Urolithiasis ( urolithiasis ) - Causes, Symptoms and Treatment .MF .
Urolithiasis (urolithiasis) - metabolic disease caused by various reasons, often wearing a hereditary, characterized by the formation of stones in the urinary system (kidneys, ureters, bladder or urethra).Stones can be formed at any level of the urinary tract from the renal parenchyma in the ureters, bladder and urethra finishing.
The disease can be asymptomatic, present with pain of varying intensity in the lumbar region, or renal colic.
history of urinary stones names very exciting.For example, struvite (or tripielofosfat), named after a Russian diplomat and scientist Hans von Struve (1772-1851gg.).Previously, these stones are called guanitami because they are often found in bats.
stones from oxalate dihydrate calcium (oxalates) is often called ueddelitami becausesuch as rocks found in rock samples taken from the bottom of the Weddell Sea in Antarctica.
prevalence of urolithiasis
Urolithiasis is widespread, and there was a trend to an increase in the incidence in many countries around the worl
there are areas where the disease occurs most often in the CIS countries:
- Don Pools and Kama;
Among foreign regions longer occurs in these areas such as:
- Asia Minor;
- Northern Australia;
- North-East Africa;
- Southern regions of North America.
In Europe urolithiasis is common in:
- Scandinavian countries;
- South-East of France;
- southern Spain;
- Southern parts of Germany and Austria;
- Throughout Southeast Europe.
In many countries around the world, including in Russia, urolithiasis diagnosed in 32-40% of all urological diseases, and is second only to infectious and inflammatory diseases.
Urolithiasis is detected at any age, most commonly in the working (20-55 years).In childhood and old age - are very rare cases of primary detection.Men get sick 3 times more often than women, but staghorn stones often found in women (70%).In most cases, the stones are formed in one of the kidneys, but 9-17% of urolithiasis has bilateral.
kidney stones are single and multiple (5,000 stones).The size of the stones is the most different - from 1 mm to giant -.. More than 10 cm and weighing up to 1000
Currently there is no single theory of the causes of urolithiasis.Urolithiasis is a multifactorial disease complex has multiple mechanisms of development and a variety of chemical forms.
main mechanism of disease is considered to be innate - a small metabolic disorder that leads to the formation of insoluble salts, which are formed in the rocks.On chemical structure distinguish different stones -. Urates, phosphates, oxalates, etc. However, even if they have an innate predisposition to kidney stones, it will not develop unless there is a predisposing factor.
following metabolic disturbances underlie the formation of urinary stones:
- hyperuricaemia (increased levels of uric acid in the blood);
- giperurikuriya (increased levels of uric acid in urine);
- hyperoxaluria (increase the level of oxalate salts in the urine);
- hypercalciuria (increased levels of calcium in the urine);
- giperfosfaturiya (raising the level of phosphate salts in the urine);
- change the acidity of urine.
In the event of these metabolic changes, some authors prefer to environmental influences (exogenous factors), the other - the endogenous causes, but often observed their interaction.
Exogenous causes of urolithiasis:
- geological structure of the soil;
- chemical composition of water and flora;
- food and drinking regime;
- living conditions (monotonous, sedentary lifestyle and leisure);
- work conditions (harmful production, hot shop, hard physical labor, and others.).
food and drinking population modes - the total calorie intake, abuse of animal protein, salt, products containing a large amount of calcium, oxalic acid and ascorbic acid deficiency in vitamins A and B complex - play an important role in the development of the ICD.
Endogenous causes of urolithiasis:
- infetstsii as urinary tract and the urinary system is (angina, furunculosis, osteomyelitis, salpingo);
- metabolic disease (gout, hyperparathyroidism);
- deficit, hyperactivity or lack of certain enzymes;
- serious injuries or diseases associated with prolonged immobilization of the patient;
- digestive tract diseases, liver and biliary tract;
- genetic predisposition to kidney stones.
a role in the genesis of urolithiasis is played by factors such as gender and age: men are affected 3 times more often than women.
addition to the general causes of endogenous and exogenous nature during the formation of urinary stones undeniable importance and local changes of the urinary tract (abnormal development of additional vessels, narrowing, etc..), Causing a violation of their functions.
symptoms of urolithiasis
The most characteristic symptoms of kidney stones are:
- pain in the lumbar region - may be constant or intermittent, obtuse or acute.The intensity, localization and irradiation of the pain depends on the location and size of the stone, the extent and severity of obstruction, as well as individual structural features of the urinary tract.
