With the changes in work, life rhythm and exercise and eating habits in modern society, the incidence of urinary stones is increasing year by year. The typical manifestations of kidney and ureteral stones are renal colic and hematuria. Before the onset of colic caused by stones, the patient does not feel anything, but due to some triggers, such as strenuous exercise, labor, long-distance travel, etc., sudden onset of severe colic on one side of the waist, and radiation to the lower abdomen and perineum, accompanied by abdominal distension, nausea, vomiting, varying degrees of hematuria; bladder stones are mainly manifested by difficulty in urination and painful urination. “Urinary stones”, also known as “urinary stones or urolithiasis”, is a common disease of the urinary system. Stones can be found in any part of the kidney, bladder, ureter and urethra, but kidney and ureteral stones are the most common. The peak age of patients with urolithiasis is between 25-40 years old, with two peaks in women, 25-40 years old and 50-65 years old. The second peak may be related to menopause and osteoporosis in women. 2-3% of stone disease occurs in children aged 2-6 years and is often associated with urinary tract infections and congenital malformations. Male:female is about 3.1-9.46/1, with large regional differences, where men suffer from urinary stones about 1-2 times more than women, with an annual new incidence of 150-200/100,000 in China. The regional differences in the incidence of urolithiasis are very obvious. According to the survey, the incidence of urinary stones in China is roughly less than 14% north of the Yellow River, 22-45% south of the Yangtze River, and up to 50% or more in individual provinces and cities (accounting for the rate of urological hospitalization). Urolithiasis is if left untreated, it may lead to impaired kidney function, and in severe cases even require removal of the kidney, uremia, etc. Clinical diagnosis The most common method for the diagnosis of urinary stones is ultrasound, which can detect stones above 0.3 mm. skilled medical personnel can use ultrasound to examine stones in the whole urinary tract, which is intuitive, convenient and non-invasive. x-ray abdominal plain, which can see most of the urinary stones, and for negative stones, x-ray can penetrate the stones and thus cannot be seen. x-ray angiography, for suspected ureteral stones CT has the highest diagnostic accuracy and is an accurate test, but the cost is high. MRI is costly and the detection rate is not very good. Common causes Urolithiasis of unknown origin and mechanism are called primary urinary stones. Metabolic urinary stones, which are the most common, are caused by metabolic disorders in the body or within the urinary stones of the kidney, such as hyperthyroidism, increased urinary calcium due to idiopathic calciumuria, increased uric acid excretion in gout, and a large increase in phosphate in renal tubular acidosis. The stones formed are mostly urate, carbonate, and cystine xanthine stones. Secondary or infectious stones are mainly bacterial infections of the urinary system, especially bacteria that can break down urea and Aspergillus can break down urea into free ammonia to alkalize the urine, prompting phosphate and carbonate to form stones with bacteriophages or pus masses as the core. In addition, stone formation is associated with race (less frequent in blacks), genetics (genetic tendency of cystine stones), gender, age, geography, diet, nutritional status, and urinary tract disorders such as urinary tract strictures and prostatic hyperplasia. Clinical treatment The location and size of stones are different, and the method of stone extraction is completely different. Due to the causes and physical and physiological characteristics of stones, the effect of internal treatment is limited. The following 7 types of treatment are available: 1. Drug therapy Patients with stones <6mm in diameter, no obvious symptoms and no renal impairment can choose drug therapy. 2.Extracorporeal shock wave lithotripsy is mainly used for kidney stones ≤2cm in diameter and ureteral stones <1.5cm in length in the upper segment. Patients with pregnancy, bleeding disorders, urinary tract infection, severe cardiovascular disease, urinary tract obstruction and renal insufficiency are not suitable for this treatment. When the stone size is too large, multiple lithotripsy is required and the stone residual rate is high. In addition, frequent extracorporeal lithotripsy within a short period of time is likely to cause kidney function damage. 