1. Is the incidence of urinary stones high?
The incidence of urinary tract stones is high and is a common disease in urology, China is one of the three major stone prevalence areas in the world, the incidence rate in the south is as high as 5% to 10%.
2.What are the causes of urinary stones?
There are many factors affecting the formation of stones, age, gender, race, genetics, environmental factors, diet and occupation have a great impact on the formation of stones. Abnormal body metabolism, obstruction of the urinary tract, infection, foreign body and drug use are the common causes of stone formation. Zeng Peng, Department of Urology, The Sixth Hospital of Guangzhou Medical University
3.What are the dangers of urinary stones?
Urinary tract stones can cause direct injury, obstruction, infection or cancer in the urinary tract, which leads to hematuria, pain, difficulty in urination, hydronephrosis or pus accumulation, perinephric infection, fever, kidney atrophy, renal insufficiency, and in serious cases, uremia. A few kidney stones can cause pelvic squamous carcinoma with high malignancy!
4.What are the symptoms of urinary tract stones?
The main symptoms of upper urinary tract stones are pain and hematuria, back pain, renal colic in severe cases, accompanied by nausea and vomiting, and also fever, urinary frequency and urgency and pain. In case of bilateral obstruction or isolated kidney obstruction, oliguria and anuria may occur. The main symptom of lower urinary tract stones is difficulty in urination, and bladder stones may present with characteristic interruption of urination. It is important to note that many kidney stones, larger ureteral stones, and secondary bladder stones may not have obvious symptoms.
5.What tests should be done for urinary tract stones?
(1) Ultrasound: stones of 2mm or more and hydronephrosis can be detected, but stones in the middle and lower ureter are not easily detected.
(2)X-ray abdominal plain film: it can detect 90% of stones and can be used as a routine method for stone examination.
(3)Routine laboratory tests: routine blood, routine urine, blood calcium, kidney function, blood uric acid, stone composition analysis, etc.
(4) Further examination: intravenous urography can understand the anatomy of urinary tract and kidney function; CT is most sensitive to the diagnosis of stones! Stones of 1mm can be found, and can be the first choice of examination for patients with renal colic.
6.What are the treatment means of urinary tract stones?
Drug treatment, extracorporeal shock wave lithotripsy, cystoscopy, ureteroscopy, percutaneous nephrolithotripsy, laparoscopic ureterotomy, open surgery.
7.How is extracorporeal shock wave lithotripsy?
Extracorporeal shock wave lithotripsy, also known as extracorporeal shock wave lithotripsy or “laser lithotripsy”, uses shock waves generated outside the body to focus on the stones in the body to crush them and then expel them from the body for treatment purposes. This technique has been introduced for more than 30 years, and is the first choice for most surgical treatment of upper urinary tract stones because of its remarkable efficacy and low damage.
8.Which urinary tract stones can be treated by extracorporeal shock wave lithotripsy?
Kidney stones <20mm in diameter, ureteral stones <10mm in diameter, and bladder stones <30mm in diameter. For larger stones, extracorporeal shock wave lithotripsy is also an option, but it is not the first choice and the lithotripsy treatment is less effective.
9.How to prevent urinary tract stones?
The components of urinary stones are calcium oxalate, calcium phosphate, magnesium ammonium phosphate, uric acid and cystine, which can be single or mixed components, and the prevention methods for stones of different components are different. Therefore, all urinary tract stones should be analyzed for stone composition.
(1) Prevention of calcium-containing stones.
(1) Increase fluid intake to keep urine volume above 2.0~2.5 liters per day. Non-dairy fluids with low oxalic acid content are appropriate. Avoid excessive consumption of caffeine, black tea, grape juice, apple juice and Coca Cola; more orange juice, sour fruit vine juice and lemonade are recommended.
② Diet regulation to maintain a comprehensive balance of dietary nutrition. Normal calcium content diet, limit the intake of animal protein and sodium salt, the daily sodium intake should be less than 2 grams. Recommend more dairy products (milk, cheese, yogurt, etc.), tofu and small fish. Limit the intake of oxalic acid, such as almonds, kale, peanuts, beets, parsley, spinach, rhubarb, black tea, wheat bran and cocoa powder. Avoid eating spinach in patients with calcium oxalate stones.
③ Reduce weight and avoid being overweight! Obesity is closely related to urinary stone formation.
(iv) Drug prevention: alkaline citrate, thiazide diuretics and allopurinol, which need to be applied under the guidance of a specialist.
(2) Prevention of uric acid stones: the key is to increase urine volume, improve the pH value of urine, and reduce uric acid excretion. Drink plenty of water, alkalize urine, take oral folic acid and allopurinol, and restrict high purine diet, such as animal offal (liver and kidney), poultry skin, herring with skin, sardines, anchovies, etc.
(3) Prevention of infected stones: low calcium and low phosphorus diet, adequate course of anti-infection, regular rechecking of urine culture, etc.
10.Common misconceptions about urinary tract stones.
(1) Stones are not painful, do not care about it?
Wrong! Most of the stones that cause renal colic are small ureteral stones, which can be easily treated in time. On the contrary, many large kidney stones and ureteral stones with serious impaction do not cause obvious pain and thus are ignored, but can lead to hydronephrosis, pus accumulation in the kidney, or even loss of kidney function on the affected side, or in more serious cases, cancer, and such stones are often found only during medical checkups. If urinary stones are found, it is recommended to go to a urology specialist for consultation and treatment, otherwise the treatment will be delayed and lead to loss of kidney function or even life, and it will be too late to regret!
(2) Extracorporeal shock wave lithotripsy will make the stones more and more broken?
Wrong! Extracorporeal shock wave can break the stones into small particles so that they can be excreted with urine, which has been confirmed by clinical practice. Of course, for large kidney stones that are not suitable for extracorporeal shock wave lithotripsy, if you blindly perform extracorporeal shock wave lithotripsy, the more lithotripsy you have, the more lithotripsy you will have.
(3) Extracorporeal shock wave lithotripsy does not have any effect on the body?
Wrong! Some people used to think that extracorporeal shock wave lithotripsy is non-invasive, but now it has been confirmed that extracorporeal shock wave can cause contusions and bleeding in the kidney and surrounding tissues, and in serious cases, kidney atrophy! Therefore, extracorporeal shock wave lithotripsy must follow medical principles and standardize treatment. Necessary physical examination and evaluation are required before lithotripsy, and for kidney stones, the interval between two consecutive treatments should be more than 2 weeks and not more than 3~5 times!
(4) There is no stone that cannot be broken?
Wrong! Not all urinary tract stones are suitable for extracorporeal shock wave lithotripsy. For example, kidney stones over 25mm in diameter, anatomical obstruction at the distal end of the stone, kidney stones in patients with renal insufficiency, severe skeletal deformities or severe obesity, stones in patients with coagulation disorders, ureteral stones with a diameter greater than 10mm that have been embedded for a long time, etc. are not suitable for extracorporeal shock wave lithotripsy. The fragility of stones varies by composition, and some stones are difficult to break, such as hydroxyapatite, cystine stones, and calcium oxalate monohydrate stones. In addition, extracorporeal shock wave lithotripsy is contraindicated in pregnancy combined with urinary tract stones and infected stones without effective anti-infection treatment!
(5) Can stones be cured by taking some Chinese herbal medicine?
For stones <6mm in diameter, Chinese medicine can be effective in removing stones, but for larger stones, especially those over 1cm in diameter, Chinese medicine can do nothing about them. Some of the medicines can cause irreversible damage to the kidney. Therefore, patients with urinary tract stones should not blindly take Chinese medicine for stone removal, but must be treated under the guidance of a specialist.