic disorders due to a deficiency of certain enzymes.

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

Pathogenesis

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

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

Classification of stones

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

Symptoms of urolithiasis

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

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

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

Renal colic

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

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

Physical examination reveals a positive symptom of Pasternatsky, pain in the lumbar region and along the ureter. Microhematuria, leukocyturia, mild proteinuria, increased ESR, leukocytosis with a shift to the left are determined in the laboratory. If there is a simultaneous blockage of two ureters, the patient with urolithiasis develops acute renal failure.

Hematuria

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

Coral nephrolithiasis

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

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

Complications

Urolithiasis is complicated by infectious diseases of the urinary system in 60-70% of patients. Often there is a history of chronic pyelonephritis, which arose even before the onset of urolithiasis. As an infectious agent in the development of complications of urolithiasis, streptococcus, staphylococcus, Escherichia coli, Proteus vulgaris act. characteristic pyuria.

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

Diagnostics

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

• ultrasound. With the help of echography, any radio-positive and radio-negative stones are detected, regardless of their size and location. Ultrasound of the kidneys allows you to assess the impact of urolithiasis on the state of the pelvicalyceal system. Ultrasound of the bladder allows to identify stones in the underlying parts of the urinary system. Ultrasound is used after remote lithotripsy for dynamic monitoring of the course of litholytic therapy for urolithiasis with X-ray negative stones.
• X-ray diagnostics. Most stones are detected by plain urography. It should be borne in mind that soft protein and uric acid stones are X-ray negative and do not give a shadow on the survey pictures. CT scan. CT is the main method for diagnosing urolithiasis. With its help, the exact localization, size and density of stones is determined.

Differential Diagnosis

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

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

Treatment of urolithiasis

General principles of therapy

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

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

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

diet therapy

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

1. a varied diet with a restriction of the total amount of food;
2. restriction in the diet of foods containing a large amount of stone-forming substances;
3. taking a sufficient amount of fluid (should provide daily diuresis in the amount of 1.5-2.5 liters.).

In urolithiasis with calcium oxalate stones, it is necessary to reduce the use of strong tea, coffee, milk, chocolate, cottage cheese, cheese, citrus fruits, legumes, nuts, strawberries, black currants, lettuce, spinach and sorrel. With KSD with urate stones, one should limit the intake of protein foods, alcohol, coffee, chocolate, spicy and fatty foods, exclude meat foods and offal (liver sausages, pates) in the evening.

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

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

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

Phytotherapy

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

Treatment of infectious complications

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

Normalization of metabolic processes

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

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

Therapy of KSD in the presence of kidney stones

If there is a tendency to independent discharge of stones, patients with urolithiasis are prescribed medications from the group of terpenes (fruit extract of ammi tooth, etc.), which have a bacteriostatic, sedative and antispasmodic effect.

The relief of renal colic is carried out with antispasmodics (drotaverine, metamizole sodium) in combination with thermal procedures (hot water bottle, bath). With inefficiency, antispasmodics are prescribed in combination with painkillers.

Surgery

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

Open surgeries

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

Shock wave lithotripsy

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

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

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

Urolithiasis (urolithiasis) is a pathological process that leads to the formation of stones in the bladder, ureter or kidneys. The disease is diagnosed in 3% of the total population. In young people, stones are most often found in the kidneys and ureter. In older people, the pathology is formed in the bladder area. There are no restrictions regarding age and gender.

Etiology

Urolithiasis develops, most often, due to metabolic disorders. But here one should take into account the fact that urolithiasis will not develop if there are no predisposing factors for this. The causes of urolithiasis are the following:

• diseases of the kidneys and urinary system;
• metabolic disorders and related diseases;
• pathological processes of bone tissue;
• dehydration of the body;
• chronic diseases of the gastrointestinal tract;
• malnutrition, excessive consumption of junk food - spicy, salty, sour, fast food;
• acute lack of vitamins and minerals.

It should also be noted that urolithiasis can develop due to the constant use of hard water. But this etiological factor is observed only with weakened immunity and the presence of background diseases.

Pathogenesis

Violation of the normal metabolism in the human body leads to the fact that insoluble salts accumulate in the genitourinary system. This leads to the formation of stones - phosphates or urates. Pain occurs when the stone begins to grow and does not pass quietly through the ureter.

General symptoms

Like most diseases, at the initial stage, symptoms of urolithiasis may be absent.

As the pathological process develops, the following signs of urolithiasis can be observed:

• unstable blood pressure;
• elevated body temperature, sometimes up to 40 degrees;
• symptoms;
• frequent urge to urinate that does not bring relief;
• pain in the lumbar region, sometimes on both sides;
• blood in the urine;
• pain when urinating.

It should be noted that in women, signs of urolithiasis are observed much more often than in men. Especially during pregnancy.

In some cases, the pain extends to the genitals. In men, the pain may radiate to the inside of the thigh, and in women, to the bladder. Due to the fact that during pregnancy, frequent urge to urinate is a normal phenomenon, many simply do not pay attention to it.

Also, the clinical picture of urolithiasis may vary depending on the position and size of the stone itself. Urolithiasis in men is diagnosed most often after 40 years.

