Signs of urolithiasis in women: diagnosis and treatment. Urolithiasis (UCD) - stones in the kidneys and urinary tract Injections for urolithiasis, home medications

Urolithiasis in women, as well as in men, is a fairly common disease, which is manifested by the formation of stones with varying salt content in them in the area of ​​the kidneys, bladder, and ureters. This disease most often affects the male part of the population, but the female part does not go unnoticed by this pathology. In the international classification, acute urolithiasis ICD 10 is also divided depending on the location of stones (stone-like formations) into N20 and N23.

Causes of urolithiasis

The occurrence of urolithiasis is associated with the influence of many factors. In modern society, this disease is quite common, as a sedentary lifestyle predominates, leading to stagnation and disruption of microcirculation. These are also common nutritional errors. The main reasons for the development of urolithiasis are:

• Genetic predisposition. That is, the presence of similar metabolic disorders in close relatives;
• Anomalies in the development of organs of the urinary system (double kidney, single kidney, etc.);
• Violation of the drinking regime (drinking a small amount of water, or drinking water rich in mineral salts);
• Systematic errors in nutrition. This occurs with frequent consumption of fatty, salty, spicy foods, large amounts of protein, and an increased concentration of canned food in the diet;
• Disorders of metabolic processes in the body;
• Physical inactivity;
• Chronic diseases of the gastrointestinal tract.

Each of the reasons, as a rule, is combined with a number of others. It is also important for the patient to ignore any problems for a long time, because the formation of calculi (stones) occurs over a certain rather long period of time. With timely elimination of predisposing factors, the appearance of such a diagnosis as urolithiasis, patient reviews of which are very sad, can be avoided.

Symptoms

Urolithiasis in men, as well as women, is not always accompanied by severe symptoms. There are cases when the disease does not manifest itself in any way and is detected by chance, during a preventive examination. But, as a rule, there are the following clinical manifestations:

• Pain when urinating. The pain is located in the area above the pubis and goes away after the process of urine excretion is completed.
• Pain along the ureters when changing body position, lifting weights, or physical impact on the abdominal organs.
• The occurrence of pain during an objective examination by a doctor (a symptom of effleurage in the lumbar region in the area where the kidneys are located).
• Changes in the color of urine, its transparency, and possible appearance of blood.

These clinical manifestations are practically initial, that is, characteristic of those stages of the disease when there are no pronounced disorders in the tissues of the kidneys or ureters. Also, the manifestations of the disease depend on the size of the formed stone and its composition, that is, from what type of salts it is formed.

In the case when a stone begins to move with a stream of urine as a result of a spasm of the urinary tract, stagnation of urine develops, which causes severe unbearable pain - renal colic. This pain usually radiates to the groin area, thigh, and the pain can spread throughout the abdomen. In such a situation, when stones pass out due to urolithiasis, vomiting, nausea, chills, increased body temperature may also appear, and of course, a violation of the act of urination, it becomes sharply painful, or even impossible.

As mentioned above, urolithiasis of the kidneys (in women and men), or rather, the clinical picture of the disease depends on the size of the stones and the salts from which it is formed. There are salts that are often found in the composition of such formations - oxalates. They look like uneven gray stones with spiny processes, which in the process of passing through the urinary tract can significantly injure the mucous membrane. Phosphates are less common than the previous ones, and have the appearance of smooth stones that are easily destroyed. And stones formed by urate salts are the least common, and look like a smooth brick-colored piece.

The size of such a stone, up to one centimeter, has every chance of independently passing through the urinary tract and exiting the body. If the size is more than one centimeter, intervention is necessary.

Treatment methods

After carefully collecting data and conducting a clinical and laboratory examination, the doctor makes a decision on the necessary treatment method in each specific case. The following treatment methods are available:

• Conservative management, both in the case of small stones and in the case of renal colic;
• Surgical treatment by removing the stone;
• Destruction of small stones;
• Crushing large stones and further management conservatively.

As a result, the disease code urolithiasis, ICD code 10, is set according to the location of the pathological process itself.

Prevention of relapses after urolithiasis

This disease, if it occurs, even after successful treatment, is prone to resumption of the process. Therefore, in order to prevent the occurrence of urolithiasis in principle, or repeatedly, the following measures are necessary:

• Introduce adequate physical activity into your daily routine.
• Adhere to a balanced diet, exclude foods that lead to metabolic disorders and diseases of the gastrointestinal tract.
• Conduct timely treatment of diseases of the urinary system.
• Visit sanatoriums for urolithiasis (ICD code 10), which rarely recurs and gives a very positive effect.

On the topic of sanatoriums, there is a common question: is it possible to undergo sanatorium-resort treatment for urolithiasis? During periods of exacerbation of the disease, the presence of stones and other acute conditions, sanatoriums are contraindicated. But in case of successful treatment, according to the doctor’s indications, this prevention and recovery is recommended, the main thing is to establish the causes of the disease and eliminate them. Which we will talk about next.

Reasons

The paths of development of this disease are diverse and depend on many factors. The main cause of stone formation is congestion in the kidney parenchyma. But this process is driven by many other common factors.

Urolithiasis causes of the disease

External factors

Modern society is characterized by types of work that do not require physical effort, which leads to physical inactivity and long-term stagnant processes in the body. This is one of the first reasons that leads to the development of urolithiasis. But none of the causes of the disease is single; as a rule, it is a combination of several.

Also among the factors contributing to urolithiasis is poor nutrition, which can also be associated with the modern rhythm of work and social standard of living. Thus, systematically eating smoked, spicy, fatty and fried foods, as well as excessively salty foods and canned food, large amounts of meat and protein of plant origin can easily lead to disruption of metabolic processes in the body. With this diet, diseases of the gastrointestinal tract occur, which lead to metabolic disorders. Which subsequently are the causes of urolithiasis in women and men.

In addition to a violation of the diet, a risk factor for the development of this disease is a violation of the drinking regime, as well as the qualitative composition of the consumed liquid. The point is that it is not recommended to abuse waters that are rich in various mineral salts. A decrease in the amount of water consumed per day also contributes to the development of the disease. This leads to the same stagnant processes and accumulation of salts in the urinary system.

Internal factors

One of the important risk factors is congenital anomalies of the urinary system (double kidney, single kidney, double ureter or bladder, or absence of any of the ureters).

The presence of diseases associated with metabolic disorders, such as gout, hyperparathyroidism.

Infectious diseases of the urinary tract, especially often recurrent. In this case, the pathogen itself is not particularly important. Although, pathogens that cause sexually transmitted infections can also affect the urinary system, causing more harm compared to other infections.

Also, as stated above, the reason why urolithiasis occurs is the development of severe chronic diseases such as hepatitis, gastritis, pancreatitis and others.

Most often, risk factors and causes of urolithiasis are combined with each other, which leads to a faster development of the disease.

Pathogenesis of disease development

The root of the whole problem lies in the development of stagnation in the urinary system. These processes are usually combined with damage to the buffer systems in which filtration processes occur, in order to release free crystals. This occurs at the moment of formation of urine itself in the nephron tubules with its subsequent removal from the body. As a result, there is a risk that the saline solution will transform into crystals, which are called calculi or stones, as they have a characteristic appearance similar to natural minerals. Thus, urolithiasis is formed, the causes of which we have examined.

When a stone has already formed, but is small in size, it may not give any symptoms, that is, there will be no manifestations. Meanwhile, the stone increases in size and grows. At the moment when the formed stone begins to move through the urinary system down the ureter into the bladder, it is called nephrolithiasis. It is this condition that often causes vivid manifestations in the form of pain - renal colic.

Men are most susceptible to developing this disease. The causes of urolithiasis in men arise as a result of their anatomical features of the structure of the urinary system. According to statistics, women suffer from urolithiasis much less often than men, but in general, the causes of urolithiasis in women are the same as in men.

Urolithiasis: causes, treatment

It should be noted that the reasons for the development of urolithiasis are the starting point for the treatment of this disease. That is, depending on what caused the disease, the method of treatment and further management of the patient, as well as a number of preventive methods to prevent relapses, depend. In order to adequately provide assistance, a complete diagnosis is necessary, the methods of which will be discussed in the next article.

Symptoms and features of treatment of urolithiasis

Urolithiasis is considered one of the most common urological diseases. Men are more likely to suffer from it, but women can also develop it due to certain circumstances. People aged 30 to 50 years are at risk. Therefore, it is necessary to always remember the features of this disease and its main symptoms.

What is urolithiasis?

Urolithiasis is the process of formation of stones in the urinary tract, kidneys and bladder. Such deposits are formed from substances that make up urine. The disease is chronic.

For young people, the formation of stones in the bladder is common. In the older generation, the problem is more often diagnosed in the ureters and kidneys. Experts have not been able to fully understand the mechanism of development of the disease. It is known that the likelihood of the disease increasing for people living in regions with unfavorable environmental conditions.

Types of urolithiasis

The problem can be classified according to several criteria. The main one is the composition of sediments. The following varieties are distinguished:

1. Phosphates. The stones consist of salts of phosphoric acid.
2. Oxalates. Formations are formed from oxalic acid.
3. Urate. Stones are formed from uric acid salts.
4. Protein. Proteins play a key role in the formation of stones.

Most often, a mixed type of formation is diagnosed. Based on the characteristics of the stones, a therapy technique is developed.

If we consider the problem from the point of view of the characteristics of the course of the disease, the following forms are distinguished:

1. Primary. In this case, the formation of stones is not associated with internal factors of the body, for example, prostate adenoma or impaired blood supply to the kidneys.
2. Secondary. The formation of stones occurs under the influence of internal factors. This leads to disruption of the outflow of urine from the kidneys.

Successful treatment of the disease is possible only if the provoking factor is identified. It is necessary to determine whether there is a problem as early as possible.

Symptoms

The following symptoms will help to identify the disease in a timely manner:

1. Pain in the lumbar region, scrotum, hypochondrium or perineum, which is paroxysmal in nature. They are caused by a problem with the outflow of urine associated with blockage of the urinary tract. Pain may occur after drinking too much liquid or shaking violently. They are accompanied by attacks of nausea and vomiting, and frequent urge to urinate. At the same time, the person becomes irritable. Such an attack can last from several hours to days.
2. Traces of blood are found in the urine. This phenomenon is called hematuria. It is detected in 92% of cases. Blood entering the urine is caused by damage to the veins of the fecal plexuses.
3. Development of the infectious process. It may manifest itself in the form of chronic pyelonephritis. The situation can be aggravated by the active proliferation of streptococcus, E. coli or staphylococcus. In the absence of proper treatment, bacteriological shock may develop.
4. In some cases, spontaneous passage of small stones is possible.

Such signs indicate the development of urolithiasis. If they are detected, you must immediately undergo a medical examination. Only a specialist can develop an adequate treatment program.

The main reasons for the development of the disease

The development of urolithiasis can be influenced by several factors. They can be divided into three main groups: exogenous, endogenous and local.

Among the exogenous, that is, external causes, the following can be distinguished:

1. Poor nutrition. Excessive consumption of sour and spicy foods affects the acidity of urine.
2. Difficult working conditions. People who work in hazardous work often suffer from urolithiasis, as well as those whose activities involve heavy physical labor.
3. Climatic conditions. Ultraviolet radiation and elevated air temperatures have a negative impact.
4. Sedentary lifestyle.
5. Poor quality drinking water. The formation of stones is promoted by drinking water with a high concentration of calcium salts.

Endogenous causes develop within the body. Among them are:

1. Increased activity of the thyroid gland.
2. Gastrointestinal diseases that are chronic.
3. Deviations in liver function.
4. Insufficient production of enzymes.
5. Injuries of the musculoskeletal system.

A number of local factors can be identified that contribute to the development of urolithiasis:

1. Increased kidney size due to obstruction of urine passage.
2. Prostate adenoma.
3. Pyelonephritis or other inflammatory processes in the kidneys.
4. Impaired blood supply to the kidneys due to injury.

Only after determining the cause of the disease can a specialist develop the correct treatment program. Therefore, the sooner you seek help, the greater the chances of a quick cure.

Accurate diagnosis

A specialist can make an accurate diagnosis only by conducting a comprehensive examination of the patient. It includes the following activities:

1. Collection and analysis of symptoms and the course of the disease. The doctor pays attention to how long ago the pain has appeared, the presence of blood in the urine, as well as accompanying symptoms.
2. Studying the characteristics of the patient’s lifestyle. The specialist needs to find out in what environmental situation the person lives, who he works for, his diet, and so on.
3. Tactile inspection. The doctor palpates and lightly taps the kidney area. The patient's reaction to such an effect is determined.
4. General blood test. It is prescribed to determine the ESR, as well as the presence of a shift in the leukocyte formula.
5. Urinalysis. The study determines the presence of red blood cells and salts in the urine.
6. Cystoscopy is an examination of the bladder using a specialized device.
7. Ultrasound. The condition of the kidneys and bladder is examined. This allows you to determine their size, structure, and also identify the presence of deposits. In addition, it is possible to consider the enlargement of the urinary tract.
8. X-ray of the entire abdominal cavity.
9. Excretory urography. Examination of the kidneys and ureters using X-rays. For greater information, a contrast agent is injected into a person’s blood.
10. Dynamic scintigraphy. Radioactive substances are introduced into the human body. After which a series of photographs is taken. This helps to identify a violation of the outflow of urine.
11. Computed tomography. The study is carried out after the administration of a contrast agent. Such a study allows you to take pictures in different projections, which helps to study the condition of the organs in detail.

Such studies will reveal the exact cause of the problem and the extent of the damage. Only after this will it be possible to develop a treatment method.

Basic principles of therapy

Conservative treatment of urolithiasis involves the use of the following methods:

1. Taking medications designed to reduce the concentration of uric acid in the blood, as well as changing the urine environment. Additionally, a course of B vitamins is prescribed, as well as various diuretics. The use of uroantiseptics helps fight microbes in the kidneys.
2. Dietary diet. It is necessary to reduce the consumption of fatty and salty foods, and also completely avoid alcoholic beverages.
3. Drinking enough liquid. You need to drink at least 2.5 liters of clean water per day.
4. Therapeutic exercise.
5. Physiotherapy.

An important part of the treatment is cleansing the body of formed stones. To do this, use the following methods:

1. The use of drugs that normalize the physical and chemical parameters of urine. Thanks to this, small stones are removed.
2. Abdominal surgery. Removal of large stones as a result of abdominal surgery.
3. Laparoscopy. This is a procedure to remove stones through small incisions.
4. Lithotripsy. Stones are crushed using ultrasonic or x-ray waves.
5. Transurethral method. A special tube is inserted through the urethra, at the end of which a camera is installed.
6. Ureterolithotripsy. Destruction of stones using a laser.
7. Percutaneous nephrolitholapaxy. A passage with a diameter of no more than 1 cm is created in the area of ​​the renal collecting system of the kidney. Stones are removed through it.

The choice of a specific technique is carried out by a specialist, based on the patient’s health condition and the individual characteristics of his body.

Possible complications

Often, urolithiasis provokes the development of complications. Among them are:

1. Hypertrophic cystitis in chronic form. Appears in cases where a large stone has been in the bladder for a long time.
2. Chronic pyelonephritis. Kidney inflammation caused by a bacterial infection.
3. Acute pyelonephritis. Sudden onset of kidney inflammation. In severe cases, pyonephrosis can form - a purulent formation on the kidney.
4. Kidney failure. Impaired kidney function.

In order to prevent the development of such complications, it is necessary to identify the problem as early as possible and begin treatment.

Preventive measures

In order to prevent the occurrence of urolithiasis, you must adhere to the following recommendations:

1. Drink more clean drinking water.
2. Move more.
3. Control your body weight and eliminate unhealthy foods from your diet.
4. Promptly identify and treat all kidney and bladder diseases.
5. Give up bad habits.

Diagnostics

Urolithiasis is a rather complex and serious disease that poses a threat to a person’s health and full life. And sometimes it can even threaten life, in the case of damage to a single kidney, or an advanced bilateral process. In order to determine the extent of damage to the urinary system, or even to differentiate this pathology from any other, a thorough diagnosis is necessary in order to make a diagnosis and provide adequate care and treatment to the patient.

Any diagnostic measures are based on the collection of complaints, data from an objective examination by a doctor, instrumental and laboratory research methods. Likewise, urolithiasis diagnostic methods include the same.

Patient complaints

Patient complaints form the basis on which other diagnostic data indicating urolithiasis are layered one by one. The most common complaint with urolithiasis is pain. Severe pain when a stone moves along the urinary tract, which is located in the abdominal cavity along the ureters and spreads to the hip area on the affected side, to the lumbar region, to the groin. With a bilateral process, the pain spreads symmetrically. The pain syndrome causes the patient to rush from corner to corner in search of a body position in which he can feel relief. Such attacks of pain may be accompanied by nausea, vomiting, fever, and chills. Also, one of the manifestations characteristic of urolithiasis is a violation of urination: the presence of frequent false urges, a feeling of incomplete emptying of the bladder, frequent and painful acts of urination. Such symptoms already suggest the manifestation of the pathology of urolithiasis, diagnosis, treatment of which is just beginning.

Objective examination

As a rule, such symptoms force the patient to seek medical help, and here the matter is in the hands of specialists. The doctor assesses the general condition of the patient, the color of the skin, and his forced position. Performs palpation of the abdominal cavity, a symptom of tapping in the lumbar region and identifies the presumptive lesion. This is followed by laboratory and instrumental diagnostics.

Urolithiasis: what tests to take

First of all, a clinical blood test is performed for urolithiasis, which reveals signs of the inflammatory process in the form of an increase in ESR and the occurrence of leukocytosis, that is, an increase in the number of leukocytes in the peripheral blood. Then, in the pathology of urolithiasis, blood biochemistry indicates the immediate focus of the disease. If the study shows elevated levels of urea, creatinine and uric acid, such data indicate a process of obstruction of the urinary system. Also, during a biochemical study, it is possible that protein in urolithiasis will be underestimated.

