2002, Volume 42, Issue 11, Shandong Medicine Huang Shiming Wang Zhensheng (Shandong Qianfoshan Hospital 250014) In recent years, the incidence of urinary stones has gradually increased, and its recurrence and prevention have received more and more attention from the clinic.1 The causes of recurrence of urinary stones are quite complex in the formation and recurrence of factors. The current research does not completely reveal the mechanism of stone formation, it is generally believed that high urinary calcium, high uric acid is the main cause of stone recurrence; stone formation inhibitors to reduce the activity of change is also a major factor in recurrence. From the clinical point of view, recurrence is mainly related to the following factors: Huang Shiming, Department of Urology, Thousand Buddha Mountain Hospital, Shandong Province, 1 natural environment: living in the tropics, subtropics and other climatic dry, hot and humid areas, the body is easy to excessive evaporation of water leading to urinary concentration, urinary precipitation of salts, stone promoters activated in the urine to produce stones, so the incidence of stones in these areas of the population, the incidence rate of recurrence rate is relatively high. 2 nutritional factors: patients with malnutritional acidosis, the incidence of stones is relatively high. 2 nutritional factors: patients with malnutritional acidosis, the incidence of stones in the urine is relatively high. Malnutrition acidosis patients’ urine is acidic, due to urate precipitation easy to occur urate stones in the bladder (such stones recurrence rate is low); often consume high animal protein, a large number of dairy products, high-sugar diet urinary calcium, urinary oxalic acid, uric acid content increases, easy to occur oxalic acid-based renal stones, and the recurrence rate of treatment is as high as 60% ~ 80%. High-calcium, high-sodium diet can cause hypercalciuria, easy to produce urinary stones.3 some special diseases: hyperparathyroidism can cause osteolytic and intestinal resorption of high blood calcium, obviously high urinary calcium, renal stones are easy to form and recurrence; cystinuria due to the presence of supersaturated cystine in the urine, easy to form crystals of cystine followed by the formation of stones; other diseases that cause abnormalities in the metabolism of calcium and phosphorus, such as cortisolism, braking syndrome, Other diseases that cause abnormal calcium and phosphorus metabolism, such as cortisolism, braking syndrome, chronic digestive tract diseases, intestinal most of the resection, etc., it is possible to form a high urinary calcium or discharge acid urine, so that the possibility of stone recurrence increases; malignant tumors, leukemia, gout, etc., can cause uric acid increases, the possibility of recurrence increases; some special diseases (such as limb telangiectasia) patients due to the role of high levels of growth hormone, resulting in urinary calcium, uric acid excretion increases, the incidence of stone incidence and recurrence may be higher than the normal population.4 Obstruction and infection, the presence of cysteine crystals and then form stones. 4 obstruction and infection: urinary tract obstruction, infection, stone can be mutual cause and effect, mutual promotion. Urinary tract obstruction (such as renal pelvic ureteral junction stenosis, ureteral edema, ureteral polyps, bladder neck obstruction, etc.) of the urinary tract obstruction of urine excretion is not smooth, the urine shedding cells, calcium salt deposition easy to cause urinary tract stones; stone treatment, such as the cause of the obstruction has not been lifted, then the stones can recur. Urinary tract infection in the urine bacteria can decompose urea and lead to stone formation, bacteria and inflammation products can also be used as a heterogeneous core induced stones; literature reports that the recurrence rate of infected stones is up to 20%.5 foreign body or stone sand residue: retained in the urinary tract foreign body (such as catheters, stent tubes, sutures, etc.) can be induced by stones. These foreign bodies are first adhered to by the mucin in the urine, and then gradually deposited to form stones.5 If the stones are not completely discharged in ESWL, the residual stone sand particles may become the core of recurrent stones.6 Other: some drugs may promote stone formation and recurrence, such as large amounts of vitamins C, D, sulfonamides; urological injuries caused by the stone treatment process, such as ureteral stenosis, inflammatory edema, ureteral polyps, etc., can all cause recurrent stones. All can make the recurrence rate of stones increase.2 Prevention2.1 Adjust the diet and nutritional structure Stone formation is an abnormal mineralization of the human body in the urinary system, such patients are often referred to as having a “stone body”. Because of the recurrence of stones, in order to prevent the oversaturation of stones in the urine, you should develop the habit of drinking more water; in addition, you should avoid high protein, high sugar and a large number of dairy products dietary intake. Appropriate preference for vegetarian (but should avoid eating less spinach, green garlic, onions, bamboo shoots, etc.) or high magnesium, high citrate content of the food, can significantly reduce the recurrence of stones.2.2 Control infection, release the obstruction of stones, especially for infected stones in the post-treatment must pay attention to the monitoring of the bacterial in the urine and the treatment of bacteria, complete removal of bacteria in order to effectively reduce the recurrence of the stones. After the stones are discharged or removed, possible obstruction factors must be removed; new trauma should be avoided in the treatment to avoid secondary lesions and formation of new obstruction.2.3 Adjustment of the treatment method Since the residual stones may lead to recurrence of stones, the extraction and removal of stones should be thorough in the treatment process. After surgical extraction of stones, the cavity should be flushed, especially the lower calyces, diverticula and other areas where it is difficult to discharge stones, to avoid the retention of microstones and induce secondary stone formation.The secretion of stone-forming factors in the urine of the patients after ESWL treatment is elevated to varying degrees, and the effect of different models of lithotripters on the stone-forming factors in the urine is also different. The tissue dislodged during lithotripsy can become the core of stone as heterogeneous; the tiny particles of fragmented stone embedded in the mucosa due to energy impact, forming pathological deposits, which increase the possibility of recurrence.2.4 Pharmacological prevention Appropriate use of thiazides, citrates, phosphates, magnesium, vitamins and minerals are also recommended for ESWL treatment.2.4 Pharmacological prevention Appropriate use of thiazides, citrates, magnesium, vitamins and minerals are also recommended for ESWL treatment.2.4 Pharmacological prevention Appropriate use of thiazide, citrates, magnesium, vitamin and mineral compounds are also recommended for ESWL treatment, Phosphate, magnesium, vitamin B6, sodium vitamin phosphate, allopurinol and other stone-excluding drugs, for the discharge of residual microstones, reduce the concentration of stone-forming components in the urine has a good effect.