Kinds

According to the ICD (International Classification of Diseases), these types of stones in urolithiasis are distinguished:

• oxalate - easily determined on x-ray, occurs most often;
• uralate - formed from uric acid and unprocessed salts;
• phosphate - is formed as a result of violations of phosphate-calcium metabolism;
• cystine;
• mixed.

The cystine type of stone is often due to hereditary predisposition. In women during pregnancy, this type of stone is almost never diagnosed.

General classification

According to ICD 10, the following classification of urolithiasis is adopted:

• by localization (kidneys, bladder, ureter);
• by the type of stones;
• by the nature of the development of the disease (primary or repeated development of the disease).

Urolithiasis during pregnancy

During pregnancy, urolithiasis is diagnosed much less frequently than in women who are not in position. If the disease proceeds without significant complications, then this does not affect the course of pregnancy and the health of the baby. Otherwise, a miscarriage is possible.

As a rule, this disease is not regarded as a contraindication to the conception and bearing of a child. Hospitalization of a pregnant woman is carried out only in such cases:

• symptom of renal colic;
• development of infection on the background of urolithiasis;
• preeclampsia;

As for the clinical picture, during pregnancy it becomes more pronounced:

• renal colic;
• unstable body temperature, high blood pressure;
• frequent urge to urinate;
• the presence of blood in the urine.

It is noteworthy that during pregnancy, urolithiasis may not be as painful as in women who are not in position.

In 80% of cases of urolithiasis in pregnant women, pyelonephritis develops against the background of this disease. Such a pathological process can manifest itself both in the first and in the second trimester. In this case, hospitalization is simply necessary.

With regard to treatment, during pregnancy, the emphasis is on a diet rich in minerals, with abundant consumption of purified water. The use of medications is kept to a minimum. Proper nutrition is also very important, with all the necessary vitamins for mother and child. Treatment of urolithiasis during pregnancy should be strictly under medical supervision.

Urolithiasis in children

Urolithiasis in children is diagnosed most often at the age of 8–10 years. In childhood, boys are more susceptible to the disease. The clinical picture in preschool children is as follows:

• bloating;
• nausea, refusal to eat;
• capricious state, crying of a child for no apparent reason;
• increased body temperature;
• unstable stool;
• aching pain in the back.

With such symptoms, the child should be immediately shown to the doctor, and not self-medicate.

Urolithiasis in children is treated with the help of special drugs and proper nutrition.

Diagnostics

With the above symptoms, you should contact a nephrologist or urologist. If the clinical picture is observed in children, then initially you need to visit a pediatrician.

After examination and clarification of the anamnesis, instrumental and laboratory diagnostics are carried out. As for laboratory research methods, only a general urine test is used.

Mandatory diagnosis of urolithiasis includes instrumental techniques:

• x-ray of the abdominal organs.

If, on the basis of such a diagnosis of urolithiasis, it is not possible to establish the exact presence of the disease, differential diagnosis is used. Only a doctor should prescribe a course of treatment for urolithiasis. Self-medication is unacceptable.

Treatment

Urolithiasis at the initial stage responds well to treatment and does not cause complications. Hospitalization is required if infectious diseases develop against the background of the disease.

If the stones are small, then drug treatment is carried out with the obligatory appointment of a diet. Otherwise, operable intervention is applicable. Drug therapy includes taking such drugs:

• painkillers;
• anti-inflammatory;
• to improve the waste of stones;
• to improve metabolism.

The dosage and regimen of taking drugs is prescribed only by a doctor. Unauthorized use of drugs for the treatment of urolithiasis can worsen the situation and lead to the development of an infectious disease.

Diet

In addition to taking medications, a patient with urolithiasis should adhere to a proper diet. The diet excludes or minimizes the consumption of such foods:

• food rich in oxalic acid;
• spicy, sour, too salty;
• coffee, chocolate;
• meat and dishes from them (including broths);
• foods rich in vitamin C.

Instead, the following foods should be present in the patient's diet:

• potato;
• cereals;
• dairy;
• coarse grains;
• fruit.

Particular attention is given to drinking. The daily rate of water consumption should be at least 1.5 liters. As for mineral water, it should be without gas. It is desirable that the type of water (composition, amount of consumption) be prescribed by a doctor.

Herbal teas can be used instead of water. But it should also be done as directed by a doctor.

Operable treatment

If the stones cannot be removed by the methods described above, surgical intervention is used. Typically, the following methods are used:

• shock wave therapy;
• ureteroscopy;
• percutaneous nephrolithotomy.

It should be noted that at the initial stage of the progression of urolithiasis, abundant consumption of mineral water and proper nutrition can avoid operable intervention.

Treatment of urolithiasis with folk remedies is possible only as prescribed by a doctor at an early stage of the development of the disease or as a preventive measure. It is best to use folk recipes in tandem with taking medications and proper nutrition. Also, do not forget about the consumption of the optimal amount of mineral water.

Prevention

As with treatment, prevention is based on the consumption of the optimal amount of purified water. At least 1.5-2 liters of clean water should be drunk per day. This is especially important for those who have already experienced this disease.

In addition, you must adhere to the following rules:

• proper, healthy nutrition;
• moderate physical activity;
• timely and correct treatment of all diseases.

If the symptoms of the disease still made themselves felt, you should immediately seek medical help. Self-medication is fraught with serious complications.

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