The composition of electrolytes is determined in the blood serum, which is taken from a vein. There is an increase in the number of calcium and phosphorus ions, and a decrease in magnesium ions.

A mandatory study is a urine test for urolithiasis, the indicators of which will be as follows. Protein appears in the urine in increased levels, an increase in the number of leukocytes, the appearance of red blood cells, salts of increased concentration, and bacteria. It is also necessary to examine additional urine parameters for urolithiasis. For this purpose, a Nechiporenko or Amburge test is performed to determine the content of leukocytes in 1 ml of urine.

Instrumental diagnostics

Until a certain point, cystography was widely used for diagnostic purposes, but at the moment it has lost its diagnostic position.

Instrumental diagnostics includes a number of examinations. Ultrasound of the urinary system ranks first in terms of accessibility and speed of the method. But X-ray examination is more diagnostically significant in determining urolithiasis. Not in all cases, a simple x-ray can be informative, since such types of stones as urate, xanthine and cystine are not visible on the image. Although these types of stones are quite rare, they, like all other similar conditions, require diagnosis. Therefore, excretory urography is used, in which the functional state of the kidneys and their structural changes are determined from the contrast agent detected on the X-ray image, which moves along the urinary tract. And also, if a patient has a defect in filling with a contrast agent on the image, but a stone is not detected, therefore, in this case there is an X-ray negative stone.

If the above methods do not give accurate results, or differential diagnosis of urolithiasis is necessary, the next step in the table of a number of instrumental methods is radionuclide diagnostics and computed tomography.

Radionuclide diagnostics is based on the recognition of urolithiasis. Moreover, this type of study makes it possible to determine the functionality of the kidneys, namely the tubules and glomeruli of the kidney apparatus. A particularly important point in the radionuclide method in patients with urolithiasis from the point of view of frequent recurrence of the disease is the determination of the amount of parathyroid hormone produced by the parathyroid gland. This analysis is obtained from the veins of this gland.

If, in order to apply treatment to the patient in the form of lithotripsy, the structure, exact location and density of the stone should be clarified, computed tomography is used. The density of a stone depends on its chemical composition and physical structure.

And so, in order to find out what tests for urolithiasis in women, and even men, you need to contact a specialist who will make all the necessary appointments.

Treatment

Today, there are many methods that form a comprehensive treatment for urolithiasis in men and women. Each specific case is considered individually and, accordingly, adequate treatment is selected.

Basic principles of treatment of urolithiasis

As a rule, when a patient is diagnosed with urolithiasis, he complains of severe pain, based on this, first of all, analgesic and antispasmodic therapy is carried out. This treatment is carried out to alleviate the patient’s condition and relax the spasmodic muscle layer of the urinary system.

And so, the basic principles by which patients suffering from this disease are treated include:

• The process of destruction or grinding of a concrement (stone);
• Removing stones from the urinary system (surgically or naturally along the urinary tract);
• Prevent stone formation in the future by eliminating the reasons why this pathology arose;
• The use of a variety of drug treatments to sanitize the urinary system and eliminate the bacterial source of inflammation.

Treatment of urolithiasis in women and men: methods

It is also possible to divide the treatment into the following methods used today that modern medicine offers in relation to urolithiasis:

• The first method can be considered conservative. It is based on drug treatment and is used when the size of the stone is up to one centimeter, as well as taking into account the natural removal of the stone from the body;
• The method of symptomatic treatment is used for renal colic, when the primary goal is to alleviate the patient’s suffering and improve his general condition;
• The most common is the surgical method. Used in cases of multiple stones and large sizes. In this case, both the stone itself and the stone containing the kidney can be removed;
• More gentle treatment methods include medicinal litholysis, local litholysis;
• A percutaneous nephrostomy is performed;
• Removal of stones that have descended into the ureter using the instrumental method;
• Aspiration (suction) removal of stone that has previously been destroyed;
• Destruction of stones by contact ureteroscopy;
• And the most modern and minimally invasive method is extracorporeal lithotripsy. In this case, a shock wave focus is used, which is created by a device outside the body and is aimed directly at the formed stone.

Let's take a closer look at some of the modern methods of treating urolithiasis.

Surgical method

The main method of treating this problem, despite modern methods, still remains surgical. This is the leading direction in how to treat urolithiasis in humans. Indications for this type of treatment are complications that arise as a result of blockage of the urinary tract, resulting in the development of anuria - lack of urine. Also, a direct indication for urgent surgical treatment is renal bleeding and obstructive pyelonephritis.

There are also relative indications that can lead the patient to the operating table. Such indications include frequent episodes of renal colic, even in the case of preserved kidney function, and chronic calculous pyelonephritis with an ever-increasing spasm of the “cavity” of the kidney. When performing a surgical intervention, which is otherwise called pyelolithotomy, anterior and inferior, posterior and superior access is used in relation to the poles of the kidney and the location of the calculus. Posterior pyelolithotomy is most often used. But, unfortunately, there are complications of this type of treatment. There is a high risk of relapse. If the disease recurs, significant difficulties arise, and repeated surgery has a high risk of death.

Conservative treatments for urolithiasis

Conservative treatment has a number of advantages and has nothing to do with surgical incisions. But there is no completely developed methodology for its implementation, and its effects, in fact, are only aimed at eliminating pain and relieving spasms. Although, the main idea of ​​this treatment is to remove the stone naturally only with the help of medications. But this treatment option has the right to life, because urolithiasis is eliminated, assistance is provided not only to remove the stone, but also to relieve pain, which together, in a certain clinical situation, gives a positive effect. In this case, drugs are used for urolithiasis of the kidneys, antispasmodic and analgesic.

Current Treatment Options

Endoscopy occupies a leading place in modern medicine. And, of course, this method did not bypass the treatment of urolithiasis. There are methods of endoscopic treatment that have gained popularity due to their low invasiveness:

• The method of ureteroscopy, with the help of which a special device called a ureteroscope is used to penetrate the kidney through the urethra, rising up. After which the stone is crushed into smaller ones and then removed;
• Nephroscopy. Access is made through the skin, the renal pelvis is expanded, where a specialized device (nephroscope) is inserted, and, as in the first case, the stone is destroyed and removed;
• And the most gentle and popular method is the method of remote lithotripsy through shock wave exposure.

Injections for urolithiasis, home medications

Patients often ask whether it is possible to treat urolithiasis at home? Treatment at home is strictly contraindicated. There is a possibility of an acute condition occurring when the patient himself is not able to assess the severity of the situation, unlike specialized medical personnel, and seeking medical help may not be timely. But most often, patients still carry out home treatment for urolithiasis in women on their own, looking for medications via the Internet or on the advice of a neighbor. Do not pay attention to what others take for urolithiasis, and do not risk your health, but rather seek medical help, where, among painkillers and antispasmodics, corrective targeted herbal medicine, for example, the drug phytolysin, will be carried out. Read about its properties and effect on the body in this pathology in the following article.

Phytolysin

Treatment of urolithiasis is multifaceted and is aimed at eliminating pain, spasm, the stone itself, restoring a satisfactory general condition and normal functioning. Often the main line is antispasmodics (spasmalgon, spazgan, no-shpa and others), painkillers (dexalgin, ketanov, ketorol and others), antibiotics of various groups. But herbal medicine also makes a significant contribution to treatment and to prevent relapses of the disease. Let's consider one of the most popular and effective herbal remedies, phytolysin.

The drug phytolysin

One of the effective means for the prevention of urolithiasis and for full comprehensive treatment is the modern herbal herbal medicine phytolysin. It has a number of certain effects and effects: it reduces the inflammatory process, has an analgesic property and relieves spasm of the smooth muscles of the entire urinary system, and also has an antimicrobial effect. It has an effect on the removal of small stones and so-called sand from the kidneys, ureters, or even the bladder.

Phytolysin, in its composition, contains many herbs, such as: onion peels, parsley fruits, bird knotweed, wheatgrass root, horsetail, birch leaves, harvest seeds, goldenrod, parsley leaves, lovage. Each herb has its own effect.

For example, parsley herb can increase the tone of the muscular component of the walls of the bladder, has a disinfectant effect, and also affects general sedation, and, of course, cannot do without a diuretic effect. Wheatgrass and onion peel are aimed at antimicrobial action and resumption of metabolic processes.

Essential oils are an important component of many drugs from pharmaceutical companies in the fight against kidney diseases, and naturally they are also added during the production of phytolysin. They are able to influence the process of removing stones and relieve inflammation.

The medicine (phytolysin), due to its components, is more conveniently produced in the form of a paste-like mixture, which is taken orally (regardless of food intake) one teaspoon, diluted in one hundred milliliters of water three to four times a day. The course of taking phytolysin ranges from two weeks to one and a half months. Many experts note the positive effect of treatment with phytolysin.

But, like all herbal remedies, phytolysin has its own contraindications. If the patient has phosphate kidney stones, acute renal and/or liver failure, cholelithiasis, or heart failure, the drug is contraindicated for use.

After phytolysin was used for urolithiasis, patient reviews were very positive. Typically, patients describe that after weeks of use, the pain symptom that had previously disturbed their general condition decreases, the process of urination becomes easier, and the quality of life increases. Thus, herbal medicine for urolithiasis, after using phytolysin, patients even note the spontaneous release of stones.

Use of other drugs

Phytolysin is not the drug of choice in the treatment of urolithiasis, that is, the use of other medications cannot be avoided. The basis of any treatment for urolithiasis includes drugs with antibacterial properties, since bacterial inflammation is present in this pathology. It is also possible for the infectious process to spread in a descending manner, that is, the risk of developing a disease such as cystitis with urolithiasis is quite high.

The most popular of them in urological practice are furagin, furadonin and furamag. All these antibiotics belong to the nitrofuran group. Furagin and Furamag contain the same active ingredient - furazidin. Accordingly, they are similar in their pharmacological action. In view of this, we can easily replace Furagin for urolithiasis with the drug Furamag for urolithiasis and other urological infectious pathologies.

They destroy and kill bacteria located in the urinary tract without destroying their capsule, which does not lead to increased intoxication of the patient’s body, and the therapeutic and visible effect in the form of improvement in general condition occurs immediately.

Furadonin, in turn, contains the active substance nitrofurantoin, but also belongs to the group of nitrofurans. This drug affects protein synthesis in bacteria, causing a bactericidal and bacteriostatic effect. Furadonin for urolithiasis is widespread, it rarely causes a number of side effects and reactions of the body, and is highly effective.

Also, diuretics are used as one of the components of therapy, for example furosemide for urolithiasis. Furosemide is a loop diuretic that causes a rapid onset diuretic effect, but of short duration. This therapeutic effect is based on the rapid physiological removal of a small stone (up to 1 cm) through urine flow. Of course, we should not forget about vitamin therapy, especially vitamin B9, or folic acid for urolithiasis.

Based on the above, it should be summarized that all components are important in the treatment of urolithiasis, including antibacterial therapy and the use of herbal remedies, such as phytolysin, or cystone, information about which will be discussed in the next article.

Cyston

Herbal medicine is one of the components of the entire complex treatment, but is of no small importance for achieving the full therapeutic effect. For this purpose, the herbal medicine cystone is used, which, among others, is widely used.

Effects of the drug cyston in urolithiasis

Cyston is a herbal medicine that consists of many components of herbal origin. It contains many extracts of rhizomes and plant stems, which have an antimicrobial and nephrolitholytic effect in the body. The latter is carried out by influencing the formed stone, by dissolving it, as well as providing contributing factors for the removal of stones and salts that contribute to their formation. The antimicrobial effect is carried out due to the influence on pathogenic flora, by reducing the growth and reproduction of pathogenic microorganisms.

Indications for use are urolithiasis, urinary system infections, preventive measures in urological practice, and gout.

Cyston: instructions, reviews for urolithiasis

This drug is usually taken orally. Prescribe two tablets, regardless of food intake, twice a day. The course of treatment is determined by the attending physician, usually it is about four months, and can last up to six months. But if the stones pass earlier, the herbal medicine can be discontinued.

After using this drug cystone, the reviews for urolithiasis in women and men sound very positive. In their reviews of the drug, people describe that after undergoing a course of treatment for urolithiasis, they managed to avoid surgical intervention, the constantly disturbing pain went away, and the process of urination improved. Some have used cystone themselves, reviews, for urolithiasis in men, and they report a positive effect, the effect of which was aimed at preventing relapses.

As a result, we have a fairly effective drug with a good therapeutic effect. But taking into account the characteristics of each organism and specific clinical case, cystone should be included in complex therapy, however, like the banal spasmalgon, which will be discussed further. And for appointments you should contact a specialist.

Spasmalgon

Spasmalgon is a widely used drug in all medical fields, including urology. Its use for urolithiasis, especially during an attack of renal colic, is more than justified.

Spazmalgon contains an analgesic of non-narcotic origin, which helps eliminate pain, thereby improving the general condition of the patient. And another of its properties exerts its effect in such a way that, as a result, the smooth muscles of the organ to which the effect is directed relaxes, thereby exhibiting its antispasmodic effect. That is why spasmalgon is widely used for urolithiasis.

Spazmalgon is the leading drug and, as a rule, for urolithiasis is used in the form of a solution, but it is also possible to use a tablet form.

Dosage regimens are established in each case. If renal colic is present, the frequency of administration can be up to five times per day.

Of course, there are also other antispasmodics used in urology for urolithiasis, as well as painkillers. But you should not place all your hopes only on this type of medication, since all therapy must be combined. Likewise, the prevention of urolithiasis, which we will discuss in more detail in the next article, requires an integrated approach.

Prevention

Any prevention of the appearance of any diseases or their relapses is important. Because the best medicine is preventative. But it is worth noting that more than half the success of any prevention depends on self-control and compliance with all recommendations by the patient himself.

Prevention is divided into primary and secondary.

Primary prevention for urolithiasis

Primary prevention involves measures aimed at preventing the occurrence of this disease if a person has abnormalities from the norm and has a predisposition to its development. In the case of urolithiasis, the same scheme works, and, based on the reasons leading to its development, primary prevention will be developed.

First of all, measures to prevent urolithiasis include regular medical examination. This is what makes it possible to identify deviations in the state of the body, for example, a chronic disease of the urinary system in a sluggish form that is not noticeable to the patient. This examination includes clinical examinations of blood, urine, and ultrasound examination of the urinary system. And if any pathology is detected, which in the future can lead to stone formation, carry out treatment. Only in this case, perhaps, does primary prevention of urolithiasis include medications for the purpose of sanitizing foci of infection.

Diet is also an integral part of preventing diseases such as urolithiasis (prevention). It is necessary to strictly adhere to the diet; meals should be fractional. You should definitely refrain from eating fatty, fried, salty, smoked, spicy foods, and try not to eat canned food. Do not load the body with only protein foods, including plant proteins, but introduce a rational, balanced diet, rich in proteins, fats, carbohydrates, and other things.

It is necessary to adhere to the drinking regime. You need to drink as much purified water as possible, and not abuse carbonated drinks, alcohol, and even mineral waters, rich in various elements and minerals.

Introduce time for physical activity into your daily routine, especially for those people whose daily routine is associated with sedentary work.

Secondary prevention of urolithiasis

This type of prevention is aimed at preventing relapses in case of cure, or at maintaining the condition of the body after surgery in order to prevent further development of the disease and aggravation of the situation.

Secondary prevention of urolithiasis, like primary prevention, includes all the same points. Depending on the type of stones that have already formed, further preventive therapy can be adjusted. Thus, stones formed from oxalate salts require the exclusion of such foods as sorrel, vitamin C, chocolate, coffee, baked goods, spinach.

If urates predominate in the urine, it is necessary to exclude fatty foods: broths, fatty fish, sauces, vegetable proteins.

Phosphate stones require sharply limiting foods containing large amounts of calcium, meat, and spicy dishes.

But there are nuances. For example, in this case, preventive examinations are carried out much more often and in accordance with the recommendations of the attending physician. There is a specific examination program for the prevention of urolithiasis.

In this section, in the pathology of urolithiasis, prevention and treatment go hand in hand. The main direction is periodic sanitation of the urinary system with medication, as well as the use of long-term medications to maintain balance in metabolic processes. Such drugs for the prevention of urolithiasis are widespread. An example is allopurinol, which reduces uric acid levels in the urine.

Herbal medicines are considered popular and effective. They contain only herbs that can have a good therapeutic effect without harm to the general condition of the body. Thus, the prevention of urolithiasis in women does not include medication in this case, just like for men. This version of preventive measures includes drugs such as phytolysin, cystone and their other analogues.

In order to avoid relapses after successful treatment, it is advisable to prevent urolithiasis in humans in the form of sanatorium and resort treatment. This method will be effective after surgery, and during the period of stone formation. The type of resort is selected by the attending physician, since different types of stones require exposure to different climates and waters. Contraindications to this type of prevention are inflammatory diseases of the urinary system and acute conditions.

Conclusions

It should be noted that everyone has approximately the same risk of developing urolithiasis. The only exception is gender. Thus, prevention of urolithiasis in men, especially those with a complicated history, should be carried out more often. But in general, in order to avoid this disease, you should adhere to a daily routine with physical activity, a balanced diet, and a drinking regime. And also regularly undergo preventive examinations, especially in more detail, in case of suspected pathology of the urinary system. By following all the above recommendations, you can prevent undesirable consequences, or identify and stop the disease in the early stages of the development of the process. It is possible that even for preventive purposes, specialists prescribe antibacterial drugs in order to sanitize the chronic inflammatory process and prevent further progression of the pathology. We will describe below exactly which antibiotics are prescribed and which ones have their own characteristics.

Antibiotics

Antibiotics for urolithiasis in women as well as men are used in the event of the development of calculous pyelonephritis, acute or chronic, against the background of this disease.

