Patients often come in and ask what happens to urinary stones. What should I do if I have kidney stones? What are the best ways to treat kidney stones and what are the new advances in minimally invasive treatment. With these questions in mind, let’s talk about the problems related to urinary stones.
Q: What is a urinary stone?
A: Urinary stones are also known as urolithiasis, urolithiasis, urinary stones, urinary stones, etc. They include kidney stones, ureteral stones, bladder stones and urethral stones. In terms of age of onset, it is mostly seen in young adults. In terms of incidence, there are more men than women.
According to the chemical composition of common stones, urinary stones are subdivided into calcium-containing stones (calcium oxalate and calcium phosphate), infected stones, uric acid stones and cystine stones. Generally speaking, positive stones are those visible on X-ray plain films and are the most common, including calcium oxalate stones, calcium phosphate stones, and infective stones, which account for about 90% of urinary stones. Negative stones are stones that cannot be seen on X-ray plain films and can be detected by ultrasound or CT, mostly referring to uric acid stones, which account for about 10%. Through laboratory tests, the chemical composition of the stones can be determined. With different stone composition, then prevention methods are different, and even treatment methods are different, and may have different effects on treatment.
It is now believed that the etiology of urinary stones formation is very complex, it is related to the natural environment, social living conditions, the body’s own metabolism and diseases of the urinary system itself, and may be the consequence of a combination of factors. Generally speaking, through laboratory analysis of blood, urine and stones, the causes of stone formation can be determined, laying the foundation for stone prevention in the future.
Q: How can I know that I have urinary stones?
A: Urinary stones can be asymptomatic, so some patients are detected by physical examination, but most patients are diagnosed clearly because of symptomatic attacks. The typical symptoms of urinary stones are pain and hematuria. The pain is located on one side of the lower back or side of the abdomen. The pain can be mild or an episode of colic. Having an episode of renal colic can last a lifetime. Colic often comes on suddenly, either after strenuous activity or during sleep. The pain is like a knife cut, radiating from the lower back to the ipsilateral lower abdomen, vulva, and inner thighs. It is sometimes accompanied by pallor, cold sweat, weak and rapid pulse, and drop in blood pressure. After a period of time, colic can be relieved spontaneously, but mostly requires the application of analgesic drugs to relieve it. After the onset of colic, laboratory tests reveal microscopic hematuria or hematuria in the naked eye. Based on these manifestations, you can usually know that you have urinary stones, and the diagnosis can be made clearly after ultrasound or X-ray examination.
Q: What damage do urinary stones do to the body?
A: Urological stones damage the body mainly in the urinary system and can cause urinary tract obstruction, infection and injury. Stones, obstruction and infection are the cause and effect of each other, forming a vicious circle, i.e. stones cause obstruction, obstruction causes infection, and infection causes stones.
(1) Obstruction? Ureteral stones are most likely to cause obstruction. If stones are embedded in the ureteral junction of the renal pelvis, they can cause hydronephrosis. If a stone is obstructed in the middle or lower ureter, it can lead to dilatation of the ureter above the stone and fluid accumulation. If the stone is located in the renal calyces, it does not necessarily cause significant obstruction and may not cause symptoms. Long-term development of stone obstruction may cause enlargement of the renal pelvis and calyces, hydronephrosis, and eventually atrophy of the renal cortex into a water sac and loss of function. Intermittent or persistent obstruction of the urethral orifice by bladder stones can cause thickening of the bladder wall and urinary retention. If urinary retention persists for a long time, it can cause uremia.
(2) Infection? Stones combined with infection cause stone pyelonephritis, pus accumulation in the kidney, perinephritis, perinephric abscess, and eventually complete destruction of the kidney parenchyma. In addition, obstruction and infection increase the size of the stone and aggravate the kidney lesion. The more common germ of kidney infection is E. coli.
3) Damage? Stones can cause direct damage to the kidney and bladder. Large or rough stones can easily cause mucosal erosion, ulceration and bleeding in the kidney or bladder, or even cause spontaneous kidney rupture or fistula. Long-term irritation of the mucosa by stones may cause squamous epithelial carcinoma, such as renal pelvis cancer and bladder cancer. Therefore, if you have urinary stones, you must treat them actively.
Q: What should I do if I have urinary stones?
