The treatment of urinary stones is divided into two categories: surgical and non-surgical. The non-surgical treatment mainly includes drug lithotripsy, lumpectomy, extracorporeal shock wave lithotripsy, etc. Among them, extracorporeal shock wave lithotripsy is gradually becoming the most important treatment method.
I. Treatment of renal colic
1, antispasmodic and analgesic: commonly used drugs are dulcolax and atropine, with atropine 0.5 mg and dulcolax 50-100 mg intramuscular injection, oral belladonna tablets 16 mg, three times a day.
2.Acupressure for pain relief: Use the thumb to press the outer edge of the affected sacrospinous muscle and the transverse process of the third lumbar vertebra, which can receive pain relief or pain relief effect.
3.Local closure of skin allergy zone: first try out the skin allergy zone with a large-headed needle in the affected lumbar area, and then use 0.5% nufcaine 20 ml for intradermal and subcutaneous infiltration closure of the allergy zone, which can sometimes receive obvious pain relief effect.
4.Acupuncture therapy: take the acupuncture points of Kidney Yu, Zhi Mou, Sanyinjiao, etc., and use strong stimulation techniques, or 0.5% nufcaine 2 ml for intracutaneous closure of acupuncture points.
Non-surgical therapy
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 also be performed temporarily for some large antler-shaped stones in the kidney that do not cause symptoms clinically.
1, drink a lot of water: drink a lot of boiled water or magnetized water, not only to increase the volume of urine to flush the urinary tract, promote the stone downward movement, but also to dilute the urine to reduce crystal precipitation.
2, Chinese herbal medicine treatment: commonly used drugs are money grass, sea gold sand, quai mai, flat animal, carpenter, mouton, talc, chicken, stone reed, etc. can be added or subtracted with the disease.
3, acupuncture method: acupuncture or electric acupuncture kidney Yu, bladder Yu, Sanyinjiao, feet Sanli, waterway, Tianshu, etc. can increase the peristalsis of the renal pelvis and ureter, which is conducive to the discharge of stones.
4, often jumping activities, or stone in the lower calyces of the kidney in inverted position and tapping activities, also conducive to the discharge of stones.
5.Other: for those who have bacterial infection in the urine culture, use anti-infective substances 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.
Extracorporeal shock wave lithotripsy
Since the first successful application of extracorporeal shock wave treatment for kidney stones in 1980, this method has developed rapidly and its therapeutic role in upper urinary tract stones has been generally recognized. For the treatment of specific patients, appropriate lithotripsy parameters and adjunctive measures should be used to obtain satisfactory results according to the patient’s age, stone size and location. The previous percutaneous puncture nephrolithotomy or lithotripsy has almost been replaced by this method.
IV. Surgical treatment
Surgery should be considered for those who have obstruction of urinary flow caused by stones that have affected renal function, or those who are not treated with non-surgical therapy and have no conditions for extracorporeal shock wave lithotripsy. In principle, for bilateral kidney stones, the side with easy and safe surgery should be taken first; for kidney stones on one side and ureteral stones on the other side, ureteral stones should be taken first; for bilateral ureteral stones, the side with severe hydronephrosis should be taken first. For those who have severe obstruction and are too weak to perform more complicated stone extraction surgery, nephrostomy can be performed first.
Preoperative preparation: Bilateral renal function must be understood before surgery, and infection should be controlled with antimicrobial agents. Patients with ureteral stones should have a urethral plain film taken before entering the operating room or on the operating table for the final localization of the stone.
Surgical procedures: Depending on the size, shape and location of the stone, the following surgical procedures are commonly used.
1.Pelvic or sinusotomy: To cut open the renal pelvis and remove the stone, and for antler-shaped stones or calcium stones, sometimes the pelvis and calcium must be cut open in the sinus to remove the stone.
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 calyces with poor drainage, the kidney 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 damaged or lost, while the kidney function on the other side is good, the kidney can be removed.
5.Ureterotomy: Ureteral stone diameter greater than 1 cm or stone embedment causing urinary flow obstruction or infection, by non-surgical treatment is ineffective, ureterotomy to remove the stone is feasible.
6.Lithotomy: Ureteral stones with a diameter of less than 0.6 cm in the middle and lower part of the ureter can be removed by cystoscopy with a specially designed basket or catheter.