In urology, a number of antibacterial drugs are used that act directly in the urinary tract. The main groups of antibiotics and representatives of these groups are:

• Fluoroquinolones and their action are based on blocking the genetic information of microorganisms and, as a result, have a bactericidal effect. These include ofloxacin, levofloxacin, gatifloxacin, ciprofloxacin and others.
• Nitrofurans affect bacterial proteins and cause the growth of bacteria to stop and their death. Such drugs are furamag, furagin, furadonin.
• Further, in case of resistance of microorganisms, a group of cephalosporins is used, which act on the cell wall of bacteria. The following drugs are used here: ceftriaxone, cefuroxime, cefepime, and so on.
• Also, if there is no effect from previous drugs, carbapenems (meropenem) are used.

When asked what antibiotics are used for urolithiasis in men and women, you should consult a specialist. But if antibiotic therapy is not needed, for treatment during the recovery period you can turn to traditional medicine, the methods of which will be discussed further.

Traditional medicine

Urolithiasis (UCD) is a multifactorial disease and, therefore, requires an integrated approach to treatment. In addition to traditional therapy, treatment of urolithiasis with folk remedies in specialized medical institutions is widespread in women and men. As a rule, this type of therapy occurs at home, without the supervision of specialized personnel over the patient’s condition. Due to the fact that any treatment, including folk remedies, must be prescribed by a doctor. Before starting therapy, you should undergo a thorough medical examination, without self-diagnosing, and consult a doctor.

Even in folk medicine, treatment is multidirectional and depends on the type of stones formed, so the composition of the stones is important in providing adequate therapy.

Treatment for the presence of oxalate stones

Stones consisting of oxalate salts are the most common in this pathology. Their occurrence is facilitated by excessive accumulation of salts formed from oxalic acid and its esters. Such stones are hard and have spinous processes, which puts them at risk of more trauma to the urinary tract in nephrolithiasis. In the case of treatment using traditional medicine of this kind, stones should not exceed 0.5 cm in size. In order to remove the stone from the body and alleviate the patient’s condition, the following is used:

• Drinking regime. It is necessary to consume large amounts of water throughout the day in small portions;
• The use of watermelon-bread diet. You just need to eat large quantities of watermelons and black bread. But the diet has disadvantages, as excessive consumption of watermelon can aggravate the condition;
• The next treatment option is the use of infusion from grape branches. To do this, chop the grape branches and pour only boiling water. Then the resulting decoction should be left to steep for about an hour. Should be taken orally three times a day, ¼ cup;
• We will also use the most effective recipe. It contains equal parts of bearberry, knotweed, corn silk, and hernia. Then, the resulting mixture in a volume of 1 tablespoon is poured with one glass of boiling water, as a result of which it is infused. Afterwards, take 1/3 cup orally 3 times a day. This composition is very close in composition to herbal medicines that are used for urolithiasis;

Traditional medicine in the fight against phosphate stones

Stones formed from phosphate salts have a soft consistency, easily crumble and dissolve, and their surface is smooth. Based on this, we can conclude that for treatment it is necessary to increase the level of urine acidity. For this purpose, grape juice and various infusions from branches and seeds are used. The use of lemon is also practiced in the fight against illness. Combinations of honey, parsley and lemon are possible; in this case, urolithiasis stops its progression and improves the prognosis.

It is necessary to make a decoction for urolithiasis from a collection of the following plants: for this, take corn silk and birch leaves in equal parts and proportions, along with steelweed and burdock root. Next, grind and pour boiling water over it, let it brew. The decoction is prepared in a 1:1 ratio, equal parts water and herbs. Take one tablespoon after meals.

Also, a collection of herbs, which includes rose hips for urolithiasis, increases the acidity of urine, and it is possible to take sour fruits, barberry, St. John's wort and other similar plants. A decoction is made from these components. Rosehip can also be used separately. To do this, you need to pour the root of this plant with one liter of just boiled water and heat it on the stove for about fifteen minutes. Afterwards, the broth is diluted with the same amount of cooler water and taken half a glass every eight hours.

You can also take sour juices for urolithiasis. At the same time, it is important to observe moderation.

Urolithiasis: traditional treatment of urate stones

This type of stone is formed from potassium and sodium salts, as well as uric acid. Here it should be emphasized that traditional treatment of urolithiasis in men is used to a greater extent, since it is men who are more susceptible to the formation of urate stones.

For this purpose, oat grains are used without peeling, washed, and then infused using the same method for 12 hours. The resulting infusion is crushed and taken in the form of porridge for food.

They also use knotweed grass in the amount of one part, and two parts each of currants and strawberries. A decoction is prepared from all this and taken 3 times a day, thirty milliliters each.

General principles of traditional medicine

In addition to specific treatment cases, there are treatment options that are applicable in all cases of stone formation. For example, a urological collection for urolithiasis, which includes dill seeds, eleutherococcus, mint, calendula and bearberry. This composition provides an antimicrobial effect, disinfects, reduces inflammation and increases the overall tone and resistance of the body. This collection contains herbs that are most often used for urolithiasis and are highly effective. And changes in their combinations also play a big role in producing a particular effect.

Also important are the foods consumed for urolithiasis. In addition to special cases of the development of a certain type of stones, there is a single dietary therapy for this disease. You should exclude fatty, fried, spicy, smoked, spicy foods, and do not eat canned food or fast food. Maintain a drinking regimen of at least two to three liters of ordinary clean water per day. At the same time, systematic consumption of alcohol, carbonated drinks, and mineral waters rich in microelements is strictly prohibited. Diet is the basis of any treatment and any disease, especially such as urolithiasis, which is associated with metabolic disorders. Indeed, in the case of using even the most effective medications and decoctions, if the diet is not followed, the disease will progress or recur. We will describe specifically which products are allowed and which are not in the next article.

Diet

Many people believe that diet plays no role in treatment, but in fact it is completely the opposite. Diet is fundamental in treatment, and just one adjustment can improve the general condition of the body, the prognosis of this disease and avoid relapses.

Nutrition for urolithiasis in men and women, general principles

In order to start eating right, it is enough to adhere to some basic principles. It is also very important to lead a healthy lifestyle and do general strengthening exercises.

But, taking into account the fact that during the disease in question, multiple disturbances in metabolic processes occur, as a result of which stones are formed in the kidneys and other parts, the composition of which differs significantly from each other. Either salts are found in the urine: oxalates, then urates, maybe phosphates and others. So, the type of food a patient eats may vary and will depend on the composition of the stone in the patient.

You should also take into account the general principles by which a patient with urolithiasis, or an already cured patient, should eat. For any kidney pathology, fried foods should be excluded, no matter how tasty they are. Spicy foods are also strictly prohibited; this includes not only hot spices, but also all possible spices. It is better to remove canned and pickled foods, even if they are homemade, from the diet. Such food should not be consumed even occasionally, “on holidays.”

It is prohibited to eat various types of food that have been smoked, especially if it is a smoked flavoring used in food industry factories (sausages, meat, especially fish). Among other things, if you have urolithiasis, it is strictly forbidden to drink carbonated drinks and coffee. As for alcohol, this is a separate topic that requires close attention. Alcohol, when consumed, carries a very large burden on the body, the products of its metabolism have a particularly detrimental effect on the liver and kidneys. This is what you should not eat if you have urolithiasis.

Mineral waters are very important, which in turn are selected in composition depending on the type of stones formed. On the manufacturers' labels you can read the composition, which should include: hydrocarbonas (HCO3-), chloridis (Cl-), sulfatis (SO4 2-), natrium (Na+), kalium (K+), calcium (Ca 2+), magnium ( Mg 2+), and other components.

What can be eaten with urolithiasis of the kidneys includes almost all foods, but not in all types of processing. If ICD is diagnosed, steam processing of most food products not included in the list of prohibited foods is allowed, and it is also possible to prepare boiled and stewed dishes. Strengthen your drinking regime with purified water. Food should not be too hot or cold, and also contain easily digestible ingredients. The meal plan should be fractional. That is, frequent meals in small portions, enough to start energy metabolism.

Diet for urolithiasis (women and men)

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In view of the fact that during the formation of kidney stones there may be a predominance of certain salts, which may consist of stones in the urinary system, nutrition must be selected on an individual basis. Such a diet will be prescribed separately by a specialist, and depends on the type of stones formed and their composition. Thanks to this, through diet therapy it is possible to influence the conditions that will contribute to the destruction of the stone in each specific case.

It is important to understand that self-medication in such cases is inappropriate, as this can result in even more complex and serious consequences, and further surgical intervention.

Diet for urolithiasis (in men) – urates

According to statistics, men are more susceptible to the formation of urate stones. Of course, the diet we will discuss is also suitable for women.

Urate stones are formed as a result of an excess of uric acid. The purpose of nutrition is to prevent alkalinization of urine and reduce the rate of stone growth. So, what you need to follow in order to get a noticeable therapeutic effect:

• Meat products and most fish dishes are removed from the diet. Food must undergo thorough steam treatment and be served in the form of boiled dishes; processing of products in an oven at a temperature not exceeding one hundred and eighty degrees, as well as in a stewed version, are acceptable.
• It is important to remember about those food products, the list of which includes meat from young animals, especially fatty varieties, sausages, sausages, sausages, and factory-produced semi-finished products.
• As for vegetables, exclude all types of legumes, spinach, and most importantly sorrel, cauliflower, and mushrooms. Do not take cranberry juice or cocoa.
• You should include low-fat varieties of hard cheeses in your diet, possibly homemade ones. This also includes cottage cheese with a low percentage of fat, coarse cereals due to their high content of B vitamins (riboflavin, thiamine, pyridoxine, nicotinic acid, cyanocobalamin, niacin equivalent or vitamin PP and many others). You can eat soups prepared with vegetable broth, adding herbs (parsley, dill).
• You should limit your intake of pasta, baked goods, jam, berries, honey, and dried fruits.
• Potatoes, bell peppers, tomatoes, beets are allowed for use.

By following these simple rules in conjunction with the prescribed medications, you can feel a positive result within a few weeks.

Diet therapy for oxalate stones

These are dense formations, which mostly contain calcium and ammonium oxalate. Accordingly, in case of formation of this type of kidney stones, it is first of all important to exclude products containing oxalic acid. Therefore, a diet for urolithiasis is recommended, the menu for which will not be difficult to create:

The patient's diet should include dairy and fermented milk products, whole cereal grains, as well as various types of cereals. The vegetable basis of the diet is all types of legumes, eggplant, pumpkin, cauliflower, peas, and potatoes. You can add pears, apples, watermelons, bananas, apricots, grapes and dried fruits to your diet.

Limit foods containing vitamin C (acidum ascorbinicum), tomatoes, parsley, dill and other herbs, berries (sour), strong tea for urolithiasis, chicken and beef.

It is forbidden to consume sorrel, lettuce, figs, spinach, and chocolate in your diet. In the acute stage, patients with this type of stones are excluded from dairy dishes.

All of the above products are also balanced in their content of vitamins (Thiaminum, Riboflavinum, Pyridoxinum, acidum nicotinicum) and many others necessary for normal functioning.

Diet for urolithiasis of the kidneys (in women and men) - phosphates

In this case, the concentration of alkalis in the urine increases, so diet therapy is aimed at its oxidation. This, in turn, allows you to restore the acid-base balance. To do this, you will need to change your diet and include the following products:

• Little by little you can eat flour products, including baked goods.
• As a source of many useful substances necessary for the body, and especially proteins, you should not give up meat and fish.
• It is also necessary to eat vegetables and greens. Fruits that can be included in the diet include apples and pears.
• Porridge included in the diet should have a more mucous and boiled consistency in order to avoid difficulties in digestion and breakdown.
• Soups without rich broths are practically a panacea for any type of body disease.
• But it is worth sharply limiting the use of butter in food, especially fatty oil; sunflower, as well as olive and others also belong here and can be used only in small quantities for the purpose of preparing dishes.
• Lovers of coffee, cocoa and chocolate should avoid them.

All diets were developed and proposed for therapeutic practice by nutritionist Pevzner. The diet table for urolithiasis has serial number 14, and it allows you to eat almost everything. But later, the diets described above were developed in accordance with the origin of the stones, which give a positive therapeutic effect.

Based on the proposed diet tables, we can offer an approximate menu for urolithiasis in men and women equally.

Breakfast can consist of any type of porridge, preferably green tea, which can be replaced with milk. After a while, eat an apple.

For a second breakfast, a small amount of cottage cheese or yogurt is suitable; you can wash it down with rosehip decoction.

Lunch includes a more extensive menu of any first course, such as soup. For the second meal, you can offer the patient steamed cutlets, meatballs and vegetables. Suitable drinks include compote or tea to suit the patient's taste.

Dinner, both the first and second, should be light and based on fermented milk products (kefir, cottage cheese), or light pastries with tea.

There are many options for creating a menu. The main thing is to follow the basic principles of cooking methods, especially the drinking regime. We will tell you further about how to observe it, and what water should be consumed and what not.

Water for urolithiasis

Urolithiasis requires close attention to your health. This disease requires not only drug treatment, surgery and diet. A mandatory point in treatment is the drinking regime. Let's look at what it includes further.

Drinking regime, what does it include

The concept of drinking regime includes taking liquid every day in the amount required by the body. For this purpose, the patient should take about two liters of liquid per day, but no less. This volume includes drinks allowed by the diet (tea, cocoa), juices, mineral waters. This is necessary in order to increase the daily excretion of urine, and, accordingly, small stones can be excreted in the urine, and this amount of liquid also helps to reduce the accumulation of salts in the urine. This reduces the precipitation of salts and, subsequently, the formation of stones.

Any water must be drunk at room temperature; drinking cold or hot water is excluded. You should also not take water from the central water supply.

In addition to regular boiled or filtered water, the use of bottled mineral waters is allowed. But it is necessary to approach the choice of mineral water of spring origin just as responsibly as when choosing a specialized diet, since not all water can be useful for this disease.

What water to drink if you have urolithiasis

Only after the patient has been diagnosed with ICD and has reliably determined the type of stones formed can one begin to choose one of the varieties of mineral waters. It is worth remembering and knowing that not every carbonated clear water in a plastic or glass bottle is mineral, much less healthy and medicinal.

At the same time, if we talk about beneficial properties, then the mineral water in its composition should contain a number of chemical elements, as well as compounds necessary for the body, especially in case of a particular disease. But, due to the fact that the shelves of pharmacy chains are replete with various brands of manufacturers and numbering of mineral waters, it becomes difficult to choose the right drink. Let's consider some of the properties that water from a spring source must have in order to have a beneficial effect on the course of urolithiasis. Mineral water should cause a slight diuretic effect, have antiseptic properties, reduce the symptoms of general intoxication in the body, and have an appropriate composition of minerals and trace elements that have a beneficial effect and promote the dissolution of stones.

Such waters that are not only allowed, but also indicated for use in urolithiasis include:

• "Essentuki 4" for urolithiasis containing carbon dioxide;
• mineral water “Naftusya”, which contains bicarbonate, a sufficient amount of magnesium and calcium;
• No. 20 and No. 17 “Essentuki” are also used for urolithiasis;
• Berezovskaya water, one of the components of which is iron;
• And other mineral waters are successfully used for urolithiasis of the kidneys. It should be noted that the content of minerals in them is slightly higher than in the previous ones (Narzan, Borjomi).

The above brands can be used for this pathology. It is better to check with your urologist about which mineral water for urolithiasis, names, list, is indicated in a particular case. As a result, if a patient is advised to drink alkaline mineral water for urolithiasis, then the choice of the type and brand of mineral water remains up to the patient. But only from the list suggested by the doctor or in our article.

How does mineral water affect the body during urolithiasis?

This kind of drink affects the body in such a way that it promotes the rapid dissolution of stones formed in the kidneys, due to a decrease in the sedimentation of salts. Since mineral waters differ in composition, depending on the presence of one or another component, water has a different effect on the course of the disease and on the body.

Water can help break down stones of phosphate origin, as well as oxalates, if it contains iron, tungsten and silicon. Therefore, the choice of mineral water should be approached with all responsibility, taking into account the composition of the liquid. But it is best to seek advice from a therapist or urologist.

Alkaline mineral water is useful for gout and urolithiasis due to the reduction in uric acid concentration due to regular intake of sufficient fluid.

If oxalate stones, which predominantly contain calcium, are formed and identified by a doctor, liquid containing calcium is contraindicated. Therefore, you should carefully read the composition before purchasing mineral water.

Water with low mineralization can have a bactericidal effect and reduce the inflammatory process.

Contraindications to taking mineral waters

Mineral waters, like any medicine, are a medicine and have a number of indications and, importantly, contraindications for their use. Contraindications to the use of such waters include:

• Presence of acute or chronic renal failure;
• The patient has a chronic bacterial long-term process in the kidneys;
• In case of any complications of kidney disease, including urolithiasis;
• The patient was finally diagnosed with diabetes mellitus.

How much water to drink if you have urolithiasis

In each specific case, only a doctor can accurately indicate the number and frequency of medicinal mineral water intakes, as well as the duration of its treatment. However, if the patient is not given any special recommendations, then to prevent relapses, any of the mineral waters should be taken up to half a liter per day. In the case of direct treatment of urolithiasis with the presence of stones, take one glass of water every two hours. The duration of such therapy is one month, in some cases – two. Also, do not forget that mineral water must be consumed heated, since the liquid is better absorbed when warm. In addition, it is recommended to first degas the liquid by opening the container.

It is not recommended to independently extend the duration of drinking mineral water due to the increased risk of disrupting metabolic processes in the body and leaching of useful substances.

Taking into account the above, we can summarize that alkaline water for urolithiasis is one of the methods that is part of a complex treatment and requires strict adherence to all instructions for its use and duration of treatment.

But, before you begin to maintain a drinking regime using mineralized spring waters, you should consult your doctor and clarify further tactics for its treatment. Since with a planned surgical intervention in the near future, there are a number of features in which this product can be excluded. We will talk about what surgical treatment may be indicated for urolithiasis in the next article.

Surgical treatment

In the treatment of urolithiasis, a variety of methods are used, including surgery. This treatment option is currently used more often than others as a result of late presentation of patients and lack of prevention.

