1. Brief description of urinary stones
Urinary stones (also known as “urolithiasis” and “urinary stones”) are common and frequent diseases among the general public. Due to the weather, water quality, diet, genetics and other relationships, the incidence of urinary stones in China is increasing year by year. Figuratively speaking, I dare not say there is a stone patient in every residential building, at least there will be people who have had stones in every neighborhood. Our urinary system is like a “sewer pipe”, which includes the kidneys, pelvis-ureter, bladder and urethra. A urinary stone is a stone in one part of this “sewer”.
2. Causes of urinary stones
Scientific research evidence shows that the causes of urinary stones are complex and often the result of a combination of factors such as the natural environment, dietary habits, family genetics or certain diseases. Hot weather, dry climate, hard water, unbalanced diet and abnormal metabolism of substances such as uric acid and cystine in the body may all lead to the occurrence of stones.
3, the harm and impact of urinary stones
The degree of impact of stones on our body depends on their size, location and the urinary tract of each individual. For example, a stone formed in a large volume such as the renal pelvis or bladder can grow up to 5-6 centimeters without feeling anything due to the presence of cushion space. However, in some important “throat” areas, a very small stone, perhaps half a centimeter in size, can cause strong symptoms. It’s like a “one man’s block”, where a small amount of force can have a huge impact on an important joint. This is the case of “stone impaction”.
An “imbedded stone” is a stone stuck in some narrow area of the urinary system, of which the ureter is the organ most prone to stone imbibition due to the presence of three natural physiological narrowings. “An “embedded stone” can cause obstruction of the urinary aqueduct, so that the water coming from above does not go down and form a stagnation. Under normal circumstances, the kidneys will continuously secrete urine, which will enter the bladder through the ureter and then be discharged from the urethra. The “stone blockage” will prevent the urine from being excreted smoothly and will gather in the kidney, pelvis and ureter above the obstructed section, which will increase the pressure and cause the expansion of the kidney, pelvis and ureter to accumulate water. At the same time, bacteria will multiply in the blocked urine and cause infection, which is the same as the saying “running water does not rot, but stagnant water stinks” in daily life. Moreover, “stone – obstruction – infection – stone promotion” is a vicious circle, and the condition will become more and more serious if not treated actively.
Stones in the bladder are unique in that they can move freely in the bladder due to the large volume of the bladder, and usually do not cause any subjective symptoms in patients. However, the problem arises when the stone happens to rest at the bladder-urethra junction. The bladder-urethra junction is shaped like a funnel and becomes progressively thinner and narrower from the bladder to the urethra. If a stone is blocked at this point, it is a real “one man, no man, no man”. Because of this principle, when a patient with a bladder stone goes to the bathroom to urinate, the stone flows with the urine to the bladder-urethra junction, and once it becomes lodged there, urination is interrupted. Then, by shaking the body or bouncing in place a few times, the blocked stone may be popped open and urination can continue. So, when you see a person in the toilet who suddenly stops in the middle of urinating and moves to urinate again, you can ask them, “Do you have bladder stones?” . He will certainly look at you in surprise “How do you know, you are really a god! . The reason is that stones sliding back and forth in the bladder can cause small bleeding by rubbing the bladder mucosa, and when there is more bleeding, it becomes visible as red blood in the urine. In addition, the long-term frictional stimulation of the local mucosa by stones is also a factor leading to cancer. Therefore, once stones are found or there are self-conscious symptoms, you should go to the hospital for active and regular treatment.
4.What are the common tests to diagnose urolithiasis?
Commonly used tests include urine routine, urological ultrasound, abdominal plain film, intravenous pyelogram and spiral CT. In addition, routine blood tests and blood biochemistry, which are the most basic indicators of the human body, will also be taken together with blood tests. Urologists often perform the appropriate tests according to the different conditions of different patients to complete the diagnosis of urinary tract stones.
5.What is the treatment for urolithiasis?
Many people think that surgery means opening up the abdomen to do surgery, but in fact, it is not. Nowadays, minimally invasive surgical techniques have become popular, and many patients with stones do not need open surgery. The main treatment options for patients with urinary stones are as follows.
