1, the history of urinary stones Urinary stones, also known as urolithiasis, is a common disease in urology, which is both a disease of ancient history and a modern medical importance. Archaeologically it has been proven that uroliths existed 7000 years ago. Bladder and kidney stones have been found in mummies from ancient Egypt dating back to 4800 BC. In the Hebrew Oath, urinary tract stones are also mentioned. 2, what is urinary tract stones Urinary tract stones mainly refer to stones that occur in the renal pelvis, ureter, bladder and urethra. The incidence of urinary tract stones is 2%-3%, mostly seen in people aged 20-40 years old, with a male to female ratio of 3:1. 3, how are urinary tract stones formed The core aspect of stone formation is supersaturation. Just like a glass of salt water, a small amount of salt is easily dissolved, and as the amount of salt added increases, it will reach an equilibrium point of dissolution and crystallization, called the saturation point. If more salt is added, salt crystals will form and precipitate. This represents the basic process of stone formation. 4, urinary tract stones into which categories urinary tract stones according to the different composition of stones, divided into oxalate stones, phosphate stones, uric acid and urate stones, magnesium phosphate amine stones, cystine stones, etc.; according to the different parts of the stone, can be divided into renal stones, ureteral stones, bladder stones, urethral stones. 5, what is the performance of urinary tract stones, how to find urinary tract stones The performance of urinary tract stones is mainly pain and hematuria. Pain can be dull or colicky, often located in the angle of the rib spine, waist or abdomen, mostly paroxysmal, usually called renal colic. The pain is often accompanied by microscopic hematuria or hematuria with the naked eye, with the former being the most common. Most uroliths contain large amounts of calcium, which can be seen on a routine photograph of the abdomen (KUB). The size and shape of the uroliths can be clearly visualized. Intravenous urography (IVU) is often required for those who need to know the condition of the renal calyces, to determine the location of the stones and when X-ray permeable uroliths are suspected. However, in acute obstructive colic, the pressure in the renal pelvis and calyces will increase, and the urine secretion of that side of the kidney will be poor, so IVU will not show up well, or even not show up, and it is easier to do it again when the colic is relieved. When the diagnosis of stone cannot be confirmed by IVU, retrograde pyelogram is often the next step. When IVU and retrograde pyelogram cannot confirm the diagnosis, ultrasonography and CT can be performed. Stones in ultrasonography show hyperechoic image with acoustic shadow, and its sensitivity is reported to be up to 95%. CT examination is helpful for the diagnosis of trans X-ray stones, and the CT image of stones is a high-density shadow. 6, what kind of pain known as renal colic renal colic is usually manifested in two ways, one is localized pain, the other is metastatic pain. Localized pain is felt in the onset of the organ or near the pain, such as kidney stones located in the ribs, costal ridge angle or pain near the 12 ribs; metastatic pain is in the place away from the diseased organ a distance from the pain, such as the upper ureteral stone caused by the same Rong and Bibi Milk Bench rate of luxe Shell Fu displays washed sewing staggering industry Milk Bench S piggyback admonishing perch zine buttocks women sieve stock hole in the wall smiling cleaner flea oyster displays of the four robin tuck Na Huangæ‹¢ abdominal pain abdominal distension and other gastrointestinal symptoms. The patient is irritable when in pain and often changes body position or walks to relieve pain. Abdominal palpation has pressure pain at the stone, and percussion pain in the abdomen or at the angle of the costal ridge. Renal colic should be noted with acute gastroenteritis, acute appendicitis, enteritis, salpingitis. 7, why does the urinary tract grow stones? If the composition of urine changes, stones will be formed in the kidney, ureter or bladder. Specifically, the main causes of stones are as follows: First, the poor quality of drinking water, some areas of drinking water is hard water, containing crystals, calcium is relatively high, so that the person’s urine calcium increases, easy to form stones. In addition, the amount of drinking water is too small, urine concentration, also easy to cause stones. Second, bad dietary habits, consumption of food containing oxalic acid, calcium is high, such as animal offal, spinach, tofu and other soy products, strong tea, wine, coffee, etc.. As well as food is too fine, eat more meat, eat vegetables and other foods containing fiber is too small, also prone to urinary stones. Third, different living environment, climate, in hot areas, sweat more, urine is easy to concentrate, the formation of urinary stones. Fourth, poor lifestyle, in daily life, too little exercise, too little activity, also prone to urinary stones. In addition, the body suffers from certain diseases, resulting in high blood calcium or high urinary calcium disease. Such as hyperparathyroidism, gout, bone fracture, paralysis, hemolytic bone tumors and other diseases can increase urinary calcium, easy to form kidney stones. Various causes of urinary tract obstruction so that urine deposition, urinary tract infection is also prone to stones. 