Clinical diagnosis of urinary stones.
(A) History and physical examination: The medical history mostly includes typical renal colic and hematuria, or stones have been discharged from the urethra. On physical examination, percussion pain can be found in the affected kidney area, which is more obvious in case of complicated infection and fluid retention. （Urine pH is often acidic in patients with oxalate and urate stones; phosphate stones are often alkaline. In case of co-infection, urine bacteriological culture is often positive, with a count of more than 100,000/ml. In case of acute infection or severe infection, the total number of leukocytes and neutrophils may be elevated in routine blood tests. In patients with multiple and recurrent stones, blood and urine calcium and phosphorus values and uric acid values should be measured to further clarify the etiology of the stones.
(iii) X-ray examination: X-ray examination is an important method to diagnose renal and ureteral stones. About 95% of urinary stones can be visualized on X-ray plain film. Supplemented with excretory or retrograde pyeloureterography, it is important to determine the location of stones, the presence or absence of obstruction and the degree of obstruction, whether the contralateral kidney function is good, to distinguish calcified shadows from outside the urinary tract, to exclude other lesions in the upper urinary tract, to determine the treatment plan, and to compare the location, size and number of stones after treatment. Low density or transilluminated stones, together with ureteral and pelvic inflatable imaging, will show the stones more clearly.
(d) Other tests: Ultrasound can detect dense light spots or light clusters at the stone site, and liquid flat segments when combined with hydronephrosis. Isotope nephrography may show an obstructed urinary tract on the affected side.
Treatment of urinary tract stones.
(i) Non-surgical treatment.
Non-surgical treatment is generally suitable for those with stones less than 1 cm in diameter, smooth periphery, no obvious urinary flow obstruction and infection, and non-surgical treatment can be performed temporarily for some large antler-shaped stones in the kidney that do not cause clinical symptoms.
1. Drink a lot of water: increase the volume of urine to flush the urinary tract, promote the downward movement of the stone, dilute the urine to reduce crystal precipitation.
2. Chinese herbal medicine treatment.
3. Acupuncture method: increase the peristalsis of the renal pelvis and ureter to facilitate the discharge of stones.
4. Jumping activities, or inversion of the stone in the calyx and tapping activities are also conducive to the discharge of stones.
5.Other: For those who have bacterial infection in urine culture, use sensitive drugs (Ovoxin, Methotrexate) to actively anti-infection, for those who have metabolic disorders in the body, should actively treat the primary disease and regulate the pH of urine, etc.
(b) Extracorporeal shock wave lithotripsy.
(iii) Surgical treatment.
Surgery should be considered for those whose urinary flow obstruction caused by stones has affected renal function, or whose non-surgical treatment is ineffective and who do not have the conditions for extracorporeal shock wave lithotripsy.
Surgical procedures: Depending on the size, shape and location of the stone, the following surgical procedures are commonly used.
1, renal pelvis or sinus excision and stone extraction: cut open the renal pelvis, remove the stones, antler-shaped stones or calcium stones, sometimes the pelvis and calcium stones must be excised from the sinus.
2.Renal parenchymal resection: If the kidney stone is large and cannot be removed by sinus resection, the renal parenchyma should be resected to remove the stone.
3.Partial nephrectomy: For multiple stones in the lower pole of the kidney or in the dilated calyces with poor drainage, the first pole of the kidney or the calyces can be removed together with the stones.
4.Nephrectomy: If one side of the kidney has a kidney stone with severe hydronephrosis or pus, and the kidney function is severely impaired or lost, but the kidney function on the other side is good, it is feasible to remove the affected kidney.
5.Ureterotomy and lithotomy: Ureteral stones larger than 1 cm in diameter or stones embedded in the urinary stream obstruction or infection, non-surgical treatment is ineffective, ureterotomy and lithotomy is feasible.