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Urolithiasis can develop in anyone, regardless of gender, age, and even lifestyle. The only way to get rid of the disease is to undergo timely diagnosis and stop the manifestations of urolithiasis in time. Modern medicine offers many ways to quickly, safely and virtually painlessly remove stones. What you need to know about the disease, how to diagnose and treat it?
General characteristics of the disease
Urolithiasis or urolithiasis is a disease in which stones form in the urinary system. Sometimes stones develop directly in the bladder, causing it to become inflamed (cystitis). In some cases, they migrate out of the kidneys with urine (nephrolithiasis).
The disease can develop at any age. The only way to fix a problem is prevention. The patient must undergo a check-up (comprehensive diagnostics of the whole organism) at least 1-2 times a year. So you can fully control your health and prevent illnesses in time. Most often, urolithiasis develops between the ages of 20 and 50 years. Approximately 30-40% of patients in the urology department of hospitals are admitted with this diagnosis.
What you need to know about the ureter
It is a paired organ of the urinary system of the human body. The right and left ureters are ducts consisting of a mucous membrane and an external muscular wall. The length of each is from 27 to 30 centimeters, and the diameter is from 5 to 7 millimeters. It is impossible to feel the organ through the abdomen, therefore additional diagnostic methods are required. The ducts begin at the renal pelvis (a cavity that connects both organs), pass in the retroperitoneal space on the sides of the spine. Then the ureters cross the transverse processes of the lumbar vertebrae, descend into the pelvic cavity to the walls of the bladder and its cavity.
The main function of the organ is to conduct urine from the kidneys to the bladder. The ureter has three physiological constrictions. One of them is located at the point of departure from the kidney cavity, the second – at the border of the intersection with the vessels, the third – at the point of passage inside the walls of the bladder. In each of these constrictions, or between them, stones can form. How exactly does this happen?
Stone formation
The mechanism of stone formation is still poorly understood. That is why scientists prefer to talk about the reasons that lead to the formation of a calculus. The formation of a stone is directly related to the violation of metabolic processes in the body. The kidneys begin to accumulate substances that cannot be dissolved in the urine. At first they look like small grains of sand or crystals. In most cases, they remain invisible, since the early stage of urolithiasis can only be diagnosed with an ultrasound or urinalysis. Gradually, the number of crystals grows, they unite and form a large calculus. It can migrate throughout the urinary system, causing pain, malaise, inflammation, and deterioration of organ function.
According to the chemical composition, it is customary to distinguish three types of stones. Each formation is based on organic / inorganic acids. Phosphates are formed by phosphoric acid, oxalates by oxalic acid, and urates by uric acid. The composition of the stone is important for the doctor and the preparation of a therapeutic course. The choice of method of removal and further prevention of stone formation depends on the type of calculus.
Symptoms of the disease
For urolithiasis, the following symptoms are characteristic:
- dull aching pain in the lower back, thigh, abdomen or genitals (increased by changing body position);
- frequent urge to urinate;
- renal colic (acute cramping pain in the lower back and lower abdomen);
- excretion of urine with blood (possibly with an independent exit of the calculus);
- problems with urination (impossibility of complete emptying, interruption of the process).
How to diagnose urolithiasis?
If urolithiasis is suspected, a urologist should be consulted. The doctor will conduct a general examination, issue a referral for a general analysis / biochemical study of urine, determination of the hydrogen index (pH) and bacteriological culture. Analyzes determine the presence / absence of stones, their chemical composition, the specifics of impurities, infections and other things. To visualize the condition of the ureters (size, location, shape), X-ray, computed tomography, ultrasound, endoscopic or echographic examination is necessary.
Features of stone removal
For decades, the only method of neutralizing stones was surgery. Later, non-surgical ways to get rid of stones developed, which combined high efficiency and minimal consequences for the patient. Their essence lies in the focusing of a shock wave of various origins (ultrasonic, laser, and so on). The wave destroys the stone into small fragments, which are independently excreted from the body. The disadvantage of the method is the pain of removing stones. The process is accompanied by bleeding, renal colic, impaired urination and can last about a month. What you need to know about the methods of removing stones from the ureter, which one to choose and what nuances of therapy should be paid attention to?