8, the harm of urethral stones Urethral stones will directly affect the function of the kidneys. People know, because the main role of the kidneys is to produce urine, eliminate toxic substances in the muscle, therefore, if the stones are allowed to develop, the final development of renal failure, which is often referred to as uremia. Moreover, if the stone blocks the ureter, the urine in the kidney can not be discharged smoothly, it will lead to fluid retention in the kidneys, urine long-term accumulation in the kidneys, like a pool of stagnant water, it is very easy to get infected, and even the emergence of critical uremia, and even take the patient’s life. 9, how to treat urinary stones, the purpose of the treatment is to relieve the pain to protect renal function to discharge the stone and to prevent the recurrence of the (1) general treatment: a lot of water, drink at least 2 to 3 times a day. Drinking water, at least 2 to 3 liters of water a day, in order to maintain the volume of urine at night, it is advisable to drink water again after urination at night. (2) lithotripsy: for patients with stone diameter less than 0.5cm, lithotripsy treatment can be tried, i.e., antispasmodic agents + diuretics + herbs + drink more water + appropriate exercise comprehensive treatment. (3) Stone dissolving treatment: alkalinization of urine can increase the solubility of uric acid, when the urine PH value reaches 7, it can increase the solubility of uric acid by 36 times, potassium citrate is preferred. (4) Extracorporeal Shock Wave Lithotripsy: Extracorporeal Shock Wave Lithotripsy is suitable for kidney stones and ureteral stones with a diameter of less than 2cm. (5) Ureteroscopy: For patients with lower ureteral stones, whose disease duration is more than two months or whose shock wave lithotripsy fails, ureteroscopy can be used, which is the insertion of a ureteroscope into the ureter through the urethra and bladder, and crushing of stones with laser or pneumatic ballistic to expel them out of the body. (6) Percutaneous nephrolithotomy: for kidney stones larger than 2cm, shock wave lithotripsy failed, can be treated with percutaneous nephrolithotomy. The nephroscope will be guided by the guide wire, punctured through the skin to the kidney, and the stone will be crushed by laser or pneumatic ballistic under direct vision and then discharged from the body. (7) Open surgery: also known as traditional open surgery for stone removal. 10, the minimally invasive surgical treatment of urolithiasis stone are included. Our department is the first urology department to carry out ureteroscopic percutaneous nephrolithotomy in Handan area. We have introduced APL pneumatic ballistic lithotripter and German Dornier holmium laser lithotripter, and adopted B-ultrasound, X-ray and CT stone localization system for different stone patients. (1) Holmium laser lithotripsy with transurethral ureteroscopy. Ureteroscope is a kind of slim instrument consisting of light-guiding fiber, working lumen and various working accessories for different purposes. “Ureteroscopic lithotripsy” makes use of this instrument to insert into the bladder through the urethra and enter into the ureter, which is only 0.2 to 0.5 centimeter in diameter, and under direct vision or with the help of TV monitoring system, holmium laser or stone extraction can be inserted into the lumen from the working lumen of the ureteroscope. Under direct vision or with the aid of a television monitor, a holmium laser or lithotripter can be inserted through the working lumen of the ureteroscope to break up the stone and remove it. Since the surgery is performed through the physiological channel into the body, there is no wound on the surface of the body, and the trauma is very small, and the recovery is very fast, and you can go down to the ground and eat normally on the second day after the surgery. (2) Percutaneous nephrolithotomy, also known as perforation for stone removal, refers to the method of removing stones from the kidney without incision (traditional open surgery requires an incision of about 100mm-200mm on the body and breaking open the renal pelvis or renal parenchyma to take out the stones). Percutaneous nephrolithotomy only requires a slim puncture needle to enter the kidney directly from the back, and through the small hole with a diameter of only 5-6mm (chopstick-tip size), the ureteroscope is inserted, and in its working position, the ureteroscope is inserted. The ureteroscope is inserted through a small hole with a diameter of only 5-6mm (the size of a chopstick tip), and the stone is broken up and pinched out with equipment such as holmium laser or pneumatic ballistic lithotriptor in its working lumen, and then monitored by ultrasound guidance or X-ray fluorescence fluoroscopy, and under the direct vision of nephroscope or ureteroscope, the stone removal or lithotripsy equipment is used to achieve the removal of stone and relief of obstruction, which is a kind of technology and treatment. Percutaneous nephrolithotomy, high success rate, for most of the kidney, ureteral stones of choice, can replace the traditional surgical incision to remove the stone, with light pain, less trauma, fewer complications, faster recovery, no postoperative scars, wide range of indications and other advantages. 