Large stones pelvis and staghorn kidney stones are inactive and cause dull pain, often permanent, in the lumbar region.For urolithiasis characteristic relationship of pain with movement, bumpy, ride, hard exercise.
For smaller stones are most common attacks of renal colic due to their migration and a sharp violation of the outflow of urine from the renal pelvis or calyx.Pain in the lumbar region, often radiating along the ureter, into the iliac region.In moving stones in the lower third of the ureter changing irradiation of pain, they begin to spread below the groin, into the egg, the head of the penis in men and the labia in women.There are imperious urge to urinate, frequent urination, dysuria.
- renal colic - paroxysmal pain caused by a stone, occurs suddenly after the drive, shaking obilinogo fluid intake, and alcohol.Patients constantly change position, do not find a place, often groan or even scream.This characteristic behavior of a patient can often establish the diagnosis "at a distance".The pain continued for several hours and sometimes even days, verses periodically.The cause of colic is the sudden breach outflow of urine from the renal pelvis or calyx caused by occlusion (upper tract) stone.Quite often, an attack of renal colic may be accompanied by chills, fever, leukocytosis.
- nausea, vomiting, bloating, abdominal muscle strain, hematuria, pyuria, dysuria - symptoms often associated with renal colic.
- independent discharge of stone
- rarely - obstructive anuria (with single kidney and bilateral ureteral stones)
Children none of these symptoms are not typical for urolithiasis.
Stones renal calyx
cause of obstruction and renal colic may be kidney stones cups.
When small stones pain usually occurs periodically when the transient obstruction.The pain is dull in nature, different intensity and deeply felt in the lower back.It can be amplified after a heavy drinking.In addition to the obstruction causing the pain may be inflammation of the renal calyx when infection or accumulation of tiny crystals of calcium salts.
kidney stones cups are usually multiple, but smaller, so should depart spontaneously.If the stone is retained in the renal calyx despite the flow of urine, then the probability of obstruction is very high.
pain caused by kidney stones small cups, usually disappears after lithotripsy.
Stones renal pelvis stones
renal pelvis diameter greater than 10 mm.usually cause obstruction of pelvic-ureteral segment.This gives rise to severe pain in costovertebral angle below the rib XII.By the nature of the pain is different from acute blunt up painfully, its intensity is usually constant.The pain often radiates to the side of the abdomen and hypochondria.To it is often joined by nausea and vomiting.
staghorn stone, which occupies the entire renal pelvis or part of it, does not always cause obstruction of the urinary tract.Clinical manifestations are often scarce.Available only non-intensive pain.In this regard, staghorn stones are finding in the survey for recurrent urinary tract infections.In untreated, they can lead to serious complications.
Stones upper and middle part of the ureter stones
the upper or middle third of the ureter often cause severe acute pain.
If a stone moves in the ureter, causing obstruction priodicheski pain fickle, but more intense.
If the stone is at rest, the pain less intense, especially with partial obstruction.In still rocks, causing obstruction expressed include compensatory mechanisms which reduce pressure on the kidney, thereby reducing pain.
When upper ureter stone pain radiating to the side of the abdomen, while the middle third of the stone - in the iliac region, in the direction from the lower edge of the ribs to the inguinal ligament.
lower part of the ureter stones
pain at lower ureteral stone often radiates into the scrotum or vulva.The clinical picture may resemble a testicular torsion or acute epididymitis.
stone located in the intramural ureter (at entry into the urinary bladder) in clinical manifestations reminiscent of acute cystitis, acute urethritis or acute prostatitis, as if it could experience suprapubic pain, palpitations, painful and difficult urination, urgency, gross hematuriaand men - pain in the external opening of the urethra.
