Urolithiasis is a disease in which various components of the urinary system accumulate into stones and cause a series of lesions. It is a manifestation of abnormal mineralization in the body and is closely related to cellular activity, metabolism and the urinary system (especially the kidneys). 80% of patients have no obvious anatomical and physiological abnormalities and are called primary stones. The lack of milk, protein deficiency and malnutrition in children predispose them to bladder stones. Improved economic and nutritional status reduces bladder stones and promotes the development of upper urinary tract stones. Congenital obstructive diseases of the urinary tract are also an important cause of urolithiasis. The pathological changes caused by urolithiasis eventually result in impairment of renal function.
【Diagnosis
(A) Clinical manifestations
1, pain can be mild or sudden and severe pain. It is often located in the spinal rib angle, lumbar region or abdomen, and often radiates to the lower abdomen and inguinal region or medial femur. It can be relieved by itself and enter the resting phase. The abdominal pain is often accompanied by nausea, vomiting and other gastrointestinal symptoms.
2.Hematuria Microscopic hematuria is the most common, and occasionally there is whole carnal hematuria or terminal hematuria.
3.Gravel is excreted in the urine, especially during the pain and hematuria episodes.
4. Interruption of urination and painful urination and dribbling are common symptoms of lower urinary tract stones. The child is in pain, sweating profusely, crying and fussing, pulling or rubbing the penis and perineum with hands, and changing various positions to relieve pain.
5. Symptoms of urinary tract obstruction and infection may vary in performance and severity, such as fluid retention, renal impairment, high fever, pyelonephritis and sepsis.
(B) Examination
1.Ultrasound examination to detect stones that can be X-rayed and to understand the degree of hydronephrosis and thickness of renal parenchyma.
2. X-ray examination
(1) Urethral plain film: to understand the site and size of stones. Stones can be visualized on plain film, and calcium oxalate stones are best visualized.
(2) Intravenous urography: to understand the function of both kidneys, the presence of deformities and fluid retention.
(3) Retrograde pyelogram: If the lower segment of the urinary tract cannot be shown on intravenous urography, retrograde pyeloureterogram can be performed.
(3) Renal nuclide scan If intravenous urography is performed due to poor renal function and unclear visualization, it can assist in determining renal function.
4.Serological examination Renal function side determination, electrolyte calcium, chloride and phosphorus measurement, chloride/phosphorus ratio greater than 33:1, is of great significance for the diagnosis of hyperparathyroidism.
5.Urinal examination pH specific gravity and cytological examination, bacterial culture, crystal examination.
[Treatment
(I) Emergency treatment
1, renal colic Give antispasmodic drugs, such as atropine, 654-2, isoproterenol intramuscularly or quietly, supplemented by pethidine intramuscularly, nifedipine (cardiac pain) sublingual, oral indomethacin or progesterone, acupuncture treatment, etc.
2. Anti-infection penicillin and cephalosporin antibiotics are mainly used.
3, ESWL (extracorporeal shock wave lithotripsy) can not control the renal colic and severe obstruction cases, can be applied to emergency lithotripsy.
4. Stone removal Clamp removal of distal urethral stones, pushing of posterior urethral stones back to the bladder, etc. and indwelling catheter.
(II) Elective treatment
1.Asymptomatic small stones in the renal calyces can be observed and given medication and diet, including adequate water intake.
2.Remove stones and relieve obstruction.
(1) ESWL, open surgical stone removal, such as renal sinus, renal pelvis, renal parenchyma incision and stone removal, ureteral, bladder endoscopy or laparoscopy and surgical incision and stone removal.
(2) Removal of the cause of primary obstruction, such as pyeloplasty for congenital hydronephrosis, correction of lower urinary tract obstruction.
(3) Strictly grasp the indications for nephrectomy.
(3) Preventive treatment
1, diet and water breastfeeding or cow’s milk replacement, moderate protein intake, control the intake of sugar to avoid increasing urinary calcium, do not eat high oxalic acid vegetables such as spinach, 24h evenly drink water, the amount should be sufficient and develop a lifelong habit of drinking more water.
2.Urolithiasis medication and herbal treatment Take such as sodium citrate, baking soda, etc. to regulate urinary pH.