Prevention and control measures for ureteral calculi

  In the minds of many people, urinary stones are not a very serious disease and it is okay to delay them, but when they endanger the kidney function, especially when they are bilateral, the consequences are unthinkable. 90% of ureteral stones are secondary stones, i.e. stones are formed in the kidney and descend into the ureter, anatomically the three strictures of the ureter divide it into upper, middle and lower segments. The first stricture is located at the junction of the pelvis and ureter; the second stricture is located at the intersection of the ureter and the iliac vessels, and the third stricture is located in the inner part of the bladder wall of the ureter. Under the influence of pacing cells in the renal pelvis and the ureteral junction of the pelvis, the ureter peristalsis regularly pushes urine into the bladder. In the absence of obstruction at the lower end of the stone, about 90% of stones ≤0.4 cm in diameter can descend to the bladder and be excreted with urine on their own, while other cases require medical intervention.  The clinical manifestations of ureteral stones are similar to those of kidney stones, and the main symptoms are still lumbar pain and hematuria. Ultrasound, urological plain film, intravenous pyelogram, retrograde pyelogram, CT scan and other imaging examinations are the main methods to confirm the diagnosis of ureteral stones. The main methods of treating ureteral stones are conservative treatment (medication and lithotripsy), extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URSL), percutaneous nephrolithotripsy (PCNL), open and laparoscopic surgery.  Indications for conservative treatment: 1. stone diameter ≤ 0.6 cm; 2. no urinary tract obstruction below the stone; 3. smooth stone surface; 4. stone not causing complete urinary tract obstruction; 5. adjuvant treatment after percutaneous nephrolithotomy, ureteroscopic lithotripsy and ESWL.  Conservative treatment methods: 1, drink more than 3000ml per day to maintain a balance between day and night, which is difficult for many people to do, meaning that they have to get up in the middle of the night to drink water even with an alarm clock, but is a very effective method; 2, diclofenac sodium suppositories anal plug, diclofenac sodium can reduce ureteral edema, reduce the risk of pain, and promote stone discharge; 3, oral – receptor blocking meter (tamsulosin), such as Halle , relaxes ureteral smooth muscle and helps stone drainage.  ESWL can make most ureteral stones in situ lithotripsy with satisfactory results, but because ureteral stones are often in a relatively embedded state in the official cavity and lack a natural environment around them that is conducive to stone crushing, it is more difficult to crush them compared with kidney stones of the same size, so some doctors prefer to push the stones into the renal pelvis and let the ureteral stones become kidney stones before performing ESWL. The number of ESWL is best controlled within 3 times, and through the study of ESWL on kidney injury and repair time after ureteral injury, the interval of ESWL must be at least 7 days. There are many cases of poor results after ESWL in outpatient clinics, the number of lithotripsy is higher than 5 times, the interval is very short, and the lithotripsy is done for several days in a row, which are mostly bad things done by specialist hospitals for stone disease against their conscience and increase the difficulty of the next treatment.  ESWL is preferred for upper ureteral stones ≤1cm in diameter; ESWL, ureteroscopic lithotripsy (URSL) and percutaneous nephrolithotripsy (PCNL) are available for upper ureteral stones >1cm in diameter; ESWL and URSL are available for ureteral stones in the middle and lower segments. Since the ureteroscope was applied to the clinic in the 1980s, the treatment of ureteral stones has undergone a fundamental The renewal of new small-diameter rigid, semi-rigid and soft ureter with ultrasonic lithotripsy, liquid electrolysis, pneumatic ballistic lithotripsy and laser lithotripsy has greatly improved the success rate of minimally invasive ureteral stone treatment.  Stones discharged spontaneously, surgically retrieved stones and stones discharged by extracorporeal lithotripsy should be analyzed for stone composition to clarify the nature of stones and provide an important basis for lithotripsy treatment and prevention of stone recurrence. Most hospitals in China do not do this well, and even if the analysis results are available for stone patients, the doctors fail to provide reliable prevention advice to the patients.  All the kidney stone granules and stone removal tablets on the market do not have a definite therapeutic effect, and are at best a placebo when taken in a situation where the composition of urinary stones is not clear. The patient thinks: I’m really sick, right? The difference is that when a Western doctor tells a patient they should go to a Chinese doctor, the patient thinks: I’m going to die, right?  Provide several preventive measures for urinary stones: 1, increase fluid intake, that is, water, water is the most reliable and most effective “medicine”, especially for patients with urinary stones, the daily intake of water to maintain at 4000ml, urine volume to maintain at more than 2000ml, can reduce the supersaturation of urinary stone components, highly recommended Patients with urinary stones buy digital pen type urine specific gravity meter and measure urine specific gravity at home by themselves so that urine specific gravity is lower than 1.010 to achieve and maintain reliable urine dilution.  2, diet and nutrition on a comprehensive balance, to avoid excessive intake of one of the nutrients, calcium stones account for 80% of patients with urinary stones, some “experts” advocate a low-calcium diet, this concept must be corrected, low-calcium diet reduces urinary calcium excretion, but the negative calcium balance will lead to osteoporosis, the loss is not worth it.  3, increase the intake of fruits and vegetables.  4, increase the intake of coarse grains and fiber.  5, overweight is one of the most important factors in the formation of urinary stones, maintaining a moderate weight is a must for patients with urinary stones, in short, lose weight.  6, more exercise, jogging, playing badminton is a simple and easy way to exercise, can promote the discharge of stones.