Bladder stones, mainly proyavlyayutsya pain in the abdomen and the suprapubic region, which can be given in the crotch, genitals.Pain occurs when moving and when urinating.
Another manifestation of bladder stones - frequent urination.Sudden unexplainable urge to appear when walking, shaking, physical exertion.During urination may experience a symptom called "laying" - suddenly interrupted urine stream, though the patient feels that the bladder is not completely emptied, and urination is resumed only after a change in body position.
In severe cases, when very large amounts of stone, patients can only urinate while lying down.
manifestations of kidney stones may resemble symptoms of other diseases of the abdominal cavity and retroperitoneal space.That's why the doctor-urologist first need to eliminate such manifestations of acute abdomen such as acute appendicitis, uterine and extra-uterine pregnancy, gallstones, peptic ulcer disease, and others., It is necessary sometimes to make together with doctors of other specialties.On this basis, the definition of IBC diagnosis can be difficult and long, and includes the following procedures:
1. Survey urologist , asking detailed medical history in order to maximize understanding of the etiopathogenesis of the disease and correction of metabolic and other disorders for the prevention of diseaseand metaphylaxis relapse.The important points of this phase are asking:
- kind of activity;
- start time and nature of the flow of urolithiasis;
- previous treatment;
- family history;
- style food;
- a history of Crohn's disease, bowel surgery, or metabolic disorders;
- drug history;
- presence of sarcoidosis;
- the presence and nature of the flow of urinary infection;
- presence of anomalies in the urogenital organs and operations on the urinary tract;
- a history of trauma and immobilization.
2. Visualization calculus :
- renal ultrasound, upper and lower urinary tract;
- perform survey and excretory urography or spiral computed tomography.
3. Clinical analysis of blood, urine, urine pH.Biochemical analysis of blood and urine.
4. Sowing urine on the microflora and its susceptibility to antibiotics.
5. If necessary, run stress tests with calcium (Differential diagnosis of hypercalciuria) and ammonium chloride (diagnosis of renal kanaltsievogo acidosis), a study of PTH.
6. stone analysis (if available).
7. Biochemical and radioisotope function studies kidney.
8. retrograde ureteropyelography, ureteropieloskopiya, pnevmopielografiya .
9. study stones for tomographic density (used for predicting the effectiveness of lithotripsy and prevent possible complications).
Treatment of urolithiasis
How to get rid of stones
view of the fact that the cause of kidney stones is not yet fully established, the removal of kidney stones surgically does not mean the patient's recovery.
Treatment of urolithiasis suffering people can be both conservative and operative.
General principles of treatment of urolithiasis include two main areas: the destruction and / or elimination of calculus and correction of metabolic disorders.Additional treatments include: improvement of microcirculation in the kidneys, adequate drinking regime, reorganization of existing urinary tract infection and residual stones, diet therapy, physical therapy and spa treatment.
After diagnosis, determining the size of calculus, its location, assess the state of the urinary tract patency and kidney function, as well as taking into account comorbidities and past treatment can proceed to the choice of the optimal method of treatment for the patient from the existing stone deliverance.
calculus methods of elimination:
- different conservative treatments, promotes discharge of stone with small calculi;
- symptomatic treatment, which is most often used in renal colic;
- surgical removal of a kidney stone or remove the stone;
- drug litholysis;
- «local» litholysis;
- removal tool descend into the ureter stones;
- percutaneous removal of kidney stones by extraction (litolapoksii) or contact lithotripsy;
- ureterolitolapoksiya, contact ureterolithotripsy;
- extracorporeal shock wave lithotripsy (ESWL);
All of the above methods of treatment of urolithiasis are not competitive in nature and are not mutually exclusive, and in many cases are complementary.However, it can be said that the development and introduction of extracorporeal shock wave lithotripsy (ESWL), creating vysokokachesvennoy endoscopic techniques and equipment were revolutionary developments in urology at the end of the twentieth century.It is thanks to this epochal event was the beginning of low-impact maloivazivnoy and urology, which is now developing with great success in all areas of medicine, and reached its epogeya associated with the creation and the widespread introduction of robotics and telecommunications systems.