Surgical treatment

This method of treatment is carried out by direct access to the location of the calculus by making a cut with sharp instruments and entering the retroperitoneal space. Such an operation is indicated in the event of a number of complications of urolithiasis, namely acute disruption of the outflow of urine due to blockage of the urinary tract by a stone, or in the presence of bleeding of renal origin. These indications are direct to surgery, or otherwise urgent. More “indirect” or relative ones include frequent attacks of renal colic that cannot be controlled with medication, chronic calculous pyelonephritis with increasing dilatation of the renal pelvis.

This type of treatment has its own adverse consequences. Urolithiasis may recur after surgery, resulting in obstacles to repeated surgery due to the high risk of mortality.

Urolithiasis laser surgery

There is a progressive modern method of treating urolithiasis - this is the method of external shock wave lithotripsy, otherwise called the “laser” method. This technology allows, without incisions or penetrations into the body, through the influence of a powerful concentrated beam of waves under the control of radiography or ultrasound, to specifically destroy large stones of the urinary system, turning them into stones of a much smaller size, and in some cases, even into sand. Consequently, the crushed calculus will be able to pass naturally with a stream of urine.

At the same time, there is a good effect in treating the disease urolithiasis, the cost of the operation, which will not be cheap, since not every medical center or clinic can afford such equipment.

Other methods of surgical treatment

At this time, the most optimal method of surgical treatment in terms of its effectiveness and cost is endoscopic surgery, which is also widely used in urology. Cystoscopy is a representative of this method. In this case, after preliminary use of antispasmodics, a special device, a cystoscope, is inserted into the urethra. Then, going up to the location of the stone, the stone is crushed with a cystoscope and removed.

And also nephroscopy is an endoscopic method, access in which small skin incisions are made and the stone is removed using a nephroscope, having previously crushed it. This kind of surgery for urolithiasis in men and women is performed in the same way.

Urolithiasis in pregnant women, the operation performed in these situations is pyelolithotomy or ureterolithotomy. But only according to strict indications. Of course, in the case of a combination of this pathology and pregnancy, it is better to carry out prevention and conservative therapy and prevent the development of an acute condition. And one of the helpers in this is physical therapy. We will talk about it in more detail in the next article.

Exercise therapy

Urolithiasis requires an integrated approach to treatment and prevention. Not only should drug or surgical treatment be used, but also diet therapy and physical therapy. ITS effects cannot be underestimated. If the stones are small in size and have a smooth surface, if this is established as a result of a thorough diagnosis, with the help of therapeutic exercises it is possible to remove the stone naturally with a stream of urine.

What is physical therapy for urolithiasis?

Like any method of treatment, physical therapy also has its own indications and contraindications.

The indication is the presence of a stone in the urinary tract up to one millimeter with a smooth surface.

Contraindications include an attack of renal colic, renal failure, pathology of the cardiovascular system, location of the stone in the renal pelvis.

The purpose of such physical education is to normalize and improve the outflow of urine, improve blood circulation in the pelvic area, reduce pain symptoms and reduce edema, provide conditions for expelling stones from the body, and stabilize the clinical situation.

There are sets of exercises aimed at strengthening the muscles of the back and abdomen. All classes are held at a slow pace and do not involve intense stress and tension on muscle tissue during and after exercise. There are also exercises for the leg muscles in the physical therapy program. Every time you start a series of exercises, you should first start with measured walking. This method of starting the complex helps to increase blood circulation and increase respiratory movements, which tones the body as a whole.

Gymnastics for urolithiasis

There are a number of exercises that must be performed slowly and gradually, while others are aimed at a sharp change in body position in order to abruptly move the internal organs, promoting the displacement of the stone. Before starting exercises, it is recommended to take an antispasmodic drug.

Start the exercise with simple walking in place at an average pace.

After this, slowly move on to the next exercise. Hands should be along the body. You need to raise your arms up and at the same time move one leg to the side as sharply as possible. Then another.

Method 4 of exercise therapy for urolithiasis includes sharp turns of the body with arms spread to the sides.

Then you need to move on to bending the whole body as close as possible to one knee, straighten up, and repeat the bend to the other knee.

As usual, any exercise ends by stretching your arms and torso upward while inhaling, and then bending down and exhaling.

And finally, while kneeling, raise your pelvis upward, while your knees should be aligned. Breathing is smooth.

As a result, the effectiveness of exercise therapy for urolithiasis is assessed through an objective examination and some studies, which are confirmed by the release of stones from the urinary tract, or by improving the general condition of the patient.

Regardless of gender, physical exercises for urolithiasis in women and men are carried out in the same way.

Physiotherapy for urolithiasis

In addition to exercise therapy, physiotherapy is carried out during the period of remission of the disease and to prevent relapses. For this purpose, a wide variety of physiotherapy procedures for urolithiasis are used: magnetic therapy, reflexology, mud therapy, massage, and massage through the shower - hydrotherapy, galvanization, ultrasound, the use of ozokerite. All these procedures improve blood circulation throughout the body, and electrical impulses under the influence of galvanization improve metabolic processes through a number of transformations. As a result, the risk of developing pathologies such as urolithiasis is reduced.

But the use of all treatment methods is completely incompatible with alcohol consumption. We will talk about its effect on the body in this situation in the next article.

Alcohol for urolithiasis

The pathology of urolithiasis develops as a result of multiple factors, the main one of which is a violation of metabolic processes in the body, which arise as a result of a violation of the diet. Alcohol intake in this case can also be attributed to a dietary disorder. Let's consider the effect of alcohol on the kidneys in principle and in case of urolithiasis and find the answer to the question of whether it is possible to drink if you have urolithiasis.

Alcohol and its effect on the kidneys

You can often find people drinking alcoholic beverages. And we are not just talking about the abuse of this product. Often banquets, holidays, and meetings are not complete without these drinks. But even drinking alcohol in small quantities can lead to negative consequences.

When alcohol enters the body, it passes through many departments and various chemical transformations occur in them. One of the most toxic substances that is formed from ethanol in the human body is acetaldehyde. This chemical compound has a destructive effect not only on the brain and liver, but also on the kidneys, since they remove all toxins from the body. This compound has a destructive effect on kidney tissue.

Also, one of the common effects after drinking alcoholic beverages is water imbalance. There is a misconception that you can drink beer if you have urolithiasis, since it is supposedly a diuretic and helps remove stones from the urinary system. This is absolutely not true. Any alcoholic drink, regardless of whether it is beer, vodka, wine, low-alcohol drinks, etc., has the same effect on the body as a whole and on the kidneys. Once in the body, alcohol retains water in it, as a result we have severe overhydration, swelling not only external, which is visible to the eye, but also internal, including swelling of the kidney parenchyma and other tissues at the cellular level. Then, when the elimination of ethanol products from the body begins, they pull with them most of the liquid, thereby causing dehydration of the body, bringing it back into a state of stress, which is manifested by severe thirst.

Is it possible to drink alcohol if you have urolithiasis?

Let's look at the interaction between alcohol and urolithiasis. With urolithiasis, the kidneys are already compromised, their function suffers due to the presence of stones in them or complications caused by the disease. And given that alcohol reduces the ability of the body and kidneys to remove uric acid from the body, this aggravates the course of the disease.

Also, it is worth noting that after fluid retention in the body after drinking alcohol, its abundant elimination begins with the help of those suffering from urolithiasis by the kidneys. As a result, an increased volume of urine can dislodge a stone located in the urinary system and cause an attack of renal colic, and, consequently, a worsening of the condition, and possibly lead to surgery.

It is also necessary to take into account the fact that alcoholic drinks disrupt metabolic processes in the body, leading to their disturbances. In view of this, there should not even be a question about what kind of alcohol is possible for urolithiasis.

Under conditions of intoxication due to alcohol, a kidney suffering from urolithiasis, which is already under increased load, may experience even greater difficulties in excreting urine and excreting toxins - the breakdown products of ethanol. As a result, the outflow of urine slows down, and alcohol breakdown products are retained in the body, which, in turn, further increases intoxication and stress on the kidneys. Further, along with toxins, fluid is retained, and swelling of all organs and tissues of renal origin develops.

So the question of whether alcohol can be used for urolithiasis in men and women is very controversial. On the one hand, alcohol is a diuretic, but, on the other hand, this effect results in a triple load for the kidneys (swelling, increased diuresis, intoxication). Therefore, you should weigh the pros and cons.

Beer for urolithiasis in women and men

The question is often asked about whether it is possible to drink beer if you have urolithiasis. In view of the above, it becomes clear that drinking beer with this pathology is absolutely forbidden.

The information that beer dissolves stones is just a myth. And the question is it possible to drink beer for urolithiasis in men? Urologists are asked quite often. This drink does not contain any substances that could in any way affect this process. Just like other drinks containing ethanol, beer has a toxic effect on kidney tissue, first causing swelling and overhydration, and then dehydration and stress for the kidney parenchyma. Plus, the “beer” that is sold on store shelves does not have a classic composition, like in home breweries, and consists of many chemicals that also have a toxic effect on the kidney parenchyma.

Therefore, what kind of alcohol can be drunk with urolithiasis is up to the patient to decide, since all drinks of this kind cause a lot of complications, sooner or later. And whether or not to drink alcohol with this disease is a personal matter for everyone.

We will describe the complications of urolithiasis below.

Complications of urolithiasis

Urolithiasis has a number of complications that can occur if the pathology is not treated or the patient seeks medical help late.

Complications of urolithiasis of the kidneys

The following complications may occur with urolithiasis:

• The development of a urinary tract infection due to blockage and disruption of the outflow of urine. As a result, pyelonephritis, urethritis or cystitis develops. They can be combined.
• Increased blood pressure, which is called nephrogenic hypertension.
• Sclerotic changes in the kidney parenchyma and its replacement with connective tissue due to prolonged compression of the kidney tissue.
• Complications in the form of purulent foci in the structure of the kidney (kidney abscess, kidney carbuncle, pyonephrosis, etc.).
• Blockage of the kidney and further accumulation of fluid in it, which compresses the kidney tissue, as a result of which it becomes thinner and hydronephrosis develops.

Urolithiasis risk factors for complications

All of the above complications develop when risk factors for urolithiasis appear. These include the presence of large stones, which can obstruct the urinary tract and cause sclerotic changes and hydronephrosis; the presence of a focus of chronic infection without appropriate treatment can also cause the development of pyelonephritis and other infectious complications; also, prolonged self-medication or failure to follow the doctor’s recommendations and prescriptions can lead to serious complications. Poor diet and alcohol abuse can also be considered factors predisposing to the development of serious complications of urolithiasis. Therefore, if this pathology is present, you should not start the process and contact a specialist.

10.1. EPIDEMIOLOGY, ETIOLOGY AND PATHOGENESIS

Epidemiology. Urolithiasis is a common disease. Nowadays, up to 5% of the population suffers from nephrolithiasis. Urolithiasis occurs in all countries of the world, but regions of its significant distribution are known, which confirms the role of exogenous factors in the occurrence of this disease. Urolithiasis is especially common in Transcaucasia, the Urals, the Volga region, Siberia, the Arctic, the Middle East, India, Central Asia, and North America.

In many countries of the world, including Russia, urolithiasis accounts for up to 40% of all urological diseases. In urological hospitals, more than a third of patients are treated for urolithiasis. Due to changes in the nature of nutrition, social living conditions and the increasing influence of unfavorable environmental factors that have a direct impact on the human body, according to the forecasts of many scientists, the frequency of urolithiasis will continue to increase.

The medical and social significance of urolithiasis is due to the fact that in 2/3 of patients it develops at working age (from 20 to 50 years) and leads to disability in every fifth patient.

Stones in most cases originate and form in the renal calices, but can be found in the renal pelvis, ureters, bladder and urethra. Most often, stones form in one of the kidneys, but in almost a third of patients, stone formation is bilateral.

Kidney stones can be single or multiple. The shape of stones can be very different, size - from 1 mm to giant ones - more than 10 cm, weight - up to 1000 g (Fig. 10.1).

Etiology and pathogenesis. Nephrolithiasis is a polyetiological disease, and the reasons for the formation and growth of stones vary in different patients.

A large amount of data has been collected on the etiology and pathogenesis of urolithiasis, but so far this problem cannot be considered a window

Rice. 10.1. General view of stones removed from the urinary tract

thoroughly resolved. Being a supersaturated saline solution, urine, due to the presence of buffer systems, remains without free crystals from the moment of its formation in the distal tubules of the nephron until excretion from the body. The formation of crystals in the urine occurs when buffer systems are damaged or when a primary nucleus appears, which is usually combined with congestion in the urinary tract.

There is no unified theory of the pathogenesis of urolithiasis.

There are various factors known to influence the formation of kidney stones. Enzymopathies (tubulopathies)—disorders of metabolic processes in the proximal and distal tubules—have a certain significance in the etiology of nephrolithiasis.

The most common tubulopathies are oxaluria, cystinuria, aminoaciduria, galactosemia, fructosemia. With tubulopathies, substances accumulate in the kidney that go towards building stones.

The formation of stones against the background of tubulopathy is facilitated by numerous factors, which are divided into exogenous and endogenous.

Exogenous pathogenetic factors include climatic and geochemical conditions, and nutritional characteristics. Thus, high temperature and humidity, the composition of drinking water and its saturation with mineral salts affect the formation of stones due to limited water consumption, but especially due to increased sweating and dehydration of the body, which increases the concentration of salts in the urine and promotes their crystallization.

The nature of diet is of great importance in the occurrence of kidney stone formation, since plant and dairy foods contribute to the alkalization of urine, and meat foods contribute to its oxidation. Among the factors contributing to stone formation, it should be noted an excess of canned food, table salt, freeze-dried and reconstituted foods, a lack of vitamins A and C, as well as an excess of vitamin D.

Endogenous pathogenetic factors of stone formation include impaired outflow of urine from the kidney, slowdown of renal hemocirculation, and the presence of a chronic inflammatory process in the kidney.

A special place among the endogenous factors contributing to the development of nephrolithiasis is occupied by hyperfunction of the parathyroid glands - primary and secondary hyperparathyroidism. In these diseases, a toxic effect occurs on the epithelium of the proximal convoluted tubules, which leads to its severe degeneration. Dystrophy of the epithelium of the renal tubules is accompanied by an increase in the blood and urine levels of neutral mucopolysaccharides, which can form into polysaccharide cylinders; each of them can become the core of a calculus.

The process of stone formation is explained by the theory of a matrix of protein composition, the basis of which may be fibrin. When fibrinogen penetrates into the abdominal cavity system of the kidney, due to the low fibrinolytic activity of urine, it is transformed into insoluble fibrin, and salts are subsequently deposited on it.

10.2. SYMPTOMATICS AND CLINICAL COURSE

Clinical manifestations of nephrolithiasis are very numerous. Usually, the formation and growth of kidney stones are asymptomatic, but as the obstruction of the urinary tract by the stone increases, the degree of disturbance of the urodynamics of the upper urinary tract, traumatization of the urothelium of the cups, pelvis and ureter by the stone, the addition of pyelonephritis and chronic renal failure, the symptoms of the disease acquire vivid manifestations.

The classic symptoms of urolithiasis are pain, very often in the nature of renal colic, post-pain total gross hematuria, pollakiuria and the passage of stones. These symptoms, with the exception of the last one, can be observed in many

urological diseases, therefore, when diagnosing nephrolithiasis, it is important to evaluate the entire symptom complex.

Pain syndrome. Pain is the most common symptom of nephrolithiasis. The severity and nature of pain are determined by the location, mobility, size and shape of the stone. If there is a fixed stone that does not interfere with the flow of urine from the kidney, there may be no pain at all (“silent stones”). Dull pain due to urolithiasis can be constant, but more often it is intermittent and appears or intensifies with movement, physical stress, shaking the body when jumping, running. Dull pain in the lower back is noted by more than 80% of patients with nephrolithiasis.

Constant aching pain without attacks of renal colic is more often observed with large stones located in the pelvis or cups, when there is no significant disturbance in the outflow of urine from the kidney. Often such patients do not seek medical help for a long time, so the disease progresses and numerous complications arise.

Often the first manifestation of nephrolithiasis is an attack of acute pain in the lumbar region in the form of renal colic, which is the most characteristic symptom that forces the patient to seek medical help at any time of the day.

The cause of renal colic is a sudden disruption of the outflow of urine from the kidney, caused by spasm of the urinary tract as a result of the passage of stones or crystals of uric salts, which cause irritation of sensitive nerve endings located in the submucosal layer of the pelvis or ureter. In this case, a sharp increase in intrapelvic pressure occurs with stretching of the pelvis and cups, and then the fibrous capsule of the kidney due to swelling of the renal tissue and enlargement of this organ.

Irritation of the interoceptors of the cups and the fibrous capsule of the kidney leads to spastic contraction of the smooth muscles of the urinary tract, which further increases intrapelvic pressure. In this case, a reflex spasm of the kidney vessels occurs, which, in turn, further increases the pain due to irritation of baroreceptors. All these irritations are transmitted to the spinal cord, and then to the cerebral cortex, where they excite the pain center.

Renal colic is characterized by severe cramping pain in the lumbar region, which appears in the form of a sudden attack. As a rule, pain radiates to the groin area, external genitalia, and inner thigh.

With renal colic due to irritation of the solar plexus, nausea, vomiting, intestinal paresis, and unilateral tension of the lumbar muscles and muscles of the anterior abdominal wall are usually observed.

During an attack of renal colic, the patient is restless, rushes about, takes different positions. An attack of renal colic may be accompanied by oliguria, sometimes even anuria, stunning chills, bradycardia and other symptoms. When a stone is localized in the intramural portion of the ureter, dysuria often occurs.

Renal colic is most often observed with nephrolithiasis. Almost 70% of patients with an attack of renal colic have various forms of urolithiasis; the remaining patients are diagnosed with other urological diseases that contribute to a sudden disruption of the outflow of urine from the kidneys (nephroptosis, renal tuberculosis, etc.).

