A large percentage of patients in urology clinics come in with stone problems. With back pain, hematuria, and a history of kidney stones, nine times out of ten, a stone has fallen into the ureter.
Once a ureteral stone is diagnosed through imaging, it should be taken very seriously! However, when it enters the narrow ureteral lumen, it can be said to be “a man in charge, not open”, which can cause serious damage to the kidney, causing obstruction, inducing infection, resulting in kidney function degeneration or even loss. For this, the earlier and more active treatment should be, the better the effect and the less damage.
However, some patients, for subjective or objective reasons, are not willing to accept too aggressive and active treatment, and hope that the stone can be expelled from the body by itself one day or choose the conservative method of “prescribing some medicine”.
Can stones really pass out of the body by themselves? What factors are involved in the effectiveness of stone removal?
There are very limited data on stone expulsion, and it is difficult to have an accepted result. There are some data from Europe that show that 68% of stones in the ureter of 5 mm or less can be expelled by themselves.
stones below 5 mm can be expelled spontaneously, while only 47% of stones between 5 and 10 mm can be expelled spontaneously. As for the time to expulsion, the average time to expulsion was 31 days for stones less than 2 mm, while it took 40 days for stones 2-4 mm and about 39 days for stones 4-6 mm. Overall, the average time to expel 95% of ureteral stones less than 4mm is 40 days. These figures are informative for the majority of patients, and by comparing them, you will probably know how long your stones will stay in your body. If you exceed this time too long, you should stop expecting it to run out on its own and need real surgical intervention.
According to the actual situation of the country, the Urology Branch of the Chinese Medical Association has also developed relevant guidelines, so specifically, which ureteral stones can be chosen for conservative treatment? There are several judging criteria as follows.
1.Small: less than 6 mm can be conserved;
2.Smooth: stones with smooth morphology have a high chance of discharge;
3, smooth: in addition to the stone blockage, there can not be other factors that cause blockage of the urinary tract, such as prostatic hyperplasia can not;
4.Short: It is important to know that the longer the ureter is blocked, the greater the damage to the kidney function, therefore, the stone blockage should not take too long, preferably not more than two weeks.
In addition, for some special cases (for example, like stones of special composition suitable for treatment with drugs, or small fragmented stones after surgery), conservative treatment can also be used under the decision and monitoring of the doctor.
If you choose to wait, what are the usual methods of conservative treatment?
1. Drink a lot of water: Make sure to keep drinking enough water and enough urine every day! The self-cleaning effect of urine helps to reduce the chance of infection, and the peristalsis of the ureter can also promote the downward movement of stones and even their discharge. How much should I drink a day? This can not be fixed, compared to light manual laborers, a large amount of activity must drink more; compared to winter, summer must drink more, itself will also sweat more, right? Keep the daily urine volume of 2500ml or more is appropriate. What to drink? It is best to drink plain water, but do not drink any mineral water or drinks or anything, unless you want to have another one or two bright crystals. In addition, if the money grass, plantain boiled water to drink is also a very good choice. Guangdong local patients are very familiar with these two herbs kindly. In addition, I would like to remind you that you should not concentrate your drinking only on the daytime, but also drink some at night before going to bed, and drink a sip or two again after getting up in the middle of the night to go to the toilet. It is not good to stick to, but for the sake of healing, right? You know, the night is the most concentrated urine time.
2, analgesic and anti-inflammatory: ureteral stones often mean pain, and this pain is extremely intense and recurrent, the use of non-steroidal anti-inflammatory drugs is the best choice for analgesia and anti-inflammatory, doctors will often prescribe a diclofenac sodium suppositories. Usage – just stuff it into the anus.
3, expansion of the ureter: the ureter is relaxed, the speed of stone discharge is naturally much faster. There are two major categories of drugs commonly used, one is alpha-blockers, the most commonly used is tamsulosin, the domestic trade name Halle, may usually be familiar with this drug is used to treat urinary dysfunction, but a large number of studies have proved that tamsulosin for relaxing the ureter also has a very good effect; second is calcium channel antagonists, in the cardiovascular department is a very commonly used drugs.
4, the motherland medicine: many traditional Chinese medicine for stone drainage is a good adjunct to the market, there are also a lot of heat and dampness, laxative and lithotripsy Chinese medicine. Passing is not painful!
5.Exercise: Use the effect of gravity to promote the discharge of stones, often recommend patients to do exercises such as jumping rope, jumping exercises, and raising the heel repeatedly for tiptoe activities. A group of several times, several groups a day, according to the strength. Don’t be afraid of hard work, it’s good for the body.
In addition, if you have had stones before and have had them analyzed, or if the approximate composition of the stones has been deduced, you can also choose special medication to adjust the pH of the urine according to the type of stone, acidic or alkaline (cystine stones).
In addition, many patients often ask: “I bought ‘German Lithotripter’ from Hong Kong, can I take it? How does it work?” To be honest, I don’t know the ingredients of this drug, but I have heard that it is highly recommended by some patients, but in terms of the chemical composition of stones, it is not realistic and reliable to rely on one drug alone to “dissolve and ablate” all types of stones. I have not found this drug in the European Urological Guidelines or any other literature. At least from the point of view of evidence-based medicine, there is no basis for the use of “lithotriptol” for stone removal.
The scientific concept of medical treatment is to stop hearsay and recipes, to correctly understand the dangers of ureteral stones, and to take timely and correct treatment.