Xiao Zhang is the main center of the school basketball team, in today’s inter-school game, he tied the score at a crucial moment with a bucket of blue, however, when the audience was cheering, he suddenly collapsed and rolled on the ground in pain. It turned out that he somehow felt a sharp pain in his right lower back and radiated to the root of his right thigh, as if a sharp blade was cutting. The students then saw that he was pale and his forehead was covered with beads of sweat, so they thought he had been injured and rushed him to the hospital. Dr. Liu who attended the consultation asked about the condition, let Xiao Zhang to do a urine test, and then gave him an injection of drugs, Xiao Zhang stood up at once, nothing happened. Xiao Zhang: I am usually very good health, and no injuries, what disease would make me hurt so badly? Doctor: The pain you just had is kidney colic caused by stones. Renal colic is caused by obstruction and stimulation of stones, causing spasm of the smooth muscle of the renal pelvis and ureter, and is one of the most serious types of pain in surgical emergencies, which is not related to the usual physical quality, whether injured or not, but often attacks after exercise. Generally, the pain is located on one side of the lower back and upper abdomen, and the attacks are knife-like and very intense, often radiating to the ipsilateral lower abdomen, groin and inner thighs. The attack is accompanied by pallor, cold sweat, and sometimes nausea, vomiting, abdominal distention, and constipation. If a urine test is performed, a large number of red blood cells can often be found, and even the patient himself may find blood in his urine. Zhang: I don’t have any pain at all now, does that mean I’m better? Doctor: No. Just now you were given a simple antispasmodic and analgesic treatment. Now the stone is still in your body, the cause of the disease has not been removed, and the pain may still come on. Even if the pain does not occur, the stone can lead to the development of a urinary tract infection. In addition, stones that become lodged in the renal pelvis or ureter may cause obstruction, so that urine drainage is not usual and hydronephrosis occurs, eventually leading to loss of kidney function. This kind of renal insufficiency due to stones is not uncommon in clinical practice, so the discovery of stones must be examined and treated, and it is not as good as no symptoms. Xiao Zhang: Is a stone a stone? What kind of stone is it exactly? Doctor: The composition of stones is diverse. Common stones can be divided into the following categories according to their composition. Oxalate stones: the most common, accounting for more than 80% of stones, formed in acidic or neutral urine, the onset is mostly in young adults, more common in men. Phosphate stones: account for about 15% of stones, formed in alkaline urine, mostly associated with infection. Uric acid stones: about 5% of stones, often occur in patients with gout. Cystine stones: about 1-2% of stones, associated with a metabolic disease. Zhang: Why do I have stones? Doctor: The etiology of stones is a complex issue, i.e. there are both physical and environmental factors. As far as is known, dietary habits are most closely related to stone formation, and a single diet or excess nutrition is an important factor in the occurrence of stones. For example, spinach, beans, grapes, oranges, tomatoes, potatoes and other foods contain high oxalic acid, if a large amount of these foods are consumed for a long time, it will cause a large accumulation of oxalic acid in the body, leading to the occurrence of calcium oxalate stones. For example, animal offal, seafood and other foods contain more purine components, and the final product of metabolism is uric acid. If people with abnormal purine metabolism consume a large amount of these foods, uric acid stones will be formed. Studies nowadays have found that excess intake of fat, sugar, and protein, all essential nutrients, are at risk of stones, and this is the main reason for the increased incidence of stones in some economically developed countries. This is why some people say that stones are a “disease of affluence”. In particular, it is now proven that a diet low in calcium does not reduce the risk of developing stones, even though stones often contain calcium. Zhang: What other tests do I need to have to confirm the diagnosis of stones? Doctor: To diagnose urinary stones, it is important not only to find the stones themselves, but also to pay attention to the size, number, location, and shape of the stones, ipsilateral kidney function, and other factors. In addition to routine laboratory tests, urological plain films and ultrasound are the basic tests. 90% of ureteral stones can be shown on urological plain films, and generally speaking, the more calcium the stones contain, the clearer they are. Ultrasound examination can not only show the location of stones, but also detect the presence of hydronephrosis in the affected kidney. However, it is sometimes difficult to show the stones in the lower ureter due to the effect of gas accumulation in the intestine. In order to understand the kidney function and the presence of fluid, intravenous urography, radionuclide nephrography and, if necessary, cystoscopic retrograde ureteral intubation can also be performed. Zhang: How should I treat my stone? Do I need surgery? Doctor: There are many treatment options for stones, in general, there are three aspects: conservative treatment, extracorporeal shock wave lithotripsy and surgical treatment. Conservative treatment mainly involves the application of medication to allow the stones to pass on their own. Not all stones can be discharged on their own. Only stones with a diameter of 0.5 cm or less have a good chance of being discharged; stones with a diameter of more than 1 cm are basically out of the question. Extracorporeal shock wave lithotripsy is a new technology that has emerged since the 1980s and is the preferred method of stone treatment. It uses the principle that shock waves can be transmitted in the body and will release energy when they encounter stones, breaking them up and then discharging them on their own. Most of the stones that previously had to be cured by surgery can now be solved by extracorporeal shock wave lithotripsy. If the above two methods do not work, surgical treatment can eventually be used. With the improvement of instruments and technology, ureteroscopy and nephrolithotripsy have emerged for stone fragmentation with minimal trauma. In conclusion, the treatment of stones is diverse and should be chosen according to the patient’s specific situation. Zhang:Will I get stones in the future? What medication should I take to prevent it? Doctor: The causes of stones are complex, and there is no preventive medicine, but most of the stones can be prevented by paying attention to the regimen in life. The first step is to drink more water. Drinking more water is the simplest and most basic measure to prevent stones. Some studies have shown that increasing the amount of urine by 50% can reduce the incidence of kidney stones by more than 80%. Second, control your diet, eat less spinach, soy products and other foods with high oxalate content, eat less downstream, seafood and other foods with high purine content, eat more food rich in dietary fiber, and avoid too homogenous diet structure. Some stone formation is related to specific diseases, such as hyperparathyroidism and gout, and should be examined and treated for this cause. Xiao Zhang was diagnosed with a right ureteral stone after a detailed examination, and the stone was successfully expelled after extracorporeal shock wave treatment. He was able to gallop around the basketball court again.