3.Ureteroscopic lithotripsy and lithotripsy is mainly suitable for lower and middle ureteral stones. Patients with urinary tract strictures and severe distortion may not be able to reach the stones with ureteroscopy. 4.percutaneous nephrolithotomy and lithotripsy Establish a channel between the patient's lumbar skin and the kidney with a diameter of less than 0.6cm (ultra-fine percutaneous nephrolithotomy SMP can make the channel extremely small) and then break up and remove the stones. It is also suitable for larger stones such as antler-shaped stones, and is the most widely used minimally invasive surgical procedure for the treatment of kidney stones. 5.Ureteroscopic Holmium laser lithotripsy and lithotripsy via the physiological channel of urethra, bladder and ureter into the pelvis and calyces, with Holmium laser lithotripsy, which is effective for stones within 2cm. 6.Ureterotomy for stone extraction Open or laparoscopic ureterotomy for stone extraction has postoperative complications such as urinary leakage and stricture. 7, "multi-scope combination" - ureteroscopy, percutaneous nephrolithotomy lithotripsy, stone extraction Many units in China have been carried out to maximize the cure. Endoscopic surgical treatment is still the first choice for treatment. Extracorporeal shock wave lithotripsy must have two conditions: one is that the kidney stone can be crushed by the shock wave, and the other is that the kidney stone can be discharged from the body in time after being crushed. These two conditions are indispensable, otherwise it will bring difficulties to the future treatment. Stones smaller than 2 cm are generally more suitable for extracorporeal shock wave lithotripsy. When it comes to how to prevent kidney stones, the cause of kidney stones is not the most clear, but drinking more water is very useful to prevent kidney stones, and you can judge whether you are drinking enough water by the amount of urination. At present, the weather is getting hot, especially in summer, it is more important to pay attention to drink more water. Stone composition analysis Calcium oxalate monohydrate is oxalic acid-dependent stone In terms of dietary control, restrict oxalic acid mainly! Calcium oxalate dihydrate is a calcium-dependent stone. In terms of dietary control, restrict calcium intake! For uric acid stones, restrict sugar intake for dietary control! Kidney stones (<1 cm) in children, combined with anatomical malformations of the kidney, magnesium ammonium phosphate stones, cystine stones often require intervention, ESWL, fURS, mPNL are all three treatment modalities, and minimally invasive flexible mirror is the direction of development. Studies have concluded that 83% of stones are idiopathic, 5% are attributed to anatomical abnormalities, 3% are caused by infectious factors, and 9% are metabolic. There is still a lack of effective prevention for recurrent stones, and increasing water intake remains the most reliable way to reduce the risk of recurrence. Stones and lasers, ureteroscopy Ureteroscopy makes minimally invasive lithotripsy possible. The pulsed release of the holmium laser links the stones to the laser, and devices such as ureter become good mediators. Depending on the length of the laser pulse width, there are four types: ultra-short pulse width (150 microseconds), short pulse width (300 microseconds), medium pulse width (600 microseconds) and long pulse width (>800 microseconds). In holmium laser lithotripsy, the shorter the pulse width, the more likely the laser is to result in fragmentation and the longer the pulse width, the more likely the laser is to produce dusting. Regardless of the density of the stones, the long pulse width laser creates a better powdering effect than the high frequency laser mode. Depending on the nature of the stones, the choice of laser with different pulse widths, i.e., the use of adjustable pulse width lasers, has become a direction of laser development. Urinary stones and diet Many kidney stone patients also suffer from osteoporosis, but since many kidney stones are calcium-containing stones, they often have the concern: I have kidney stones in my body, or I just had kidney stone surgery, can I still take calcium supplements? Do I need to limit my calcium intake? 