Hematuria. With nephrolithiasis, very often (in almost 90% of patients) there is an admixture of blood in the urine, but it cannot be considered a permanent symptom of urolithiasis. The cause of hematuria may be damage to the mucous membrane of the pelvis or cup by the calculus. In addition, one of the causes of gross hematuria in nephrolithiasis is the rupture of thin-walled veins of the fornical plexuses, caused by the rapid restoration of urine outflow after a sudden increase in intrapelvic pressure.

Gross hematuria often occurs immediately after the cessation of an attack of renal colic, therefore it is characterized as total and post-painful, in contrast to pre-painful, observed with tumor damage to the kidney. Microscopic hematuria with up to 20-25 unchanged red blood cells in the field of view most often appears in patients with nephrolithiasis after exercise or after tapping the lumbar region (Pasternatsky's symptom).

In patients with low-lying ureteral stones, especially in the juxtavesical and intramural regions, due to reflex effects, pollakiuria, nocturia, dysuria may appear, and during renal colic, even acute urinary retention. Severe dysuria sometimes leads to misdiagnosis. Often, patients with stones in the lower ureter are treated for a long time with diagnoses of cystitis, prostatitis, BPH and other diseases.

Dysuria with bladder stones is caused by irritation of the mucous membrane or secondary cystitis. Leukocyturia (pyuria) is an almost constant symptom of kidney stones, although it is more correct to consider it as a symptom of a complication of this disease, namely calculous pyelonephritis. Hematuria

and leukocyturia may be absent if urine taken at the time of renal colic is examined, i.e., when the ureter is obstructed by a calculus, when urine enters the bladder from a healthy kidney.

Passage of stone. The pathognomonic and most reliable sign of nephrolithiasis is the passage of stones or sand in the urine. Most often, stones pass on their own soon after an attack of renal colic, but occasionally (in no more than 20% of patients) painless passage may occur. Usually small stones are passed with urine - up to 1 cm in diameter. The passage of a stone depends not only on its size and shape, but also on the state of urodynamics of the urinary tract.

When a stone moves along the ureter, it can linger in the juxtavesical or intramural region, then, due to reflex effects, patients may experience dysuria or even acute urinary retention.

10.3. COMPLICATIONS OF URILOSTICAL DISEASE

Complications of nephrolithiasis include acute and chronic calculous pyelonephritis, hydronephrosis, nephrogenic arterial hypertension, acute and chronic renal failure.

Most often, nephrolithiasis is complicated by pyelonephritis. The pathogenetic factors of this complication are impaired urine outflow, increased intrapelvic pressure, impaired intrarenal hemodynamics, and renal pelvic reflux. Pyelonephritis in patients with nephrolithiasis can occur in acute or chronic form.

Acute calculous pyelonephritis most often develops when the pelvis or ureter is obstructed by a stone, while the serous phase of inflammation quickly turns into a purulent phase if the outflow of urine from the kidney is not restored. Manifestations of acute calculous pyelonephritis are usually characterized by the severity of clinical symptoms. The patient's condition quickly deteriorates, body temperature rises, chills appear, and pain in the lumbar region becomes permanent. An enlarged and painful kidney is palpated.

In some patients, meningeal signs are observed against the background of high body temperature. Leukocyturia with complete blockade of the ureter may be absent for some time. As a rule, there is high leukocytosis with a shift of the leukocyte formula to the left. During the transition of acute serous pyelonephritis to the purulent phase

inflammation with the appearance of apostema, abscess or carbuncle of the kidney, the patient’s condition sharply worsens, shaking chills are accompanied by a decrease in blood pressure and a decrease in diuresis. There is a threat of spread of the purulent process to the perinephric tissue with the development of paranephritis and diffuse purulent peritonitis. Therefore, the first signs of acute inflammation in the kidney against the background of nephrolithiasis are an indication for urgent hospitalization in a urological hospital for active treatment.

It should be remembered that in weakened and elderly patients, the clinical symptoms of acute calculous pyelonephritis may be less pronounced, appear unclear, but have serious consequences.

Chronic calculous pyelonephritis almost always accompanies nephrolithiasis. Its clinical manifestations depend 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. With calculous pyonephrosis, intoxication, pain in the lumbar region, and increased body temperature are expressed.

With a long course of chronic calculous pyelonephritis, kidney shrinkage gradually develops, which is accompanied by a decrease in its function and arterial hypertension.

Acute renal failure is the most serious complication of nephrolithiasis. It usually occurs with bilateral kidney stones or a stone in a single kidney and develops when both ureters or the ureter of a single kidney are obstructed. Its first sign is severe oliguria or anuria, then thirst, dry mouth, nausea, vomiting and other symptoms of renal failure appear. This complication requires immediate assistance, which consists of draining the kidney.

Chronic renal failure in urolithiasis develops gradually due to impaired urine outflow from the kidney, the addition of pyelonephritis and kidney shrinkage and is much more common with bilateral nephrolithiasis or a stone in a single kidney.

10.4. DIAGNOSIS OF URINOSIS

When recognizing urolithiasis, it is important to establish not only the presence, location, size, shape of the

crements, but also the activity of chronic pyelonephritis, the morphological and functional state of the kidneys, the stage of chronic renal failure. At the same time, along with the study of kidney function, it is necessary to determine the state of the systems and organs that ensure organ homeostasis. This is advisable for the correct choice of treatment and prevention of relapses, due to the fact that deviations in the electrolyte, immune and hemocoagulation balance contribute to the re-formation of stones in the urinary tract.

Diagnosis of nephrolithiasis should be comprehensive and include identification of complaints and medical history, physical, laboratory, ultrasound, instrumental, radiological and radionuclide research methods, CT.

Complaints and anamnesis. Pain from urolithiasis can be constant or intermittent, dull or sharp. The localization and irradiation of pain depend on the location of the stone. Large pelvic stones and coral kidney stones are inactive and cause dull pain in the lumbar region. Absence of pain from kidney stones is rare. Nephrolithiasis is characterized by the association of pain with movement, shaking, etc. Pain in the lumbar region often radiates along the ureter to the iliac region.

As the stone moves down the ureter, the irradiation of pain successively changes; it begins to spread lower to the groin, thigh, testicle and head of the penis in men and the labia in women.

Physical examination. General clinical examination methods can reveal pain on palpation of the kidney, a positive symptom of tapping on the lower back, Pasternatsky's symptom (the appearance of microhematuria after light tapping on the XII rib). During an attack of renal colic, the doctor can determine muscle tension in the lumbar region, anterior abdominal wall and a sharply positive symptom of tapping on the lower back.

Laboratory methods include blood and urine tests. Blood tests begin with a general clinical analysis, which, outside of exacerbation of pyelonephritis and renal colic, reveals almost no changes. During the active phase of calculous pyelonephritis, leukocytosis increases with a shift in the leukocyte formula to the left, and the ESR increases. In chronic renal failure, anemia is usually detected in patients with nephrolithiasis. A biochemical blood test allows you to determine levels

creatinine, urea, uric acid in the blood serum, which tend to increase, especially at the time of urinary tract obstruction. The electrolyte composition of blood serum (potassium, sodium, calcium, phosphorus, magnesium), as well as the acid-base state, are determined. With nephrolithiasis, there is an increase in the content of calcium and phosphorus ions with a simultaneous decrease in magnesium levels.

When analyzing urine, a moderate amount of protein (0.03-0.3 g/l), leukocytes, red blood cells, salts and bacteria are detected. The severity of leukocyturia depends on the phase of activity of chronic pyelonephritis. When the number of leukocytes in a general urine test is minimal, when counting them in the field of view, the Kakovsky-Addis (the content of leukocytes in daily urine), Amburge (the number of leukocytes released in 1 minute) or Almeida-Nechiporenko (the number of leukocytes in 1 ml of urine) tests are used.

To determine the phase of activity of chronic calculous pyelonephritis in the urine, the ratio of active to inactive leukocytes and Sternheimer-Malbin cells are determined. A decrease in the osmotic concentration of urine (less than 400 mOsm/l) and a decrease in the clearance of endogenous creatinine (below 80 ml/min) are also of diagnostic and prognostic significance in chronic calculous pyelonephritis. The study of urine should include determining its reaction in numerical terms pH due to the fact that with an alkaline reaction of urine (pH>8.0), the formation of phosphate stones is more active, and with an increase in its acidity (pH<6,0) - оксалат-ных и уратных камней. Определяют также микробное число мочи и выполняют посев мочи на микрофлору с определением ее чувствительности к антибиотикам и антисептикам.

Instrumental research. Until recently, cystoscopy was widely used in the diagnosis of nephrolithiasis, which still has a certain diagnostic value today. With chromocystoscopy, you can see a stone if it is “born” from the mouth of the ureter into the bladder, and also determine the time of release of indigo carmine-stained urine from the mouth of the ureter and the intensity of its color. The latter helps to assess renal function and the possible presence of ureteral occlusion, which is especially important when carrying out the differential diagnosis of renal colic.

Ultrasound examination. In recent years, renal ultrasound has been widely used to recognize nephrolithiasis. Ultrasound scanning can identify acoustic features

both single and multiple kidney stones. The method is harmless, and its particular value lies in the ability to recognize not only X-ray positive, but also X-ray negative kidney stones. Due to the impossibility or extreme undesirability of X-ray examinations in pregnant women and children, ultrasound scanning is the preferred method for diagnosing nephrolithiasis.

X-ray examination. X-ray examination plays a leading role in recognizing urolithiasis.

The simplest and most accessible method of examining a patient with suspected nephrolithiasis is survey urography(Fig. 10.2). With its help, you can see stones that block x-rays and are therefore called x-ray positive. However, not all kidney stones produce a shadow on a survey image. X-ray negative include stones consisting of uric acid (urate), cystine and xanthine stones. These stones occur in 8-12% of patients with nephrolithiasis. Ultrasound is used to identify X-ray negative kidney stones. excretory urography, tomography, retrograde pneumopyelography.

With X-ray positive (oxalate and phosphate) stones, their shadow is clearly visible on the survey image, since they contain elements with high atomic mass. The sizes of stones determined on a survey radiograph range from small and multiple to gigantic, occupying the entire pelvicalyceal system and resembling coral in shape. In doubtful cases, targeted or layer-by-layer images of the urinary tract (tomography) are performed.

The next stage of X-ray examination of a patient with nephrolithiasis is excretory urography

Rice. 10.2. Overview of the urinary system. Bilateral kidney stones

Rice. 10.3. Excretory urogram. Right ureteral stone

(Fig. 10.3). This research method makes it possible to identify both the morphological and functional state of the kidney and determine whether the shadow visible on a plain radiograph refers to the projection of the kidneys and urinary tract. If the patient has an X-ray-negative stone in the projection of the pelvis or cup, a filling defect is determined.

Significantly less often in case of nephrolithiasis they perform retrograde pyelography with an X-ray contrast liquid or gaseous substance. Retrograde pneumopyelography with the introduction of oxygen or carbon dioxide is used for X-ray negative kidney stones, if the data of excretory urography are questionable (Fig. 10.4). Very rarely, antegrade pyelography or renal angiography is currently performed to diagnose nephrolithiasis.

Radionuclide diagnostics. Dynamic nephroscintigraphy has become widespread in the recognition of urolithiasis, which makes it possible to separately determine the degree of preservation of the function of each kidney and evaluate its secretory and evacuation abilities. Radioisotope renography characterizes the functional state of both the tubular and glomerular apparatus of the kidney, which is important in the choice of treatment method.

A very important radionuclide test in patients with nephrolithiasis from the point of view of the origin and rapid recurrence of stone formation is the determination of parathyroid hormone in blood obtained from the parathyroid veins.

Computed tomography. When choosing a treatment method for patients with nephrolithiasis, especially for determining the indications and prognosis of extracorporeal shock wave lithotripsy (ESWL),

Rice. 10.4. Retrograde ureteropyelogram. Stone in the upper third of the right ureter

given to estimate the density of the stone. The density of the stone depends on both the physical structure and the chemical composition of the stone.

Currently, stone density is determined using X-ray CT. The essence of the method lies in the perception by special detectors of the energy of X-ray radiation that repeatedly passes across the area under study and different points of the same plane. Then the received information is processed using a computer and reproduced in the form of an image of a cross-section of a given area of ​​the body. The density of the stone is determined using the conventional Hounsfield scale. The relative density of normal renal parenchyma ranges from 30 to 70 units. H, which is due to different degrees of hydration of this organ, and the density of the stone is from 100 units. N and above. Most often, stones with a density of 500 to 1000 units are detected. N. Based on the results of determining computed tomographic density, it is customary to divide stones into four groups: the first is stone density up to 500 units. N; the second - from 501 to 1000 units. N; third - from 1001 to 1500 units. N; fourth - more than 1500 units. N.

10.5. DIFFERENTIAL DIAGNOSTICS

A very important task in case of urolithiasis, especially at the time of renal colic, is to carry out a reliable differential diagnosis with acute surgical diseases of the abdominal organs, especially acute appendicitis, perforated gastric and duodenal ulcers, intestinal obstruction, acute cholecystitis, acute pancreatitis, ectopic pregnancy. With these diseases, only emergency surgery can save the patient’s life, while with renal colic, conservative treatment is possible.

In some cases, with renal colic, reflex tension of the muscles of the anterior abdominal wall, gas and stool retention are observed, which can create a picture of an acute abdomen.

However, with renal colic there are no symptoms of peritonitis characteristic of surgical diseases of the abdominal organs; intestinal paresis and characteristic one-sided reflex tension of the lumbar muscles and the corresponding half of the abdominal wall, a pronounced symptom of tapping on the lower back, are noted.

Patients with renal colic are excited, tossing about in pain, unable to find a comfortable position, while patients with acute appendicitis and other acute processes in the abdominal cavity strive to remain motionless and protect the abdominal wall, which in acute abdomen does not participate in the act of breathing. The pulse in these patients is rapid and weak in filling, whereas in renal colic the pulse filling is good, there is no increase in heart rate, and there is even a tendency to bradycardia.

With a perforated ulcer of the stomach or duodenum, there is an acute, “dagger-like” pain at the time of perforation. When the contents of the stomach and intestines enter the abdominal cavity, a picture of severe peritonitis develops. The entire anterior abdominal wall is sharply tense.

Percussion of the abdomen reveals tympanitis against the background of hepatic dullness, which is explained by the entry of gas into the abdominal cavity. The area of ​​hepatic dullness narrows and even disappears completely. When performing a survey X-ray of the abdominal organs in a standing position, in such cases gas is detected in the upper parts of the abdominal cavity and under the anterior abdominal wall if the patient is lying down.

Hepatic colic is characterized by pain radiating to the right shoulder girdle and scapula. Vomiting of bile is observed. Body temperature with purulent cholecystitis always rises to 39-40°C, the liver and gall bladder are enlarged and painful on palpation. Usually there is high leukocytosis with a significant shift of the leukocyte formula to the left, and the content of bilirubin in the blood is increased.

Intestinal obstruction differs from renal colic in that with it, painful, incessant acute pain affects the entire abdominal area. The patients' condition is characterized by severe intoxication. With paralytic and mechanical obstruction, the abdomen is greatly distended. Mechanical obstruction is accompanied by vomiting of intestinal contents, pronounced leukocytosis with a shift to the left.

10.6. TREATMENT OF PATIENTS WITH NEPHROLITHIASIS

There are no and cannot be standards in the treatment of patients with urolithiasis, since each patient is unique. Each patient has his own, unique composition of the stone, its size, shape, location, structural features of the cavity system of the kidney and ureter, functional activity of nephrons, urinary microflora. Modern treatment is based only on general principles, which consist of dissolving, destroying, excreting, removing stones from the urinary tract, restoring optimal patency of the urinary tract, eliminating the identified causes of stone formation, and sanitizing the urinary system using various therapeutic agents.

About 60% of all kidney surgeries are performed for urolithiasis. This treatment is not etiotropic and is fraught with complications of varying severity, and in almost a third of operated patients it leads to recurrent stone formation. It is much more difficult to treat patients with recurrent kidney stones than patients with primary kidney stones. The percentage of severe complications increases in proportion to the frequency of surgical interventions in patients with nephrolithiasis, and the number of secondary nephrectomies in these cases increases to 36%. Postoperative mortality is high when performing repeated surgical interventions on the kidneys for nephrolithiasis.

In recent years, the frequency of detection of both large and staghorn kidney stones has also increased, which together account for up to 45%

among all patients with nephrolithiasis. Therefore, nephrolithiasis has been and remains a pressing medical problem, and methods of its treatment are subject to wide discussion.

In modern conditions, it is possible to use different methods of treating patients with nephrolithiasis, depending on the location, shape and size of the stone, its chemical composition, the functional state of the kidneys, the degree of urodynamic disturbance and other complications. There are ten main methods of treating patients with nephrolithiasis:

1) the use of conservative treatment methods to promote the passage of 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) percutaneous nephrostomy;

7) instrumental removal of stones descended into the ureter;

8) percutaneous removal of kidney stones by extraction or litholapaxy;

9) contact ureteroscopic destruction of stones; 10) remote shock wave lithotripsy.

Treatment of patients with nephrolithiasis can be conservative and surgical, but must be comprehensive.

Conservative treatment is a desirable prospect in urology, and the use of medications that can dissolve and remove grown crystals from the urinary system should be recognized as an ideal therapeutic method. Currently, conservative treatment for nephrolithiasis pursues more modest goals, consisting of relieving a painful attack in renal colic, sanitizing the urinary tract by dilating the ureters and forcing diuresis to expel the stone, as well as preventing attacks of pyelonephritis using modern uroantiseptics.

The idea of ​​dissolving uric acid stones has been implemented in the treatment of patients with urate lithiasis. As is known, uric acid salts (urates) form and grow only in an acidic environment (pH<5,0); если мочу ощелочить, то ураты не смогут расти, и даже будут распадаться. Применение данного метода лечения требует длительно (2-3 мес) удерживать рН мочи не выше 7,0, ибо в противном случае на уратное ядро будут оседать фосфатные соли и рост конкремента продолжится.