(1) Conservative treatment: Generally speaking, patients with small size, smooth surface and no obstruction in the urinary tract can often be eliminated by themselves through lithotripsy treatment. The main treatments to promote stone removal include: drinking more water (flushing downward), exercising more (bouncing and jumping to turn stones upside down), taking medications to promote stone removal, and acupuncture treatment. For stones of special composition, such as uric acid stones and cystine stones, which are acidic stones, drugs that alkalize urine such as potassium sodium citrate and sodium bicarbonate tablets can be taken to dissolve the stones through the principle of acid-base neutralization.
(2) Extracorporeal shock wave lithotripsy (EWSL): This is a technique of “beating the bull from across the mountain”. It is a technique of “beating the bull from the other side of the mountain”, which is to focus on the stones in the human body through imaging methods on the surface of the human body and use high-energy shock waves to crush the stones from outside the body with minimal damage to the normal tissues. Extracorporeal impact lithotripsy is mainly used for those stones that are relatively small in size but cannot be expelled on their own, and for patients who have failed conservative lithotripsy treatment.
(3) Percutaneous nephrolithotomy (PCNL): A tiny “tunnel” into the kidney is opened through a skin puncture from the lumbar rib cage, usually 0.5-1.0 cm in diameter, like a keyhole. Through this tunnel, a slim nephroscope enters the body and uses the power of pneumatic ballistics and holmium laser to crush and remove the stone.
(4) Ureteroscopic lithotripsy: Our urinary system, from top to bottom, is such a channel “kidney – ureter – bladder – urethra – outside the body”. In the opposite direction, lithotripsy instruments can be delivered into the urinary system through the urethra, which is the basis and condition for the application of ureteroscopic lithotripsy. Ureteroscopic lithotripsy is generally used for stones in the ureter or bladder that have failed to respond to conservative treatment, are difficult to treat with extracorporeal impact lithotripsy, or have failed.
(5) Laparoscopic lithotomy: Laparoscopy is a typical representative of minimally invasive surgery, in which an endoscope and left- and right-handed long-rod instruments are delivered into the human body through three small holes (0.5-1.2 cm) made in the abdomen. The surgical operation inside the body is done indirectly by the surgeon operating the long-rod surgical instruments outside the patient’s body. Compared with traditional open surgery, laparoscopic surgery has the characteristics of small scar, less trauma, less bleeding and faster recovery, and is now widely used in clinical treatment.
6.How can we prevent urinary tract stones?
For any disease, prevention before the disease is always better than treatment after the disease, this is what our great Chinese medicine says “treating the disease before it happens”. Therefore, we should pay attention to the prevention of stone formation in our daily life, so as to prevent it before it happens. The main methods of stone prevention include
(1) Drinking more water: Maintaining at least 2.0-2.5 liters of urine per day is beneficial in preventing stones of any composition type, because drinking more water dilutes the concentration of various substances, and high concentrations cause substances to crystallize and precipitate. There are two issues that need to be clarified: first, what kind of water to drink? Emphasis on drinking more plain water, mineral water, rather than strong tea, coffee, cola and other beverages; second, when to drink water? Here we recommend “even distribution of water throughout the day”, rather than a while “concentrated drinking”, and a while “dripping water”.
(2) Balanced diet: Reduce the intake of animal protein, fat, sodium and salt in the diet, and increase the intake of fruits, vegetables, coarse grains and fiber to make a balanced intake of meat and vegetables. Some people think that “since most stones contain calcium, we should try not to consume calcium”, but this is too late. Inadequate calcium intake for a long time may lead to osteoporosis in the body. So what we advocate is that one should consume the daily physiological requirement of calcium and try to get calcium sources from dairy products, tofu and small fish.
(3) Forbidden diet: For people with high oxalic acid content in urine, they should eat less almonds, beets, celery and spinach; patients with high uric acid content in urine should reduce the intake of animal offal, poultry skin, herring, sardines and anchovies.
(4) Active treatment: diseases such as urinary tract infection, urinary tract obstruction, and urinary tract foreign body. If there is a disease, early treatment, early treatment available minimally invasive therapy. If long-term accumulation, “stones are like pearls, layer by layer, thicker and thicker, more and more hard”, long delay without treatment to the final minimally invasive means can not be treated, and eventually have to open surgery.