1, calcium supplementation and kidney stones In recent years, studies have found that the role of oxalic acid in the formation mechanism of calcium oxalate stones is more than ten times greater than the role of calcium. Although kidney stones are mainly formed by the combination of oxalic acid and calcium, the formation of kidney stones does not depend on the amount of calcium intake, but mainly on the level of oxalic acid concentration. The body’s blood calcium concentration maintains a dynamic balance Generally speaking, the body’s blood calcium concentration is certain. When there is a lack of calcium in the diet, parathyroid hormone promotes the dissolution of calcium from the bones to maintain the balance of blood calcium concentration. Even without calcium supplementation, the precipitation of bone calcium can still bind oxalic acid to form stones. In other words, if the oxalic acid concentration is too high, even if you do not take any calcium supplement, oxalic acid will combine with the calcium released from the bone to form new small stones or increase the size of existing stones. Therefore, for this type of kidney stone patients, strict restriction of calcium intake will not prevent the formation of stones. Therefore, to prevent kidney stones and slow down the development of kidney stones, controlling the concentration of oxalic acid is the key. Intake of high doses of vitamin C increases urinary oxalic acid excretion in normal subjects. Long-term overdose of vitamin C supplements may lead to calcium oxalate stones. The daily intake of vitamin C is advisable at 100 mg, which can be obtained from fresh fruits and vegetables. 2, reasonable calcium supplementation can prevent kidney stones For some types of kidney stones, reasonable calcium supplementation will not only not cause you to develop kidney stones, but on the contrary, it also has the effect of preventing kidney stone formation, and for patients who have had stone removal treatment, it also reduces the risk of recurrence of kidney stones. Calcium can combine with oxalic acid in food to reduce the absorption of oxalic acid in food to enter the body through the digestive tract. Calcium can combine with oxalic acid in the gastrointestinal tract to form calcium oxalate precipitation, which can prevent oxalic acid from being absorbed by the small intestine and excreted directly from the body, which is the key to the effect of kidney stone prevention. Some studies have shown that kidney stone patients with high concentration of oxalic acid in urine reduced the concentration of oxalic acid after eating more calcium-rich foods, while the excretion of urinary calcium did not change in any way. Calcium can reduce the oxalic acid concentration in blood by inhibiting the absorption of oxalic acid, therefore, reasonable calcium supplementation can prevent kidney stones and reduce the risk of recurrence of kidney stones. Excessive calcium restriction can also cause kidney stones In addition, it is also believed that excessive restriction of calcium intake may lead to increased calcium reabsorption by the renal tubules, thus increasing the local calcium concentration and causing kidney stones. The daily calcium intake should be 1000~1200 mg. 3, spinach and tofu cause kidney stones spinach and tofu can not be eaten together, small onions and tofu can not be eaten together, these so-called “food compatibility” statement, from the fear of oxalic acid and calcium combination. The combination of oxalic acid and calcium in the digestive tract is nothing to worry about. What is the harm of combining oxalic acid and calcium? There is no harm in combining in a pot, in a bowl, or in the digestive tract. This is because once calcium oxalate is formed, it is no longer possible for the body to absorb it into the bloodstream. Therefore, eating spinach and tofu together is at most a waste of a little calcium. What we need to worry about, instead, is the oxalic acid ingested alone is absorbed by the body, and then encounter calcium in the blood, and then free to the kidneys, urine concentration, before it may cause kidney stones, bladder stones or urethral stones. 4, kidney stone patients should eat less vegetables Not all vegetables contain oxalic acid, oxalic acid is a common component in vegetables, but the content varies greatly, up to be able to vary by a hundred times. Generally speaking, vegetables with a distinctly astringent taste have a high oxalic acid content. Blanching can remove most of the oxalic acid oxalic acid content of high spinach, amaranth and other vegetables, just boiling water blanching can remove 40-70% of oxalic acid. 5, sufficient magnesium and potassium help prevent kidney stones Vegetables are quite rich in potassium, green leafy vegetables also contain more magnesium, both elements are conducive to reduce the amount of urinary calcium excretion, and urinary calcium concentration decreases, for the prevention of kidney stones is very beneficial. Magnesium deficiency increases the risk of calcium oxalate kidney stone formation; proper magnesium supplementation reduces the risk of calcium oxalate kidney stone formation. More intake of purple cabbage, millet, corn, winter vegetables, amaranth, chili peppers, mushrooms, popcorn, cinnamon, walnuts and other foods with high magnesium content to prevent stone formation. 