Citric acid salts (sodium and potassium citrate) are used to alkalize urine. Based on these components, the drugs Uralit-U, Blemaren, Magurlit, etc. have been created and used. These drugs should be taken to dissolve urate stones, strictly following the instructions, and, most importantly, measure the pH of the urine every time you urinate, and increase or decrease the dosage according to the results drug.

Symptomatic drug treatment is carried out for patients with nephrolithiasis both during renal colic and outside of an attack, as well as to combat infection. Drugs prescribed to relieve renal colic are combined with thermal procedures: a heating pad, a hot bath. One of the best drugs for relieving renal colic currently is baralgin, which is both an antispasmodic and an analgesic. This drug contains three components: novalgin (a pyrazolone derivative), benzophen, which relaxes smooth muscles, and diphenyl piperidinoethyl acetamide bromomethylate, which blocks parasympathetic ganglia.

During an attack of renal colic, 5 ml of baralgin is administered slowly intravenously or intramuscularly, and outside of an attack - orally, 1-2 tablets 3-4 times a day. You can also prescribe a 0.1% solution of atropine (1 ml) subcutaneously, a 0.2% solution of platiphylline (1 ml) subcutaneously, papaverine 0.02 g 3-4 times a day orally, no-shpu (2 ml of a 2% solution ), analgin (2 ml of 50% solution) intramuscularly and other antispasmodics. Complex drugs for the treatment of nephrolithiasis such as spasmo-cystenal, olimethine, enatin, cystenal, cystium, etc. have an antispasmodic effect. In case of intractable renal colic, the patient must be hospitalized in a specialized urological department, where catheterization of the ureter will be performed to create an outflow of urine from the kidney .

Antibiotics and antiseptics play an important role in the treatment of patients with nephrolithiasis complicated by pyelonephritis. Drugs are prescribed based on the general principles of antibiotic therapy.

To accelerate the passage of small kidney stones (up to 4-5 mm), drugs with an antispasmodic effect on the ureter and a diuretic effect are used: dry madder extract 0.5 g 3 times a day, cystenal or panabin 5 drops in sugar 3 times a day , olimethine or enatine 1-2 capsules 3-5 times a day, nieron 30 drops 3 times a day, etc. Water loads are also prescribed

(1.5-2.0 liters of warm tea, drunk over 20-30 minutes) in combination with antispasmodics and diuretics - 20-40 mg of furosemide (Lasix).

Litolysis (or dissolution of kidney stones) can be descending or ascending. With descending litholysis, the patient takes drugs orally or parenterally to help dissolve stones. With ascending litholysis, these drugs are applied directly to the stone located in the kidney, both by catheterization of the renal pelvis with special catheters, and through a drainage tube inserted into the kidney during surgery.

Instrumental methods of treatment. For the treatment of patients with nephrolithiasis, endoscopic methods are widely used, which make it possible to destroy or remove stones in the urinary tract under visual control without damaging the skin or with minimal trauma.

Depending on the route of insertion of the instrument into the urinary tract, there are two types of endoscopic treatment for patients with urolithiasis:

a) nephroscopic, when after percutaneous puncture of the kidney and dilatation of the resulting fistulous tract, a nephroscope is inserted into the renal pelvis and the stone is crushed or removed under visual control;

b) ureteroscopic, when the ureteroscope, after preliminary dilatation of the mouth, is inserted into the ureter from the side of the bladder and then passed retrograde into the renal pelvis, removing or destroying stones (Fig. 10.5).

Rice. 10.5. Scheme for performing ureteropyeloscopy

Percutaneous removal of kidney stones has been widely used in many clinics around the world in recent years. It is used in patients in whom it is impossible to perform extracorporeal lithotripsy or otherwise remove a stone from the kidney. The operation is performed by creating a puncture nephrostomy fistula and removing kidney stones through it (lithoextraction) after its intrapelvic fragmentation (lithotripsy). To extract stones from the kidney, extractors are used: Dormia, Zeiss, Davis, etc. (Fig. 10.6). Currently, there are special nephrostomy kits for performing percutaneous puncture nephrostomy, and modern ultrasound scanners are equipped with a sensor connected to a puncture needle, which allows the instrument to be targeted to the stone under constant ultrasound control.

It is believed that percutaneous nephroscopy in combination with lithoextraction, i.e. removal of a kidney stone without its preliminary destruction under visual control, is applicable for stone sizes of no more than 1.5 cm. To remove large and coral stones, only a combination of this method with preliminary contact destruction of the stone - lithotripsy. First to break the stone

during percutaneous nephrolithotomy, only its mechanical disintegration was used. Currently, three methods of lithotripsy are used for contact intracorporeal stone destruction: with an ultrasonic, electrohydraulic or light energy source in the form of a color pulsating laser. Pneumatic lithotripsy is also performed.

External shock wave lithotripsy (ESWL). The use of ESWL in clinical practice since 1980 has radically changed the understanding of the treatment of patients with nephrolithiasis. The basis of remote destruction

Rice. 10.6. Instruments for ureterolith extraction:

A - Dormia basket; b - Zeiss loop; V - Davis loop; G- biopsy forceps; d - alligator tongs; e - birdclaw clip

stone in the urinary tract is a stone-focused shock wave generated outside the body. Short pulses of energy in the form of a shock wave create pressure in the focal area of ​​up to 160 kPa (1600 bar), which leads to the destruction of the stone.

ESWL for nephroureterolithiasis has become widely used due to the high efficiency and low invasiveness of this treatment method. Currently, the advantages of ESWL over such methods of treating nephrolithiasis as open surgery or percutaneous puncture nephrolithotripsy have been proven. In some cases, this method is used in outpatient practice, and emergency extracorporeal lithotripsy is also being introduced.

The use of ESWL has led to a decrease in the number of surgical interventions in patients suffering from urolithiasis. At the same time, as medical experience accumulates, it has been proven on the example of hundreds of thousands of patients that ESWL is not a panacea, but only one of the methods of surgical treatment of patients with nephrolithiasis. It has been proven that a shock wave can not only have a therapeutic effect, but also cause significant traumatic damage to the renal parenchyma, which should be taken into account when prescribing this treatment method.

There are three types of shock wave generation in lithotripters. The first is electrohydraulic, creating an interelectrode discharge, which leads to a local increase in pressure. Since the electric discharger is placed in the first focus of a bronze ellipsoidal mirror, the propagating shock waves are collected in the zone of the second focus of the ellipse, which is combined with the stone (Fig. 10.7). The second is electromagnetic: an alternating current is passed through the coil, which causes an alternating magnetic field to appear around it. Under the influence of this field, the membrane begins to vibrate and generate a shock wave, which the lens focuses on the stone. The third is piezoelectric: part of the sphere is covered with a large number of piezoceramic crystals (4-5 thousand). All crystals are simultaneously supplied with high voltage alternating current, which causes a synchronous change in their shape. The pressure fluctuations that occur near each crystal are summed up at the focus of the sphere on the stone.

The high-pressure zone (focus) is aimed at the calculus using an electron-optical converter of an X-ray machine or ultrasound scanning. Since the shock wave penetrates the soft tissues while not yet focused, the specific energy density is low and its entry into the patient’s body is not painful. On

Rice. 10.7. Scheme of generation of shock waves during external shock wave lithotripsy:

1 - electrode; 2 - bronze semi-elliptical mirror; F - shock wave focus

In modern ESWL devices, it is performed after intravenous or intramuscular administration of narcotic anesthetics, after local anesthesia, and sometimes without any anesthesia at all.

The stone crushing stage is completed, and multiple fragments from the crushed stone remain in the abdominal cavity system of the kidney. If the size of the fragments is small enough and their number is small, then they come off without complications.

ny. To speed up the passage of fragments, patients are recommended to drink plenty of fluids, active movements, and are prescribed stimulation of the upper urinary tract (drug, sound vibration therapy), etc. If stone fragments do not pass out on their own and lead to occlusion of the ureter, they resort to catheterization of the ureter, endoscopic ureterolithoextraction or percutaneous puncture nephrostomia.

If lithotripsy is performed on a patient with a large or coral-shaped stone and it is known in advance that there will be many fragments, then before manipulation a ureteral stent is installed in the kidney or percutaneous puncture nephrostomy is performed. After stone crushing and removal of stone fragments, the drainage and stent are removed. In the presence of large stones or coral stones, the combined use of endoscopic, percutaneous puncture nephrolithotripsy and subsequent ESWL of unremoved fragments is possible and justified.

It has now become obvious that surgical methods for treating patients with urolithiasis should be used extremely limitedly - in cases where, in addition to stone removal, it is necessary to perform surgical correction of urolithiasis disorders of the upper urinary tract. Surgical treatment is performed for acute destructive pyelonephritis.

The possibilities for non-operative removal of stones in case of urolithiasis are higher, and the number of their complications is lower, the earlier such treatment is undertaken. It is necessary to identify the con-

small-sized crements are still in the kidney and destroy them using remote lithotripsy. An increase in the size of stones, as well as their migration into the ureter, in many cases make it necessary to use endoscopic manipulations, and this increases the risk of complications, and therefore medical examination of the population with ultrasound of the kidneys is of particular importance.

Surgical treatment of patients with nephrolithiasis. There are absolute and relative indications for open surgery for urolithiasis.

Absolute indications for surgical treatment include three complications of nephrolithiasis:

1) anuria resulting from obstruction of both ureters or the ureter of a single functioning kidney by stones;

2) renal bleeding, accompanied by progressive anemia of the patient due to disturbances in the hemostatic system and mechanical damage to the renal pelvis with a stone;

3) obstructive pyelonephritis - active inflammation of the kidney against the background of impaired outflow of urine from the abdominal system.

There are also relative indications - frequent attacks of renal colic with normal functional activity of the kidney, chronic calculous pyelonephritis with frequent attacks and increasing dilatation of the renal cavity system.

The most widespread among open operations for urolithiasis is pyelolithotomy. Depending on which wall of the pelvis is dissected, pyelolithotomy can be anterior, inferior, posterior and superior. Most often, posterior pyelolitotomy is performed (Fig. 10.8), since

Rice. 10.8. Posterior pyelolithotomy

The main renal vessels pass along the anterior surface of the pelvis. Less commonly, pyelonephrolithotomy or nephrolitomy is performed. In cases of severe kidney destruction due to calculous pyonephrosis, nephrectomy is indicated.

Patients with nephrolithiasis should follow a rational diet that helps restore impaired metabolism. For kidney stones consisting of uric acid salts (urates), limit the consumption of foods that promote the formation of uric acid (smoked and fried meat, dried fish, liver, kidneys, meat broths). With phosphate stones, food should contribute to the oxidation of urine, so patients are recommended to eat meat and exclude milk, beans, and peas. For oxalate stones, limit the introduction of oxalic acid into the body by excluding tomatoes, tomato paste, herbs, and sorrel from the diet.

Sanatorium-resort treatment. The therapeutic effect of many mineral waters has been proven, which, by causing a diuretic effect, have a beneficial effect on metabolic processes and water-electrolyte balance in the body of patients with nephrolithiasis. At the same time, certain indications for staying at a water resort have been established. It is believed that stone expulsion therapy is indicated in the presence of small (up to 0.5 cm) stones with preserved evacuation function of the kidney in the absence of obstructive changes in the upper urinary tract. The decision on spa treatment is made by the attending urologist, based on a study of metabolic disorders. Otherwise, treatment may lead to the opposite effect - an increase in stones. Mineral waters increase diuresis, allow you to change the pH of urine, its electrolyte composition and the acid-base state of the blood.

Patients with urate nephrolithiasis with an acidic reaction of urine are recommended for spa treatment with alkaline mineral waters: “Slavyanovskaya”, “Smirnovskaya” (Zheleznovodsk), “Essentuki” (? 4, ? 17), “Borjomi”, TIB-2 and others, as well as weakly mineralized alkaline. For calcium oxalate urolithiasis, treatment is indicated at resorts with weakly acidic, low-mineralized mineral waters: “Essentuki” (? 20), “Truskavets” (“Naftusya”), “Sairme”, etc. For calcium phosphate urolithiasis caused by impaired phosphorus-calcium metabolism and alkaline reaction of urine, the resorts of Zheleznovodsk, Pyatigorsk, Kislovodsk and others are indicated, where mineral water (“Narzan”, “Arzni”) promotes acidification of urine. With cystine stones, patients should be sent to resorts in Zheleznovodsk, Essentuki, Pyatigorsk.

It is advisable to recommend spa treatment that helps increase diuresis after the destruction of the stone or its surgical removal. Mineral waters also have an anti-inflammatory effect.

10.7. FORECAST

For different forms of urolithiasis, it is very ambiguous. Some patients, the so-called chronic stone excretors, accumulate a collection of several hundred small stones that pass in the urine monthly, weekly and for many years, but they do not have symptoms of active pyelonephritis and chronic renal failure. There are cases when a small calculus in a patient with a single kidney leads to the development of acute purulent pyelonephritis and urosepsis within 24 hours.

It should be assumed that the patient’s timely visit to a specialized urological hospital, where, according to indications, he will undergo extracorporeal lithotripsy or surgical treatment, allows us to evaluate the prognosis for urolithiasis as favorable. However, relapse of stone formation always poses a certain threat, which occurs on average in 20% of patients. Patients with nephrolithiasis require constant medical supervision. During a medical-labor examination, it is imperative to take into account the individual characteristics of the clinical course of the disease. It is necessary to accurately assess the functional state of the kidneys and the active phase of chronic pyelonephritis. The prognosis worsens with bilateral kidney stones or solitary kidney stones.

10.8. METAPHYLAXY OF STONE FORMATION

Carrying out the prevention of nephrolithiasis is very problematic for the reason that while a person does not have a stone in the urinary tract, it is impossible to force him to follow a preventive diet and the correct drinking regime. The target is a patient who has already passed a calculus or has had a urinary stone removed or destroyed. Metaphylaxis is understood as the prevention of recurrence of urolithiasis, which is based on the treatment of metabolic disorders leading to stone formation, timely treatment

chronic pyelonephritis and restoration of impaired urine passage.

Diet therapy comes down to limiting the consumption of certain foods: it is advisable to completely eliminate meat broths, coffee, cocoa, fried and spicy foods. With normal glomerular filtration, it is recommended to take at least 1.5 liters of fluid per day.

It is advisable to suppress the formation of increased levels of uric acid (hyperuricemia) in the body with enzyme inhibitors (milurite, allopurinol). Reducing the level of uric acid in the blood can be achieved by using uricuretics (butadione). In all cases, it is advisable to maintain urine pH at a level of 6.2-6.8 using citrate mixtures (magurlite, blemarene, etc.) and sodium bicarbonate (baking soda).

To reduce oxaluria, magnesium oxide or magnesium and pyridoxine salts are used, which reduce the formation of oxalic acid and increase the solubility of calcium oxalate. When treating hypercalciuria, it is often sufficient to limit the intake of calcium into the body by eliminating dairy products from the diet.

As agents that have a diuretic effect, ethacrynic acid (uregit) is recommended at a dose of 0.1 g once a day, hypothiazide at a dose of 0.015-0.025 g twice a day. When treating with hypothiazide, it is necessary to increase the potassium content in the diet. Prescribe 200 g of dried fruits (dried apricots, raisins) or 2 g of potassium chloride per day. Treatment must be carried out under strict control of the electrolyte composition of the blood. Reduction of hypercalcemia in primary hyperparathyroidism is achieved by using thyrocalcitonin.

10.9. BILATERAL KIDNEY STONES

Bilateral nephrolithiasis occurs in almost 30% of patients with urolithiasis, has a severe course, and rapidly progresses, so this form of nephrolithiasis is classified as a special group. It is bilateral stone formation that indicates the systemic nature of the damage to metabolic processes in the body, in contrast to unilateral stone formation, when stone formation can occur as a result of local anatomical features of the kidney or ureter.

Indications for various methods of treatment for bilateral kidney stones, including surgery, are the same as for unilateral nephrolithiasis, but bilateral nephrolithiasis is more often complicated by pyelonephritis and chronic renal failure, so patients need

are given in earlier active actions and surgical treatment. The operation can be performed on one or both sides at once (one- and two-step). In case of bilateral nephrolithiasis, preference is given to surgical intervention, since stone removal gives more favorable results than conservative treatment. Simultaneous removal of stones is possible in young people with their general good condition, satisfactory kidney function and easily accessible location of the stones. In case of severe chronic renal failure or obstructive anuria, the operation should begin on the kidney, which is functionally more intact.

Most often in clinical practice, a two-stage operation is used. First of all, the kidney that has the worst urine outflow and a more active phase of pyelonephritis, which gives the greatest pain symptoms, is subjected to surgical intervention. In case of a single pelvic stone on one side and multiple stones on the other, with satisfactory function of both kidneys, it is better to start the operation with pyelolithotomy for a single stone.

Simultaneous removal of bilateral staghorn and multiple kidney stones is technically very difficult, so it is rarely performed. In such patients, surgical treatment is often carried out in two stages, the interval between which should not exceed 2-3 months. Nephrectomy for bilateral kidney stones is performed in extremely rare cases for vital indications, for example, in case of profuse life-threatening bleeding from the kidney.

10.10. SOLE KIDNEY STONES

Nephrolithiasis in patients with a solitary kidney is identified as an independent clinical form due to the severity of the disease, the lack of functional reserve of the body, the presence of chronic renal failure, chronic pyelonephritis and other complications in most patients, as well as due to the peculiarities of treatment of this group of patients.

The number of patients with urolithiasis in a single kidney is not decreasing. Among diseases of a single kidney, nephrolithiasis ranks second after pyelonephritis. Stones in the remaining kidney after nephrectomy occur in almost 30% of patients. If the opposite kidney was removed due to nephrolithiasis, then stones form in the remaining kidney much more often.

Stone formation in the kidney remaining after nephrectomy must be distinguished from primary bilateral nephrolithiasis.

The course of the disease with a solitary kidney stone depends on the size, shape and location of the stone, the presence of chronic renal failure, the active phase of chronic pyelonephritis and other complications.