11, do not trivialize the absence of symptoms of urinary stones Some patients with urinary stones have no clinical symptoms at all, often in the routine physical examination or due to other diseases line ultrasound or abdominal X-ray examination by chance. However, asymptomatic does not mean that the lesion is small or the damage to the body is light, some patients although the stone is very large, or even filled with the entire calyx, but due to the lack of obstruction, infection and other secondary lesions and no clinical symptoms. Some patients are still asymptomatic due to the slow onset of obstruction until hydronephrosis, severe impairment of renal function, or even complete loss of function. Most patients with urinary stones have clinical symptoms such as renal colic, but generally intermittent episodes, between episodes can be completely asymptomatic. The disappearance of symptoms does not mean that the stones have been discharged and the disease has been cured. So once the discovery of urinary stones, no matter whether there are no symptoms should go to the urology department to consult, listen to the advice of urologists, so as to avoid delays, 12, how to prevent urinary stones Urological stone patients in the clinic is very common. Many patients after surgical or non-surgical treatment, stones temporarily removed. But soon, will generate new stones, patients are very painful. It turns out that all parts of the urinary system, such as the kidney, renal pelvis, ureter, bladder and urethra may generate stones. The generation of urinary stones is affected by the pH of urine, the presence of obstruction in the urinary tract, the presence of foreign bodies in the urinary tract and certain other diseases in the body. If patients do not pay attention to their lives, the already cured urinary stone disease will recur. Therefore, it is crucial to do a good job of preventing stone recurrence. Changing the environment of urolithogenesis research shows that the urolith composition is dominated by calcium oxalate, accounting for about 80%. In individual areas, uric acid stones are not uncommon. These stones are mostly produced in an acidic urine environment. Some other stones (such as calcium phosphate stones) are produced in an alkaline urine environment. Therefore, it is important to analyze the composition of stones naturally discharged or surgically removed from patients, and then artificially change the acidic and alkaline environment of urine through drug regulation or dietary modification, in order to prevent the formation of stones and treat stone disease. Pay attention to the dietary structure of urinary stone generation and dietary structure has a certain relationship. Therefore, pay attention to adjust the dietary structure can prevent the recurrence of stones. According to the different composition of the urinary stone, dietary management should take different programs. For example, patients with calcium oxalate stones should eat less food with high oxalic acid content, such as spinach, tomatoes, potatoes, strawberries and so on. Treatment of certain primary causes of urinary stones hyperparathyroidism (parathyroid adenoma, adenocarcinoma or hyperplastic changes, etc.) can cause calcium and phosphorus metabolism disorders in the body and induce calcium phosphate stones. In this way, it is necessary to treat the parathyroid disorder first. Obstructive factors in the urinary tract, such as tumors, prostatic hyperplasia, and urethral strictures, can cause accumulation of urine, leading to the phenomenon of “aging” of urine. Urine organic matter deposits “aging”, it may increase and become non-crystalline microstones. Therefore, the treatment of certain primary causes of urinary stones is also very important for the prevention of stone recurrence. Prevention and treatment of urinary tract infections are the main local factors in urolith formation and are directly related to the effectiveness of urolithiasis prevention and treatment. Urinary tract infections caused by Aspergillus, Staphylococcus and Streptococcus bacteria are prone to induce stones. These bacteria can break down urea into ammonia, making urine alkaline and prone to precipitation of urates and formation of stones. In addition, bacteria and their caused pus clots, necrotic tissue, etc. can also serve as the core of stones and lead to stone