6, vitamin B6 can inhibit the synthesis of endogenous oxalic acid Adequate vitamin B6 can avoid the formation of oxalic acid precursors, thus reducing the amount of oxalic acid in the urine. 7, Vitamin A intake Because vitamin A is necessary to maintain the health of the urethral lining, it helps to prevent the recurrence of stones. Vitamin A deficiency can increase the risk of kidney stones. Supplement with foods rich in vitamin A. Eat foods rich in vitamin A such as carrots, cauliflower, melon, squash and beef liver. However, supplementation of vitamin A should not be excessive, otherwise poisoning will occur. 8, excessive intake of vitamins Excessive intake of vitamin D can produce excess vitamin D3, which promotes intestinal calcium absorption, causing the occurrence of hypercalciuria and increasing the risk of kidney stones. The daily intake of vitamin D for adults should be 10 to 15 mg. With the exception of sea fish, there are few foods that contain significant amounts of vitamin D in the diet, and one need not worry that the diet will cause an excess of vitamin D. It is important to note that additional supplementation with vitamin D preparations can easily cause overdose. Urological stones and endocrinology The parathyroid glands, so called parathyroid glands, occasionally “migrate” to other places, such as in the thymus, mediastinum, or thyroid gland. It is composed of two main types of cells – principal cells and eosinophils, the former secreting parathyroid hormone (PTH). About 80% of normal people have four parathyroid glands, two pairs of upper and lower parathyroid glands, located between the inner and outer peritoneal layers of the thyroid gland and attached to the posterior margins of the right and left lobes of the thyroid gland. 13% of normal people have only three parathyroid glands, 6% have five, and a few have a large family of up to 10. Each parathyroid gland in normal adults is about 6.5mm x 3.5mm x 1.5mm in size and weighs 25mg on average. Hyperparathyroidism causes increased secretion of parathyroid hormone (PTH) by the parathyroid glands, which raises blood calcium. In hypercalcemia, nausea and poor appetite may occur, and patients may complain of dry mouth and excessive urination due to excessive calcium excretion in the urine. Causes of hypercalcemia include increased intestinal calcium absorption, such as the consumption of large amounts of calcium-containing foods and medications, or the occurrence of hypervitaminosis D, which results in excessive bone calcium absorption and the release of large amounts of calcium into the blood. Calcium salts are deposited in the kidneys, causing recurrent kidney stones.PTH stimulates bone resorption, mobilizes calcium and phosphorus from bone into the blood; promotes calcium reabsorption from the distal tubule; it also inhibits phosphorus reabsorption from the proximal tubule and may also promote phosphorus secretion from the renal tubule. It indirectly promotes the absorption of calcium and phosphorus in the small intestine by stimulating vitamin D production. Low blood calcium can stimulate parathyroid hyperplasia and promote PTH secretion, causing an increase in blood calcium, while high blood calcium can inhibit PTH synthesis and secretion, causing blood calcium to shift to bone and tend to decrease. At the same time, an increase in blood phosphorus concentration can promote the secretion of PTH. Therefore, PTH is the most diligent “carrier” of calcium and phosphorus in the body, which ensures the relative stability of the internal environment of mineral metabolism in the body. In addition, calcitonin promotes the secretion of PTH by the parathyroid glands, while vitamin D inhibits the secretion of PTH. The prevalence of primary hyperparathyroidism is about 1/1000, the incidence increases with age, and the prevalence in postmenopausal women is 5 times higher than that in the general population. The onset of the disease is slow, ranging from asymptomatic, to those with bone pain as the main manifestation, to those with gastrointestinal symptoms, to those found with recurrent kidney stones. Therefore, the occurrence of endocrine diseases must be considered for recurrent kidney stones. Endocrine diseases such as acromegaly, pheochromocytoma, and certain malignant tumors (breast cancer, kidney cancer, lung cancer, etc.) can also cause kidney stones.