Severe complications of nephrolithiasis of a single kidney include anuria, which, as a rule, is of an excretory nature. This complication is observed in almost 40% of patients with urolithiasis in a single kidney.

Another severe complication is acute pyelonephritis or the active phase of chronic pyelonephritis. Acute pyelonephritis in patients with a single kidney is much more severe. Purulent-destructive forms of the disease in acute pyelonephritis in such patients are observed 3 times more often. There is a protracted course of the disease, and the duration of treatment in the hospital is significantly extended. Thus, obstructive pyelonephritis against the background of nephrolithiasis is present in half of patients with one kidney, and its purulent-destructive forms are present in a third.

Most often, patients are admitted to the hospital with exacerbation of chronic pyelonephritis, chronic renal failure, and a significant decrease in working capacity. In almost half of the patients, the main symptom of nephrolithiasis of a single kidney is renal colic, accompanied by fever and chills. In this case, micro- and macrohematuria, thirst, dry mouth, nausea and vomiting are noted. A stone in a single kidney already in the early stages of the disease causes severe impairment of its function, which progresses over time.

Impaired function of the only kidney in patients is caused mainly by calculous pyelonephritis and destruction of renal tissue due to impaired urine outflow. The functional state of a single kidney undergoes the most significant changes in coral nephrolithiasis, accompanied by a profound disturbance of water-electrolyte and acid-base balance.

The problem of treating patients with a solitary kidney stone has been and still remains one of the most pressing in urology. Treatment should be aimed, first of all, at restoring urine passage followed by antibiotic therapy for pyelonephritis.

Many clinicians previously considered it inappropriate to perform planned interventions for stones in a solitary kidney and

Patients were operated on only for health reasons. However, in recent decades, this point of view has changed radically, and many recommend removing the stone from the solitary kidney as early as possible, since the best results are achieved when intervening at a stage when decompensated renal failure has not yet developed.

When admitting patients with a solitary kidney stone accompanied by renal colic, it is recommended to perform ureteral catheterization to prevent exacerbation of pyelonephritis.

For anuria, treatment usually begins with catheterization of the kidney to restore urine outflow, and after the patient’s general condition improves, further examination is performed and the issue of further treatment tactics is decided.

To drain a blocked kidney, a stent or percutaneous puncture nephrostomy is used.

The results of planned intervention in patients with a solitary kidney are much better than with urgent operations.

Indications for planned surgical treatment: stones in a single kidney that cannot pass away on their own, large stones accompanied by hematuria, hydronephrosis and chronic renal failure.

When choosing the type of operation, the general condition of the patient, the functional ability of the only kidney, liver, cardiovascular system, the type of structure of the pelvis, the size and location of the stone are taken into account.

In some patients, elective surgery is combined with nephrostomy.

Recently, in patients with a solitary kidney stone, ESWL is performed rather than open surgery, the indications for which must be especially strict.

10.11. BLADDER STONES

Bladder stones are one of the first urological diseases that medieval stone cutters learned to diagnose and treat surgically. This clinical form of urolithiasis is common, especially in older men and boys. In women, bladder stones are extremely rare due to the anatomical features of the urethra. Bladder stones can be of secondary origin - these are stones that have descended down the

ureters from the kidneys. Often there are primary stones formed in the bladder.

Stagnation of urine in the bladder is one of the main conditions for primary stone formation. It is promoted by developmental defects (phimosis, urethral valves and bladder diverticula, narrowing of the external opening of the urethra), as well as neurogenic bladder dysfunction.

Foreign bodies that enter the bladder (metal fragments, bullets, catheters, ligatures, etc.) can become the nucleus on which a stone is formed. Bladder stones are common in men with an enlarged prostate due to benign prostate hyperplasia or cancer, or urethral stricture.

Bladder stones usually have an ovoid shape, can be single or multiple, and differ in chemical composition. There are cases where several thousand stones were removed from the bladder.

Symptoms and clinical course. The main symptoms of bladder stones are pain, dysuria and hematuria. Pain in the suprapubic area is dull in nature and is associated with walking, jolting, and physical activity. The pain radiates to the head of the penis, perineum, and anus. Sometimes pain does not bother you at all, which is observed with large stones.

With bladder stones, dysuria is most pronounced; it is often associated with the underlying disease - BPH or urethral stricture. However, if the patient has a stone in the bladder, pollakiuria may be more pronounced during the daytime, when the patient is more physically active and the stone, moving in the bladder, irritates the neck, causing a false urge to urinate.

The most characteristic symptom of a bladder stone can be considered trembling and interruption of the stream of urine - a sudden “slamming”, and the restoration of the act of urination when the body position changes. This is why men suffering from bladder stones prefer to urinate while sitting.

With bladder stones, hematuria is observed (especially after fast walking, bumpy driving, physical work). Trauma to the mucous membrane of the bladder leads to chronic cystitis, which gives frequent exacerbations, causes dysuria and is accompanied by terminal hematuria and leukocyturia. Stone

Rice. 10.9. Overview of the urinary system. Bladder stone

in the bladder can injure dilated veins in its neck, cause cystic bleeding and even bladder tamponade.

Diagnostics. Bladder stones are easily recognized by the characteristic complaints of patients about typical dysuria and, of course, on the basis of ultrasound, endoscopic and x-ray data. The simplest and non-invasive method that allows you to obtain information about the condition of the walls of the bladder and the presence of stones in it is ultrasonic scanning.

Using plain radiography of the pelvis, you can see the shadow of a stone in the projection of the bladder, estimate its size, and get an idea of ​​the density of its structure, which is important for determining the method of stone crushing (Fig. 10.9).

Despite the importance of the information obtained from plain radiography, it should be remembered that bladder stones containing uric acid salts (urates) do not block x-rays and are not detected during this study. An overview photo allows you to determine the number of stones and their sizes.

Since ancient times, a metal bougie stone probe has been used to determine a stone in the bladder. When a metal instrument is inserted into the bladder, a characteristic sensation of metal rubbing against a stone occurs. The most informative is an invasive study - cystoscopy, which allows you to determine the capacity of the bladder, the condition of its mucous membrane, the number of stones, their size and type.

Treatment Treatment of patients with bladder stones cannot consist only in removing the stone, because very often the stone is a consequence of a pathological process in the urinary tract. Stone removal must be preceded by identifying and eliminating the causes of stone formation. Often these two interventions are performed simultaneously. Thus, they usually combine the removal of stones from the bladder with transvesical prostatectomy for BPH complicated by the formation of a stone in the bladder; transurethral resection of the prostate gland - with contact lithotripsy.

There are two methods of treating patients suffering from bladder stones: stone crushing (cystolithotripsy) and stone cutting (cystolithotomy). Bladder stones are crushed using a bladder lithotripter, which, after being inserted into the bladder through the urethra, allows, under visual control, to capture and destroy the stone into small fragments, which are washed through a evacuator using an aspirator; A urethral catheter is installed in the bladder for 2-3 days.

A relative contraindication to cystolithotripsy is strictures of the urethra, therefore, the introduction of a lithotriptor into the bladder is preceded by an optical ureterotomy. Cystolithotripsy, like other endoscopic manipulations, is not performed against the background of acute cystitis, low bladder capacity and in the active phase of chronic pyelonephritis.

In our country, a unique device “Urat-1” was created for contact electrohydraulic cystolithotripsy. In addition, ESWL is currently used to crush bladder stones. However, this method can be used only in the absence of bladder outlet obstruction in patients.

If cystolithotripsy is impossible or stone crushing is contraindicated, a high section of the bladder and cystolithotomy are performed.

If in a patient with a bladder stone the causes that caused lithogenesis are eliminated, relapses are practically not observed. To prevent the formation of stones in the bladder, the urinary tract should be sanitized using uroantiseptics, as well as factors that impede the outflow of urine from the bladder should be eliminated.

Forecast. If the causes that caused stone formation in the bladder are eliminated (removal of the enlarged prostate gland due to BPH, dissection of the urethral stricture, etc.), the prognosis is favorable, otherwise re-formation of stones is possible.

10.12. URETHAL STONES

Urethral stones are rarely primary, formed in patients with urethral stricture. They are mainly secondary, migrating from the kidneys, ureters and bladder. The main symptom is urinary retention, which may be incomplete or chronic. Pain in the urethra, dysuria, gross hematuria, and urethrorrhagia are noted. Some patients develop purulent discharge from the external opening of the urethra due to urethritis. Occasionally, perineal fistula stones occur in patients with urethral stricture.

Recognizing urethral stones does not cause difficulties, because very often they can be felt not only in the hanging part, but also in the posterior section, when palpated through the ampulla of the rectum. A urethral stone can be recognized when it is blocked. To diagnose urethral stones, you can take a clear x-ray of the urethra or fill the urethral lumen with a liquid radiopaque substance.

When treating stones in the anterior urethra, first of all, it is necessary to try to remove the stone using forceps for removing kidney stones, a forceps, forceps from a surgical cystoscope set, or a sharp spoon. If these measures are ineffective, urethrolithotomy is indicated. If the stone is localized in the posterior part of the urethra, it can be pushed with a metal bougie into the bladder, and then cystolithotripsy can be performed.

Security questions

1. What factors of stone formation can you list?

2. What are the main symptoms of nephrolithiasis?

3. What is the peculiarity of hematuria in nephrolithiasis?

4. What is the difference in the clinical course of stones in the kidneys, ureters and bladder?

5. What is the role of X-ray and ultrasound methods in recognizing urolithiasis?

Urolithiasis(renal stones, nephrolithiasis) - the formation of hard concretions (stones) of various natures in the calyxes and pelvis of the kidneys (pyelocalyceal system - CLS).

Urolithiasis (UCD) develops as a result of metabolic disorders and the acidic properties of urine. Salts are constantly present in urine in dissolved form. Under certain conditions, they begin to precipitate, first forming crystals, which can then turn into quite large stones (several centimeters). Small stones (so-called sand) gradually descend along with urine through the ureter into the bladder, and then come out when urinating. This process is usually accompanied by pain when urinating, the intensity of which depends on the size and shape of the stones being removed.

The formation of stones is provoked by various infections of the urinary system, stagnation of urine, impaired metabolism of uric and oxalic acids, phosphorus, and calcium.

Stones differ in their nature of formation:

• phosphates- are formed from insoluble calcium phosphate and other phosphorus salts, due to increased function of the parathyroid gland, due to bone damage, due to hypervitaminosis D. Phosphates are formed during an alkaline reaction of urine (pH more than 7.0);
• oxalates- are formed from salts of oxalic acid, which is associated with excessive formation of oxalates in the body and/or excessive intake of oxalic acid and substances that form oxalates as a result of metabolic reactions. Oxalates are formed when urine is acidic (pH about 5.5). The solubility of oxalates is enhanced by the presence of magnesium ions in the urine;
• urates- stones from uric acid salts are formed when purine metabolism is disrupted and when there is an excessive intake of purine bases from food. Urates are formed when urine is very acidic (pH less than 5.5). At a pH above 6.2, urates dissolve.

Symptoms of ICD

• The classic symptom of ICD is an attack renal colic, which occurs when a stone leaves the kidney and travels down the ureter. During an attack, the patient feels acute intense pain in the lumbar region, which may be accompanied by vomiting, frequent urination, and fever;
• between attacks of renal colic, the patient feels a dull pain in the lower back, which intensifies with long walking, shaking, or lifting heavy objects;
• large stones, which are obviously larger than the diameter of the ureter, as a rule, hardly manifest themselves, sometimes making themselves felt by dull, unexpressed pain in the lumbar region. Such stones are discovered by chance during an ultrasound of the kidneys.

Complications of ICD:

• kidney block;
• development of renal failure.

If you experience periodic pain in the lumbar region, you should consult a therapist to find out its causes. During renal colic, it is necessary to call an ambulance to receive urgent medical care. From my own experience, I can say that I withstood an attack of renal colic for no more than 10 minutes, after which I was hospitalized by ambulance in a medical hospital.

Treatment of urolithiasis

To make an accurate diagnosis, an in-depth study of the condition of the urinary system may be necessary; for this purpose, additional examination methods are prescribed (except for a general medical examination and routine tests):

• determination of phosphorus and calcium levels in the blood;
• intravenous urography;
• cystoscopy;
• Ultrasound of the kidneys;

First of all, treatment of urolithiasis is aimed at relieving a painful attack of renal colic and spontaneous passage of stones: heat on the lower back, hot baths, drinking plenty of fluids, antispasmodics. If treatment is ineffective, the patient must be hospitalized in a hospital.

If conservative therapy is ineffective, catheterization of the ureter is indicated, performed by cystoscopy. In the event of the development of complications such as kidney blockage, purulent pyelonephritis, surgery is performed to remove stones from the kidney or ureter, and drainage of the urinary tract.

At the moment, bloodless operations to remove stones - laser lithotripsy - are widely used in medical practice. The operation is performed under general anesthesia. A flexible hollow hose equipped with a light source and a video camera is inserted into the patient through the urinary tract. The image from the video camera is displayed on the monitor. The surgeon advances the hose, monitoring the progress of the process on the monitor, through the urinary tract, bladder, ureter to the place where the stone is located. When the flexible system has reached the desired location, a source of laser radiation is applied to the stone and, under the influence of high concentrated energy of the laser beam, the stone is crushed into small pieces, which can independently leave the patient’s body. If the stone is small, it is removed entirely, for example, using a Dormia loop (tested on myself). The main advantage of such surgical interventions is their high efficiency (in most cases, the patient is completely and guaranteed to get rid of stones), a relatively low likelihood of complications, short hospitalization time (the patient is usually discharged from the hospital 3-5 days after surgery). Disadvantages include the relatively high cost and low prevalence of medical institutions that perform such operations.

Diet for ICD

The choice of medications and diet to prevent recurrent stone formation depends on the composition of the stones and the nature of their formation.

Phosphate stones

• foods rich in calcium that have an alkalizing effect are limited: vegetables, fruits, dairy products;
• recommended foods that change the reaction of urine in an acidic direction and drinking plenty of fluids: meat, fish, grains, legumes, pumpkin, green peas, cranberries, sour apples, lingonberries.

Oxalate stones

• foods rich in oxalic acid are excluded: beans, green beans, leafy greens, nuts, rhubarb, citrus fruits, sorrel, spinach, cocoa, chocolate;
• products containing a lot of calcium are limited: cheese, cottage cheese, milk;
• A balanced diet is recommended with the obligatory inclusion in the diet of products that help remove oxalates from the body: watermelon, melon, apples, pears, plums, dogwood, light grapes, decoction of apple peels; as well as foods rich in magnesium: cereals, bran.

Urate stones

• broths, soups and sauces of meat, fish, mushrooms, meat by-products, minced meat, smoked products, veal, venison, goose, chicken, partridge meat, sardine, mackerel, herring, cod, trout, anchovies, sprats, mussels, shrimp are excluded;
• consumption of beef, other types of meat products after boiling, duck, pork lard, soybeans, peas, beans, lentils, asparagus, cauliflower, sorrel, spinach is limited;
• Dairy products, eggs, cereals and pasta, most vegetables, fruits, berries, and nuts are recommended.

You should know! When cooking meat and fish, approximately half of the purines they contain go into the broth, therefore, after boiling, the meat or fish is caught and used to prepare various dishes, and the broth, rich in purine, is poured out.

Important! The above strict dietary recommendations should be followed for no more than 1.5-2 months, after which the diet should be gradually expanded from previously limiting foods. Otherwise, the acidity of urine may shift in the opposite direction, which will lead to the formation of stones of a different nature. If the corresponding salts (urates, phosphates, oxalates) appear in the urine, it is necessary to return to the previous diet for 1.5-2 months, etc.

Medicines for ICD

Medications are taken as prescribed by a doctor and under his supervision:

• drugs to prevent stone formation: allopurinol, blemarene, hydrochlorothiazide, magnesium oxide, magnesium citrate, sodium citrate, urodan;
• antispasmodics: no-spa, spazoverine, belladonna preparations, papaverine, cystenal.

Folk remedies for ICD

For uric acid diathesis and urate stones:

• Pour 10 g of the collection into 0.25 liters of boiling water, heat in a water bath for 10 minutes, leave in a warm place for 2 hours, strain, take half a glass warm 3 times a day half an hour before meals for 1.5-2 months. Composition of the collection (in equal proportions): lingonberry leaves, knotweed grass, curly parsley root, calamus rhizome, corn silk;
• It is necessary to include in your daily diet apples and carrots in any form, cucumbers, pumpkin, fruits and juices of strawberries, lingonberries.

For oxalate and phosphate stones:

• Pour 10 g of the collection into 0.25 liters of boiling water, heat in a water bath for 10 minutes, leave in a warm place for 2 hours, strain, take half a glass warm 3 times a day half an hour before meals for 1.5-2 months. Composition of the collection (in equal proportions): common barberry flowers, sandy immortelle flowers, lingonberry leaves, black elderberry flowers, common heather herb, melilot herb, madder root, motherwort herb;
• the diet should be supplemented with berry and fruit juices, apples, quinces, pears, grapes, apricots, currants;
• 5 tbsp. apple peels per 1 liter of boiling water, leave for 1 hour, strain, drink 2 glasses a day with sugar or honey;
• Pour 30 g of the collection into 1 liter of boiling water, leave in a warm place for half an hour, strain, and take warm for an hour. Composition of the collection (in equal proportions): silver birch leaves, prickly steelhead root, common juniper fruits, peppermint leaves, greater celandine herb, cinquefoil herb.

To relieve renal colic, use a hot bath with a water temperature of about 39°C for 10 minutes, after which the patient should remain in a warm bed for at least 2 hours and constantly drink large amounts of fluid (at least 1.5 liters). If renal colic does not stop, calling an ambulance is necessary. From my own experience, it will hurt so much that you will rush to the hospital yourself (toothache compared to renal colic is “little flowers”).

ATTENTION! The information provided on this site is for reference only. Only a specialist doctor in a specific field can make a diagnosis and prescribe treatment.