A: Clinically, it is important to know not only whether you have a stone, but also the size, number, location, and cause of the stone. Generally speaking, 90% of stones less than 0.5 cm in diameter can be expelled naturally. When stones are larger than 0.8 cm in diameter, surgical intervention is required. Currently, all patients with urinary stones do not require open surgery for stone extraction. Extracorporeal shock wave lithotripsy is preferred, and minimally invasive treatment can be implemented by intracorporeal intervention for larger, multiple, or complex kidney stones, or for ureteral stones with adhesive obstruction, as well as for larger bladder stones. For example, transurethral giant bladder stone lithotripsy, transurethral ureteroscopic lithotripsy and percutaneous nephrolithotripsy can be used to crush the stones and remove them with less trauma, less pain and shorter hospital stay using combined pneumatic ballast/ultrasound lithotripter and laser lithotripter.
Q: What is extracorporeal shock wave lithotripsy? For which patients is it suitable?
A: With the development of related disciplines and the continuous innovation of medical devices, the treatment of urinary stones has made a breakthrough or revolutionary change, and urinary stones generally do not require open surgery! This is the credit of extracorporeal shock wave lithotripter! The stones can be shattered outside the body, and the stones can be as big as green beans or as small as fine sand, and can be excreted with urine. Therefore, extracorporeal shock wave lithotripsy is called “the revolution in the treatment of urinary stones”. Extracorporeal shock wave lithotripsy can treat kidney stones less than 2 cm in diameter and ureteral stones less than 1 cm in diameter, and it is the preferred treatment method. Of course, patients with larger stones or comorbidities need lumpectomy, such as percutaneous nephrolithotomy, transurethral ureteroscopy, transurethral cystoscopy, etc., which requires specific treatment for specific problems.
Q: What is percutaneous nephrolithotomy for stone extraction?
A: Complex and difficult kidney stones include stones larger than 2.0 cm in diameter, antler-shaped stones, multiple stones, ectopic kidney stones, combined horseshoe kidney stones, infected stones, cystine stones, isolated kidney stones, etc. These are large stones or special stones that cannot be solved by extracorporeal lithotripsy machines, and are also the most recurrent stones, which often require multiple surgical interventions during the patient’s lifetime, and multiple openings for a patient in the past Stone extraction, which is common, has seriously affected the physical and mental health of patients. Currently, minimally invasive treatment through percutaneous nephrolithoscopy, ureteroscopy and other lumpectomy techniques are promoted for these complex and difficult stones.
Percutaneous nephrolithoscopy technology is to make a pen-sized hole in the patient’s waist to establish a channel from the skin to the kidney, and then use laser or pneumatic ballistic combined with ultrasonic lithotripsy under the nephrolithoscope to break up the stones and suck them out of the body, which is imaginatively compared to “making a hole to get a stone”. Percutaneous nephrolithotomy is mainly used to treat difficult giant kidney stones, multiple kidney stones and upper ureteral stones.
Q: What is transurethral ureteroscopy for stone extraction?
A: For ureteral stones, extracorporeal shock wave lithotripsy is generally used for treatment, but ureteral stones with a stone diameter greater than 1 cm across, or stones for which extracorporeal shock wave lithotripsy has failed, can be treated minimally invasively using ureteroscopic techniques. Ureteral stones near the bladder are treated by transurethral ureteroscopic lithotripsy, while ureteral stones near the kidneys can be treated by minimally invasive percutaneous transluminal ureteroscopy.
Q: How to prevent stone recurrence?
A: Urinary stones are prone to recurrence, which is a headache for doctors and patients. So how can recurrence be prevented? First of all, to develop the habit of drinking more water, how much to drink, a simple method of judgment is recommended, the color of your urine discharge is not yellow, the amount of water is enough. Generally, you should drink 2,000 to 3,000 ml of water every day, clinically called “hydration”, which is essential to prevent stone formation. Second, is to pay attention to dietary regulation, such as high calcium urine patients, should eat less high calcium food such as milk; high oxalic acid urine patients should eat less food rich in high oxalic acid, such as spring spinach, black tea, etc.; uric acid stone patients should eat less purine-rich food, such as liver, kidney and other animal offal. Finally, you should insist on taking medication for prevention, especially for recurrent stone patients, you should go to the hospital to find out the cause of the stone, so as to carry out selective drug treatment. Most of them can prevent the recurrence of stones as long as the medication is taken consistently.