I. Definition
Stones that occur in the urinary system, such as: kidney, ureter, bladder or urethra, are called urinary stones.
II. Etiology
1, dietary habits: drinking too little water, eating too much high purine (such as: seafood, beans, offal), high protein or calcium food, oxalic acid food (such as: spinach).
2, metabolic abnormalities: hyperparathyroidism, long-term bed rest, tumors, taking hormonal drugs, renal tubular acidosis, cystinuria, hyperuricemia, etc.
3, urinary tract obstruction: hydronephrosis, ureteral stenosis, duplicated kidney ureter, sponge kidney, polycystic kidney, horseshoe kidney, prostatic hyperplasia, etc.
4, urinary tract infection.
5.Urinary foreign body.
6, drugs: sulfonamides, anti-HIV drugs, Vit C, Vit D, etc.
Three, common symptoms
1, pain: the typical pain is renal colic, pain in the lower back or abdomen, sometimes radiating to the perineum. In acute attacks, the pain is severe and may be accompanied by nausea and vomiting. When the kidney stone is not obstructed, it can be asymptomatic or less painful.
2, hematuria: the most common symptom, mostly urine routine microscopic hematuria, occasionally flesh-eye hematuria.
3, urethral irritation symptoms: may be accompanied by urinary urgency, urinary frequency, urinary pain.
4, infection: urinalysis may have inflammation, obstructive infection may have fever.
Four, examination methods
1.Urinary routine: recommended to understand the presence of microscopic hematuria and assist in diagnosis. Understand the presence of urinary tract infection.
2.Urological ultrasound: recommended as the first choice for examination, low sensitivity of middle and lower ureteral stones.
3.X-ray abdominal plain film (KUB): recommended, some stones do not show up on X-ray.
4.Urological CT: the highest diagnosis rate, can detect negative stones that are not visualized on X-ray, and is of great significance in the diagnosis of emergency renal colic.
5.Intravenous pyelogram: to understand the location of stone obstruction, the presence of stenosis and other anatomical abnormalities, and to understand the excretory function of the kidney.
V. Treatment methods
(A) Etiological treatment: treat the original disease such as hyperthyroidism and urinary tract obstruction.
(B) Drug treatment
1, antispasmodic and analgesic drugs.
2.Antibiotics: for treatment or prevention of infection.
3.Lithotripsy drugs: combination of Chinese and Western drugs.
4.Fluid intake 2000-3000ml daily.
(iii) Extracorporeal shock wave lithotripsy: high success rate of lithotripsy for kidney stones less than 1.5-2.0 cm in diameter and upper ureteral stones.
(d) Percutaneous nephrolithotomy: it is suitable for kidney stones and upper ureteral stones, especially for larger or complex stones, with the highest success rate and low complication rate.
A small 1 cm orifice is created by puncturing and dilating a fine needle in the posterior lumbar region, through which a special minimally invasive lithotripsy instrument enters the renal calyces and renal pelvis to break up the stones and aspirate them out of the body. It is the most widely used minimally invasive lumpectomy treatment for urinary tract stones at home and abroad.
(e) Ureteroscopic lithotripsy: It is suitable for middle and lower ureteral stones.
(f) Ureteroscopic lithotripsy and lithotripsy: This is a minimally invasive procedure that has developed rapidly in recent years. It is a minimally invasive procedure that can be performed through the natural lumen of human body, with little trauma, quick recovery and short hospital stay. It can deal with upper and middle ureteral stones and kidney stones, and can be used with percutaneous nephrolithoscopy to reduce surgical trauma, reduce the number of operations and improve the stone removal rate.
Sixth, care guidance
1.Ureteroscopic lithotripsy, cystoscopic lithotripsy or extracorporeal shock wave lithotripsy
(1) Drink more water, at least 2000ml-2500ml per day, to facilitate stone discharge and prevent recurrence.