Medication
Most often, stones enter the ureter from the kidneys. Violation of metabolic processes changes the structure of urine and leads to the formation of substances that cannot dissolve in it. Substances gradually accumulate, turning into a dense stone, which can be a threat to the body. If the size of the formation is small and it is still in the renal cavity, doctors may prescribe litholytic therapy.
The displacement of the stone and its progress along the urinary tract is one of the complications of the disease. The process is accompanied by damage to the mucous membranes, spasm of smooth muscles, irritation and pain. The complication can be caused by physical activity, shaking in public transport, hypothermia, eating spicy foods, large amounts of fluids or diuretics.
Most patients diagnosed with urolithiasis go to the doctor with severe pain, renal colic, and mucosal lesions. The doctor simply cannot wait for the stones to dissolve, so surgical methods are used to remove them. The use of drug therapy is possible in rare cases, when the size of the stone is minimal, and the patient’s condition is satisfactory.
Ureterolithoextraction
The operation is performed in emergency cases, when the calculus interferes with the outflow of urine and is not amenable to conservative therapy. The size of the formation should not exceed 8 millimeters. The surgeon inserts the endoscope into the internal cavity through the bladder and urethra. The calculus located in the mouths of the ureter is cut into several parts, hooked with a special loop and brought out. After extraction, the surgeon performs stenting. He installs a stent (special frame) in the lumen of the ureter to increase it, to increase the excretion of urine / sand / microscopic fragments of the stone.
Contact laser lithotripsy
This is a minimally invasive operation based on the properties of laser energy. How exactly does the intervention take place? Miniature instruments are inserted into the stone through the urethra. Then a laser fiber is brought to it and proceed to removal. The laser begins to release energy that crushes the calculus into dust, regardless of its chemical composition / density. Manipulations are carried out under the visual control of the surgeon, which reduces the risk of damage to the ureter or kidney.
The efficiency of removing stones up to 10 millimeters by the contact laser method exceeds 95%.
The patient is pre-injected with local anesthesia, so discomfort or pain is excluded. The risk of developing an inflammatory process or any other complications is negligible. A day after the operation, the patient is discharged from the hospital and given a few days/weeks for full recovery.
Remote lithotripsy
One of the safest and most common methods of neutralizing stones. A special apparatus generates waves that crush the stone into a huge number of small fragments. Fragments are excreted from the body on their own along with urine. The duration of the procedure varies from 40 to 90 minutes. The need for anesthesia is determined in each case. Remote lithotripsy can remove small stones – from 0,5 to 2 centimeters. The calculus should be well contoured on x-rays, so that the doctor knows where and with what force to direct the apparatus.
The method is contraindicated in case of blockage of the lumen of the ureter and violation of the outflow of fluid. It is impossible to perform lithotripsy even in a serious condition of the patient. The surgeon simply will not be able to lay the person on the table and carry out the necessary manipulations.
Ultrasonic lithotripsy
Endoscopic manipulation based on ultrasonic shock wave. Special equipment is inserted through the human urethra, which generates ultrasonic energy and crushes the stone into pieces. The method is not suitable for removing stones with a dense structure larger than 1 mm. Before the surgeon’s actions, the patient is given general anesthesia. Healthy tissues that are around the stone are not exposed to pathological effects. The duration of the procedure depends on the number, shape and density of formations. After 1-2 days, the patient is discharged from the hospital and he can return to the usual rhythm of life.
Laparoscopic ureterolithotomy
Ureterolithotomy is used to treat urolithiasis in renal colic, infection/other complications, obstruction of a solitary kidney, and failure of other methods. First, the surgeon must gain access to the organ. He makes a Fedorov incision, separates the ureter from the surrounding connective tissue, makes several incisions, and removes the stone with a forceps. It is very important not to damage the walls and not destroy the calculus inside the human body. After removing the calculus, the surgeon sews up the incisions and installs a drain. Recovery after surgery takes from 3 weeks to 2 months.
The choice of stone removal method always remains with the doctor. He makes a decision based on the results of the tests. Some techniques are suitable for removing large phosphate stones, while others are better for miniature urates. Only complex diagnostics will help to choose the best method that can solve the patient’s problem. The main thing – do not self-medicate. Do not try to dissolve the stones with medication or avoid going to the doctor if the stones are passed in the urine on their own. Tell your doctor about any symptoms that may affect the course of therapy. Be careful and healthy.