The leading direction of our work is the treatment of urolithiasis. We treat all forms of urolithiasis, including the most complex ones. We provide treatment for kidney stones, staghorn stones, and ureteral stones. The technical equipment of the clinic and the experience of doctors correspond to the level of leading foreign clinics.

We carry out all types of modern operations for kidney and ureteral stones: removal of stones through small punctures of the skin from the back, removal through the natural openings of the urinary tract, remote crushing, laparoscopic removal.

We carry out:

Technical equipment of the clinic:

• Nephroscope Karl Storz® (Germany) 9.3 mm thick for removing large kidney stones
• Mininephroscope Karl Storz® 5.3 mm thick
• Micronephroscope Karl Storz® 3 mm thick
• Ultrathin nephroscope MicroPerc® from PolyDiagnost (Germany) only 1.5 mm thick!
• Disposable fibroureteroscope LithoVue from Boston Scientific (USA)
• Device for external lithotripsy Dornier (Germany)
• Holmium laser Dornier (Germany)

Percutaneous puncture nephrolithotripsy

Percutaneous puncture nephrolithotripsy is the removal of kidney stones through a small 5-7 mm puncture of the skin from the lumbar region. Surgery is the method of choice for large kidney stones and coral stones.

Successful performance of such operations requires good technical equipment in the operating room and the experience of the surgeon. We have the ability to remove kidney stones using instruments of different thicknesses - both standard and ultra-thin nephroscopes from Karl Storz and PolyDiagnost.

We perform several hundred such operations every month. Head of department Dr. Gadzhiev N.K.- is one of the world's leading experts in the field of percutaneous nephrolithotripsy.

Retrograde intrarenal surgery (RIRS)

Removing kidney stones through the natural openings of the urinary tract using a flexible instrument is the most high-tech method of removing urinary stones at the moment.

Through the external opening of the urethra, the instrument is inserted into the bladder and then into the ureter without cutting the skin. The use of a flexible instrument allows for a complete examination of the renal collecting system. Fragmentation of the stone is carried out using a laser, which turns the stone into dust.

In our work, we use flexible disposable LithoVue ureteronephroscopes from Boston Scientific. The use of disposable instruments provides additional safety of treatment, completely eliminating infection of the patient during the operation.

Combined access

When removing a number of kidney stones and the pyelourethral segment, we use a combined approach (percutaneous puncture access + access through the natural openings of the urinary system). This allows you to achieve maximum results during one operation, one anesthesia.

Such operations are performed using a nephroscope and uretereroscope. In case of prolonged standing of the ureter, impaired renal function, or current pyelonephritis, the operation may result in the installation of a ureteral stent for prolonged unloading of the kidney. Typically, such operations are performed under spinal or intravenous anesthesia. Therefore, such operations are also called “natural orifice surgery.”

External shock wave lithotripsy

The first device for external lithotripsy in Leningrad appeared in 1989 at our department. At the moment, we perform external lithotripsy on a device from a leading global manufacturer (Germany). The device is equipped with an X-ray and ultrasound guidance system.

External lithotripsy is indicated for ureteral stones up to 8-10 mm in size and kidney stones up to 1-1.5 cm in size. Stones of low density and heterogeneous structure are especially susceptible to destruction.

Treatment is carried out by the head of the department A.O. Ivanov and urologist Yu. A. Radomsky. Over 30 years, they have performed more than 12 thousand such operations.

Choosing the optimal method for removing a kidney stone:

Dissolving stones with medications

Only stones consisting of uric acid can be dissolved. This is approximately 10% of patients. For several months, patients take medications that change the properties of urine. All this time they are under the supervision of a urologist, who adjusts the dosage of medications. The effectiveness of such treatment in our clinic is 95%.

We dissolve kidney stones, including large ones, and ureteral stones. In some cases, preliminary installation of a ureteral stent is required to unload the kidney.

Identifying the causes of stone formation and preventing relapse

The causes of stone formation can be diseases of the endocrine system, metabolic disorders, urinary tract infections, impaired urine outflow, and genetic diseases. Elimination of identified causes, selection of the right diet and medications significantly reduce the incidence of relapse.

To determine the cause of stone formation, it is necessary to undergo the following examination:

• Determine the chemical composition of the stone
• Biochemical blood test (ionized calcium, uric acid, vitamin D level, parathyroid hormone)
• Biochemical analysis of 24-hour urine

For the convenience of patients, a free application for mobile devices has been created

Every three months we hold thematic meetings, during which we give lectures, answer patients’ questions, and conduct screening ultrasound examinations.

Examples of treated patients

Complete doubling of the left kidney. Left ureterocele.
Performed: endoscopic dissection of ureterocele

Stones of both kidneys, left ureter.
Performed: percutaneous percutaneous nephrolithotripsy and ureteroscopy

Stones of both kidneys of high density 1301 HU.
Performed: transurethral nephrolithotripsy on the right, change of the ureteral stent on the left.

Coral stones of both kidneys.
Composition: ammonium urate, carbonate apatite.
Treatment: Percutaneous nephrolithotripsy

Right renal pelvis stone 20*13 mm.
Percutaneous nephrotitotripsy was performed on the right

Left kidney stone with a density of 367 HU.
Oral litholysis is performed.

Stone n/3 of the left ureter.
Performed: contact ureterolithotripsy on the left

Left ureteral stone, left ureteral stent.
Performed: extracorporeal lithotripsy

Multiple stones in the left kidney.
Retrograde nephrolithotripsy was performed with a flexible disposable instrument.

Stone in the right ureter 9/6 mm, 963 HU.
External lithotripsy was performed.
Stone composition: 50% weddellite, 42% wewellite, 8% carbonate apatite.

Stone in the middle third of the ureter. ESWL was performed. Doctor: Radomskiy Yu.A.

Urolithiasis- symptoms and treatment

What is urolithiasis? We will discuss the causes, diagnosis and treatment methods in the article by Dr. A.E. Rotov, a urologist with 19 years of experience.

Definition of disease. Causes of the disease

Urolithiasis- one of the oldest diseases that has plagued humans for thousands of years and has not lost its relevance to this day. The famous ancient doctors Hippocrates and Avicenna described this disease and even performed surgical operations to remove stones (it’s terrible to imagine yourself in the place of their unfortunate patients!). Many powerful people and great minds, including Peter the Great, Napoleon, Newton, could not avoid this disease. In the modern world, we, unfortunately, are seeing a steady increase in the incidence of urolithiasis (UCD), which is associated with poor nutrition, poor environment, poor-quality drinking water, physical inactivity and other “benefits” of civilization.

According to statistics, urolithiasis ranks second in the structure of urological diseases in Russia, second only to infectious and inflammatory diseases of the genitourinary system. The relevance of our topic is associated not only with the high prevalence of urolithiasis, but also with the unpredictability of its course and the risk of serious complications. Many people do not realize that they have kidney stones until the first attack of renal colic, which occurs against the background of “full health.” If timely and qualified assistance in this case is late, then the consequences can be very sad, including the loss of a kidney.

What are causes of urinary stones formation? We have already mentioned some of them.

• hereditary predisposition - attention to those who have a family history of people with urolithiasis;
• congenital or acquired metabolic disorders;
• poor nutrition, excessive consumption of animal and vegetable protein, lack of vegetables and fruits, some vitamins and microelements;
• insufficient fluid intake (the minimum recommended daily intake for a healthy person is 1.5 liters, for a patient with urolithiasis - at least 2.5 liters), low-quality “hard” water;
• sedentary lifestyle;
• unfavorable environmental factors: dry hot climate, frequent overheating, etc.

If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of urolithiasis

The pain is initially localized in the lumbar region, radiating down the abdomen, sometimes to the genitals, and is often accompanied by nausea and vomiting. The pain can be so severe that the patient “cannot find a place for himself” and rushes about until the ambulance arrives. A frequent accompaniment of renal colic is the presence of blood in the urine, so when such attacks occur, it is recommended to urinate in a jar to monitor the color of the urine and the passage of stones.

Large or coral-shaped kidney stones can manifest as long-term dull, aching pain of low intensity in the lumbar region and also blood in the urine, especially after physical activity or long walking/running.

In the later stages, when kidney function is impaired and chronic renal failure develops, general well-being suffers, weakness, fatigue occur, and appetite worsens. During this period, blood pressure often rises and headaches occur.

When the inflammatory process occurs, there is an increase in body temperature (sometimes to high numbers, over 38-39 degrees), accompanied by chills.

Pathogenesis of urolithiasis

The insidiousness of this disease is that for a long time a person may not be aware of the formation of kidney stones in his kidneys, that is, the disease proceeds secretly. Manifestation occurs at the moment when the stone begins to shift, disrupting the natural outflow of urine, which is accompanied by an attack of intense pain, called renal colic. Usually an attack occurs after physical exertion, a long journey (especially by train), or drinking alcohol. Often these factors occur on vacation, threatening to turn the vacation into a struggle for survival (in the literal sense).

Complications of urolithiasis

Despite the successes achieved in the fight against stones thanks to modern technologies, complications of urolithiasis still occur in the practice of a urologist. These include persistent disruption of the outflow of urine from the kidney (hydronephrosis) and inflammation of the kidney (pyelonephritis). With hydronephrosis, an obstruction to the outflow of urine leads to an expansion of the renal cavity system and a gradual depression of its functional state (up to complete atrophy). The tricky thing is that at this stage the pain, as a rule, has already subsided, and the person feels practically nothing and, accordingly, does not see a doctor. A serious complication of urolithiasis is acute pyelonephritis, which can turn into a purulent phase within a short time, which may require urgent surgical intervention, including removal of the affected kidney. The recurrent nature of stone formation in the absence of adequate treatment leads to a chronic inflammatory process - chronic pyelonephritis, which usually affects both kidneys. The outcome of prolonged inflammation can be loss of functional activity, shrinkage of the kidneys with the development of chronic renal failure and the need for hemodialysis.

Diagnosis of urolithiasis

To detect stones in a timely manner, it is enough to undergo an annual kidney ultrasound. When an attack of renal colic occurs, ultrasound is also the main diagnostic method, however, computed tomography of the urinary system (even without intravenous contrast) has higher sensitivity, allowing the detection of up to 95% of stones.

Excretory (or intravenous) urography provides valuable information on the anatomical features of the kidneys and upper urinary tract. Stones that do not contain calcium salts (for example, urate or cystine stones) are not visible on x-ray film (therefore they are called x-ray negative).

Laboratory tests (general analysis of morning urine, biochemical analysis of blood and daily urine) make it possible to identify a concomitant inflammatory process (pyelonephritis), assess the functional state of the kidneys, the presence of metabolic disorders, and increased concentrations of stone-forming salts and minerals.

Treatment of urolithiasis

Treatment of urolithiasis depends on the size and location of the stone (kidney, ureter or bladder), the condition and characteristics of the urinary tract (for example, narrowings or fixed bends that make it difficult to pass the stone), and the presence of complications. In mild cases, if the stones are small (usually up to 5 mm), drug stone therapy can be used with the prescription of diuretics, antispasmodics and painkillers. Herbal products are widely used. To speed up the spontaneous passage of stones, it is recommended to drink plenty of fluids in combination with physical activity.

Some types of urinary stones (for example, urates) can be easily dissolved using so-called citrate mixtures (Blemaren or Uralit-U). This method is based on increasing the solubility of urate stones when the urine acidity (pH) shifts to the alkaline side. The dissolution process is quite lengthy and labor-intensive, requiring regular monitoring of the pH (indicator strips are included in the package), but with the right approach it allows you to completely get rid of stones without additional intervention.

(or non-contact crushing of stones) is a unique method of getting rid of kidney and ureteral stones, when the stones are destroyed directly in the body without the introduction of instruments. Crushing is carried out using a special apparatus - a lithotripter.

Previously, due to their high cost, such complexes were installed only in large research centers and hospitals, but today the method is more accessible, including in commercial clinics. A modern device for remote lithotripsy is a fairly compact shock wave generator combined with a device for targeting the stone. Structurally, ultrasonic or x-ray guidance is possible. At the same time, ultrasonic guidance is advantageous in the absence of ionizing radiation (radiation exposure) and the possibility of continuous monitoring of stone destruction in real time. In addition, ultrasound can be used to target stones that are X-ray negative (that is, invisible to X-rays). The crushing procedure usually takes no more than an hour and does not require serious pain relief. Recently, external lithotripsy has been performed on an outpatient basis, that is, without hospitalization.

During crushing, the stone is destroyed by shock waves into small fragments, which then independently pass through the natural urinary tract. To facilitate and speed up this process, antispasmodic and diuretic drugs are often prescribed. With the help of extracorporeal lithotripsy, kidney stones of relatively low density up to 2 cm in size can be effectively destroyed.

When a stone gets stuck in the ureter and blocks the outflow of urine, which is manifested by recurrent attacks of renal colic that are difficult to relieve with conventional medications, endoscopic intervention is used to quickly remove the stone and restore the outflow of urine - transurethral contact lithotripsy. As the name suggests, in this operation, performed through the urethra (urethra), the instrument, under visual control, is brought directly to the stone and the latter is destroyed by contact - laser, ultrasound or a pneumatic probe.

The advantage of contact lithotripsy is the complete destruction and removal of the stone immediately during surgery, restoration of urine outflow and the absence of the stage of passage of fragments. In some cases, for additional drainage of the upper urinary tract, a plastic catheter (internal stent) is installed in the ureter after surgery. Contact lithotripsy is usually performed under spinal anesthesia and requires short-term hospitalization. An additional advantage of transurethral lithotripsy is the ability to simultaneously eliminate narrowing or fixed kinks of the ureter below the stone, which can be an insurmountable obstacle to the passage of stones (or even fragments after remote crushing).

Large and dense kidney stones, which cannot be destroyed using extracorporeal lithotripsy, are today removed through a small puncture in the lower back. This operation is called percutaneous nephrolithotripsy. Under ultrasound and X-ray guidance, an instrument is inserted into the kidney through a puncture, with the help of which, under visual control, the stone is destroyed and fragments are removed. As with transurethral contact lithotripsy, destruction is achieved using a laser, ultrasound or pneumatic probe. This method can destroy stones of any size and density. True, in some cases it is necessary to make additional punctures for this. The operation often ends with the installation of a thin drainage tube (nephrostomy) into the kidney through an existing puncture, which is removed after a few days. Percutaneous nephrolithotripsy is usually performed under general anesthesia and requires hospitalization for a period of 3 to 5 days. The most modern modification of this operation is minipercutaneous laser nephrolithotripsy. The main difference is the use of miniature instruments with a diameter of about 5 mm, which is approximately half the size of traditional ones. Thus, the puncture in the skin becomes almost invisible, the recovery period is reduced, as well as the likelihood of complications.

Another modern and minimally invasive method for removing stones from the kidneys and ureters is flexible transurethral contact lithotripsy (or fibroureteronephrolithotripsy, or retrograde intrarenal surgery). The main advantage of this method is the absence of cuts and punctures, that is, damage to the skin. A flexible miniature instrument equipped with an actively moving tip with a high-quality video camera is inserted through the natural urinary tract (urethra). Depending on the task, the instrument is passed into the ureter or into the kidney and brought to the stone. The latter is destroyed with the help of a laser into “dust” (dusting effect), which does not require the extraction of fragments - they are washed off with a current of liquid during the operation. This method is ideal for relatively small and dense kidney stones, especially multiple ones located in different calyxes. The flexibility of the fibroureterorenoscope allows it to be passed through narrowings and fixed bends, without the risk of damage. The main disadvantage of this technology is the very high cost of the equipment. Therefore, not all even large urological centers have a fibroureterorenoscope in their arsenal.

Laparoscopy for kidney and ureteral stones is used quite rarely, mainly when urolithiasis is combined with urinary tract anomalies (for example, a large stone in the pelvis and narrowing of the ureteropelvic segment), when it is necessary to simultaneously remove the stone and eliminate the anomaly.

Thus, as we see, today open operations (that is, performed through a skin incision) are almost completely replaced from the arsenal of means for removing urinary stones. This made it possible to make surgical treatment of urolithiasis quick, easy and safe, which is especially important given the tendency of the disease to relapse.

Forecast. Prevention

Proper and timely treatment allows you to quickly and safely get rid of the stone and prevent complications. Given the tendency of the disease to recur, special attention should be paid to preventing the recurrence of stones.

The upward trend in the incidence of urolithiasis observed in recent years determines the importance of preventing this disease. This is of particular importance in people with a hereditary predisposition to the formation of urinary stones.

The main methods of prevention are:

• drinking enough fluid (at least 1.5 liters per day for a healthy person and at least 2.5 liters for patients with urolithiasis);
• proper balanced diet with sufficient consumption of fiber, vegetables and fruits, vitamins and microelements;
• regular physical activity, sports.

Patients with urolithiasis must necessarily determine the composition of urinary stones. The most reliable way is chemical analysis of the loose (or removed) stone. Depending on the composition (urates, phosphates or oxalates), the doctor will select the appropriate diet and medications.

Diet is very important to prevent the recurrence of kidney stones. All patients with urolithiasis are recommended to limit table salt to 5-6 grams per day (food is prepared without salt and add salt already on the plate), limit animal and vegetable protein (up to 1 gram per kg of body weight). For urate stones (that is, consisting of uric acid salts), in addition to the above-mentioned dietary restrictions, dark beers, red wine, pickles, smoked meats, offal, coffee, cocoa and chocolate are not recommended.

In the case of a bilateral recurrent nature of stone formation, when serious metabolic disorders in the body are expected, one should try to establish and, if possible, eliminate these disorders. For this purpose, a biochemical analysis of daily urine for calcium, phosphates, urates, citrates and oxalates, and a biochemical blood test (calcium, phosphorus, magnesium, parathyroid hormone) are often prescribed. It is also very important to regularly, 1-2 times a year, do an ultrasound of the kidneys, which will identify small stones at an early stage, when they can be removed with the help of medications without resorting to complex and expensive interventions.