(2) Get out of bed as early as possible to promote blood circulation, reduce lung infection and promote exhaustion, as well as to promote stone debris discharge.
(3) After surgery, it is important to observe the color of the urine. It is normal to have slight hematuria. If the urine is bright red and dark in color, notify your healthcare provider immediately.
(4) If you have a urinary catheter placed, you should pay attention to whether the urinary catheter is open or not.
2. Percutaneous nephrolithotomy for lithotripsy
(1) After surgery, pay attention to the patency of the nephrostomy tube and ureter, the flow of drainage and the volume and color of urine, and inform the medical staff immediately if the blood color is heavy.
(2) If there are no signs of bleeding after surgery, get out of bed as soon as possible to promote blood circulation, reduce pulmonary infection and promote exhaustion.
(3) Before exhaustion, fasting water is required, and after exhaustion, a small number of meals and normal diet should be resumed gradually according to medical advice.
VII. Discharge guidance
1.After stone surgery, most patients are routinely placed with ureteral stent tubes (D-J tube, double pigtail tube).
(1) After 4 weeks, outpatient review and cystoscopic extubation.
(2) During this period, mild lumbar and abdominal pain, lower abdominal pain, and discomfort in urination may occur, and the urine may occasionally turn red and washout-like in color. No need to be nervous, just rest, brake and drink more water, most of them can be relieved.
(3) Avoid sitting, standing or walking too much before cystoscopy to remove the D-J tube, do not hold urine, urinate regularly and pay attention to the color and amount of urine.
(4) After removal of the D-J tube from the cystoscope, you can gradually increase your activities according to your physical condition.
(5) Do not lift heavy objects, engage in strenuous activities or heavy physical work for three months.
2.If any of the following conditions require immediate medical attention.
(1) Severe pain in the lower back, which cannot be relieved continuously.
(2) Decreased urine output
(3) Fever: high fever or repeated low fever.
(4) Urine becomes red in color.
(5) Wound with redness, swelling, heat, pain or sudden increase in discharge. You should take medication and follow up on time.
3. Review and follow up: The recurrence rate of stones is very high, about 30-45%, so ultrasound, KUB, urine routine and renal function should be reviewed every 3-6 months on an outpatient basis.
VIII. Dietary guidance
For different stones, different dietary guidance can be given to reduce the recurrence of stones. The following are the main points of the diet for various types of stones for reference.
1. Calcium-containing stones.
(1) Increase water intake and urine output: For those without water restriction, try to take in as much water as possible, about 2000-3000 ml per day. avoid excessive consumption of caffeine, black tea, grape juice, apple juice and Coca Cola. Drinking more orange juice and lemon water is recommended.
(2) Dietary balance.
Normal calcium content diet, soy and dairy products are recommended.
Calcium restricted diet and uncontrolled high calcium diet are not recommended.
Increase vegetables, fruits, coarse grains and fiber diet.
Limit animal protein, sodium intake and excessive vitamin C intake.
Restrict high purine diet: animal offal, poultry skin, sardines, anchovies, etc.
Avoid oxalic acid-rich foods such as kale, almonds, peanuts, spinach, black tea and cocoa powder in patients with calcium oxalate stones.
(3) Weight restriction: overweight is one of the important factors in the formation of urinary tract stones.
(4) Drug prevention: take alkaline citrate and other drugs as prescribed by the doctor to prevent stone recurrence.
2. uric acid stones.
(1) Increase water intake and urine volume: keep urine volume above 2000ml per day.
(2) Drug prevention: alkalize the urine and take drugs such as alkaline citrate as prescribed by the doctor.
(3) Reduce uric acid formation: take allopurinol, folic acid and other medications as prescribed.
3. Infectious stones
(1) Increase water intake and urine volume: keep urine volume above 2000ml per day.
(2) Recommend low phosphorus and low calcium diet.
(3) Select antibiotics according to the urine culture drug sensitivity test to actively treat the infection, the course of treatment should be sufficient.