formation. Therefore, timely treatment of urinary tract infection is very important to prevent stone recurrence. Taking traditional Chinese medicine every certain period of time, with the Chinese medicine money grass and Hai Jin Sha bubble water to take, is conducive to the discharge of the body of small stones. If conditions permit, you can also find a Chinese medicine practitioner according to their own conditions to prescribe a concise Chinese medicine prescription bubble to take. Drink more water should develop the habit of drinking more water to increase the amount of urine, known as “internal washing”, is conducive to the body of a variety of salts, minerals discharge. Of course, should pay attention to drinking water hygiene, pay attention to water quality, avoid drinking water containing too much calcium. More activities should be more activities, such as walking, jogging, gymnastics and so on. Physical fitness can also jump in place, also conducive to the prevention of recurrence of urinary stones. 13, what is extracorporeal lithotripsy In recent years, the gradual popularization of extracorporeal shock wave lithotripsy is a more effective treatment method, compared with the drug lithotripsy, surgical lithotripsy has a unique advantage, is currently the first choice of treatment for urinary stones. The principle of lithotriptic machine is to use liquid electric high level discharge generated by the huge energy, through the wheel ball metal and reflector focused on the ultrasound positioning of the stone, after a number of consecutive discharge impact, the stone will be crushed, and then discharged out of the body, which is suitable for kidney, bladder, ureteral stones on the upper, middle, and lower part of the treatment of stones. Prevention of stone ten strokes 1, drink more water, do not hold urine Do not hold urine, drink more urine to help bacteria, carcinogens and easy to crystallize materials quickly discharged from the body, reduce the kidney and bladder victimization. 2, drink less beer Some people think that beer is diuretic, can prevent the occurrence of urinary calculi. In fact, brewing beer wort contains calcium, oxalic acid, nucleotides and purine nucleotides and other acidic substances, they are used with each other, can make the body of uric acid increase, become an important cause of kidney stones. 3, meat, animal offal to eat less Control the intake of meat and animal offal, because meat metabolism produces uric acid, animal offal is high purine food, decomposition of the metabolism will also produce high blood uric acid, and uric acid is a component of stone formation. Therefore, the daily diet should be vegetarian, more food containing fiber. 4, eat less salt Too salty diet will increase the workload of the kidneys, and salt and calcium in the body has a synergistic effect, and can interfere with the metabolic process of the prevention and treatment of kidney stones drugs. The daily intake of salt should be less than 5 grams. 5, careful eating spinach According to statistics, more than 90% of the stones contain calcium, and calcium oxalate stones accounted for about 87.5%. If the food intake of oxalate is too much, calcium oxalate in the urine is in a supersaturated state, excess calcium oxalate crystals may be precipitated from the urine and the formation of stones. In the food, the highest oxalate is spinach, and spinach is often eaten vegetables. 6, don’t drink milk before going to bed Because milk contains more calcium, and most of the stones contain calcium salts. The most dangerous factor in the formation of stones is the sudden increase in concentration in the urine within a short period of time. Drinking milk after 2-3 hours, it is the peak of calcium discharged through the kidneys, so that time is in a state of sleep, urine concentration, calcium through the kidneys more, so easy to form stones. 7, should not eat more sugar after eating sugar in the urine calcium ion concentration, oxalic acid and uric acidity will increase, uric acidity increases, can make calcium urate, calcium oxalate easy to precipitate, prompting the formation of stones. 8, eat dinner early, the peak of human calcium discharge is often 4-5 hours after eating, if the dinner is too late, when the peak of calcium discharge, people have gone to bed, the urine will be retained in the ureter, bladder, urethra and other urinary tract, can not be discharged in a timely manner, resulting in an increase in the calcium in the urine, it is easy to deposit down to form small crystals, and over time, the gradual expansion of the formation of stones. 9, eat more vegetables and fruits Vegetables and fruits contain vitamin B1 and vitamin C, their final metabolites in the body is alkaline, uric acid in alkaline urine is easy to dissolve, so it is conducive to the treatment and prevention of stones. 10, reduce protein intake Some studies have shown that high protein diet can increase the incidence of urinary calculi. Therefore, moderation of food protein, especially animal protein, is beneficial to all stone patients.