According to a cross-sectional study of the national epidemiology of urolithiasis conducted on adult populations in seven provinces and cities, including Guangdong, Chongqing, Heilongjiang, Hunan, Shanghai, Gansu and Shanxi, the incidence of urinary calculi in the south was significantly higher than in the north; the incidence in rural areas was higher than in urban areas; and the incidence in men was higher than in women. “Urolithiasis is one of the most common diseases in urology, which can cause symptoms such as pain, hematuria and fever, leading to recurrent and severe urinary tract infections and acute urinary tract obstruction, causing serious consequences such as acute and chronic renal failure, and even nephrectomy.” The incidence of urolithiasis in different regions of the world ranges from 2% to 20%. No nationwide incidence has been reported in China. The survey found that the national prevalence of urolithiasis in adults was 6.06%. If China is divided into southern and northern regions by the Yangtze River, the incidence rate in southern regions is higher than that in northern regions, with the highest incidence rate in Guangdong and Chongqing, 11.63% and 11.29%, respectively, and the lowest incidence rate in Gansu and Shanxi, 1.86% and 0.14%, respectively; the incidence rate in rural areas is higher than that in urban areas; and the incidence rate in men is higher than that in women. The survey results also showed that the incidence rate increased with age. “The incidence of urinary calculi was significantly higher in the South than in the North.” In urological diseases, the most southerners suffer from urinary stones, accounting for more than 50% of urology inpatients; while in the north, the proportion of urological tumors and prostate enlargement is a little more. The reason for this is that the temperature in the south is higher than that in the north, which is an important reason. “High temperature means more sweating, if you do not drink enough water, urination will be reduced, and once the urine is concentrated, inorganic salts in the urine are prone to supersaturation and precipitation to form crystals.” At this time, if there is damage to the renal tubular epithelium, crystals will adhere to the tubular epithelium, and the more they accumulate, the more stones will be formed. Sweating more and urinating less in physical labor is also one of the important reasons why the incidence of urinary stones is higher in men than in women and in rural areas than in urban areas. Therefore, people at high risk of urinary stones should pay more attention to drinking water. “It’s best to make sure you have more than 2,000 milliliters of water to drink every day.” For those with existing stones, he said, it is recommended to drink 200 milliliters of water before bedtime. “That way, you can get up once during the night, thus reducing the accumulation of crystals in the renal collecting system. Of course, patients with poor sleep quality will need to weigh the pros and cons before making a choice.” Treatment Myth #1: Thinking that if you don’t have pain, you can stop taking your medication Treatment of urinary stones requires a treatment plan based on the size of the stone. Usually, small stones less than 5 mm can be treated conservatively with medications; stones less than 2 cm can be treated by extracorporeal shock wave lithotripsy or holmium laser lithotripsy and stone extraction under ureteral soft microscopy; stones larger than 2 cm can be treated by percutaneous nephrolithotomy for stone extraction. Patients also have two misconceptions about the treatment of urinary stones. One is that many patients who use drugs to treat small stones think that if they are not in pain, they can stop taking the drugs and that they are cured. This is not true. Just because a person with stones is not in pain does not mean that the stones do not exist anymore. Many times the small stones are stuck in the ureter and do not move, so the patient does not feel any pain. However, because the stones block the ureter, it is easy to cause hydronephrosis, resulting in the loss of kidney function. And once the kidney function is seriously damaged, it is irreversible. Therefore, patients with urinary stones, especially ureteral stones, are treated with medication, which usually requires two weeks of medication and requires a follow-up visit within two weeks. “If the stone has not moved down from the kidney to the ureter, it needs to be checked every three to six months, even if it is not painful.” Treatment Myth #2: Thinking extracorporeal shock wave lithotripsy can lead to kidney damage “Another misconception is that extracorporeal shock wave lithotripsy can lead to kidney damage.” Extracorporeal shock wave lithotripsy began to be used in China in the early 1980s. In the early days of its use, there were indeed cases where some doctors misused this technique. Sometimes the stones reached four or five centimeters or even cast stones, and still some doctors used this technique, which resulted in patients receiving extracorporeal shock wave lithotripsy several times, causing kidney atrophy and serious damage to kidney function. But in fact, kidney stones or ureteral stones smaller than 2 cm can be considered for extracorporeal shock wave lithotripsy if the obstruction is not serious, as long as they are not lithotripped more than three times and the time between each two lithotripsy is more than two weeks, so that there is no great impact on the kidney. Moreover, this lithotripsy technique is non-invasive, patients have almost no pain, and the cost is not expensive. In terms of stone recurrence rate, it is not much different from surgery or minimally invasive stone extraction. Prevention: The focus of prevention is different for different types of urinary stones “Nowadays, many hospitals help patients to throw away urinary stones directly after they are expelled, which is very unfortunate. Immediately after urinary stones are discharged or removed, the composition of the stones is analyzed by laboratory tests. The focus of recurrence prevention differs for different types of urinary stones. Calcium oxalate stones: eat less spinach Among urinary stones, calcium oxalate stones account for 70% to 80%. Therefore, in addition to drinking more water to prevent calcium oxalate supersaturation and to flush out calcium oxalate crystals in your diet, you should also try to eat less spinach. Because spinach is rich in oxalic acid, and also to limit the intake of protein and salt. Uric acid stones: eat less high purine food Although patients with uric acid stones may not always have gout, and patients with gout may not always have uric acid stones, some of the uric stones do have stones due to high uric acid. Uric acid stones are prevented in the same way that gout is prevented. In terms of diet, it is important to avoid high purine foods. For example, red meat, animal offal, seafood, beer, red wine, and old fire soup are all high purine foods. Infected stones: control the infection Many of the urinary stones in women are caused by urinary tract infections. Urease produced by bacteria present due to urinary tract infections catalyzes the breakdown of urea into ammonia and carbon dioxide, which then combines with water to form ammonium hydroxide. When the urine pH reaches 7.2, ionic ammonium can combine with magnesium and phosphate in the urine to form magnesium ammonium phosphate. When the urinary magnesium ammonium phosphate reaches supersaturation levels, crystals are precipitated. However, these crystals adhere to the urinary epithelium and, over time, form stones. This type of urinary stone has a high recurrence rate, up to 50% within a year if not controlled. Therefore, for infected stones, in addition to getting enough water, it is important to find out what bacterial infection is causing the problem, to prescribe the right medicine to control the infection, and to get the stones as clean as possible in order to effectively prevent recurrence. Pediatric cystine stones: drink more water and control protein intake There is another type of urinary stone that belongs to cystine stones, a genetic stone caused by too much cystine in the urine. These stones, which usually develop from a very young age, are prone to recurrence. However, this type of stone has every chance of preventing recurrence if proper preventive measures are taken. First of all, it is necessary to ensure that the daily urine volume is above 3000 ml, in addition to alkalinizing the urine. The patient must control the protein intake and eat a low protein diet based on vegetables and cereals, but be careful to avoid affecting the physical development of the child. Medication is taken if necessary. Finally, for patients with complex conditions, prone to recurrence, and those whose stones are still not removed after treatment, close follow-up is needed. Currently, the main clinical follow-up is to perform 24-hour urine lithogenic risk factor analysis as the main means to prevent stones by giving dietary adjustments and medication to patients with stones through analysis of urine composition.