What Are the Signs of Kidney Stone in the Ureter?

Kidney and ureteral stones, also known as upper urinary calculi, occur in middle to middle-aged men and women, with a ratio of 3 to 9: 1. The incidence is similar on the left and right sides, with bilateral stones accounting for 10%. The main symptoms of kidney and ureteral stones are colic and hematuria. Common complications are obstruction and infection. Most cases can be confirmed through medical history, physical examination, necessary X-rays and laboratory tests. The purpose of kidney and ureteral stone treatment is not only to relieve the pain and protect the kidney function, but also to find and eliminate the cause as far as possible to prevent the recurrence of stones.

Kidney and ureteral stones, also known as upper urinary calculi, occur in middle to middle-aged men and women. The ratio of male to female is 3 to 9: 1. The main symptoms of kidney and ureteral stones are colic and hematuria. Common complications are obstruction and infection. Most cases can be confirmed through medical history, physical examination, necessary X-rays and laboratory tests. The purpose of kidney and ureteral stone treatment is not only to relieve the pain and protect the kidney function, but also to find and eliminate the cause as far as possible to prevent the recurrence of stones.

English name

kidney andureter calculi

Visiting department

Urology

Common causes

May be related to factors such as metabolism and infection

Common symptoms

Waist discomfort, right lower quadrant pain, hematuria, typically renal colic

Clinical manifestations of kidney and ureteral stones

Hematuria is another major symptom of kidney and ureteral stones. When pain occurs, it is often accompanied by gross hematuria or microscopic hematuria, the latter being mostly. Large amounts of gross hematuria are rare. Hematuria can increase after manual labor. Patients may occasionally seek medical attention for painless hematuria. In recent years, a regular physical examination, routine urine and B-ultrasounds found that asymptomatic kidney stones increased significantly.

Common complications of kidney and ureteral stones are obstruction and infection, and many cases seek medical treatment for symptoms of urinary tract infection. Obstruction can cause hydronephrosis and a lump in the abdomen or waist. Sometimes tenderness along the ureteral stroke. Solitary kidney or bilateral urinary stones cause anuria due to obstruction, the so-called stone obstructive anuria.

Kidney and ureteral stones

Medical history

A detailed medical history often provides valuable information. Activity-related pain and hematuria should be considered first as upper urinary stones. It is more likely if you have typical renal colic.

2. Physical examination

The onset of renal colic is at rest, and only the costal spine and angulation of the affected side is painful. At the onset of colic, the patient's body is flexed, the abdominal muscles are tense, the spine and ribs may have tenderness and local muscle tension, and those with hydronephrosis can touch the enlarged and tender kidney when the abdominal muscles relax. Most cases of kidney stones without obstruction have no obvious signs.

3. Imaging examination

B-mode ultrasound is economical, convenient, and harmless to the human body, and can be used as a screening method. In recent years, many asymptomatic kidney stones have been found during routine physical examinations. This test can also provide information on the status of hydronephrosis in the kidney and ureter, and the thickness of the renal cortex. It is helpful for the diagnosis of negative stones. But the stones were too small to be identified.

(1) X-ray examination is an important step in the diagnosis of kidney and ureteral stones. You can understand the shape of the kidney, the size, shape, number, and location of stones, the shape of the renal pelvis, renal function, and bone changes, especially the anatomy of the kidney and ureter The exception.

(2) X-ray film of urinary system (KUB) must include the whole urinary system. 95% of kidney stones can be displayed on plain radiographs. Various stones also have their own characteristics on plain radiographs.

(3) Radionuclide nephrogram and scan can understand the degree of renal impairment and the status of obstruction caused by stones.

(4) CT examination can show X-ray negative stones (uric acid stones).

4. Ureteroscopy and nephroscopy

If the plain radiograph of the abdomen does not show any stones and the IVU has a filling defect that cannot be diagnosed, this test can be performed and treated.

5. Laboratory inspection

Laboratory tests are very important for the diagnosis of the cause of kidney stones. They usually include serum calcium, phosphorus, uric acid, plasma protein, carbon dioxide binding capacity, electrolytes, and creatinine; urine routine, urine culture, and 24-hour urine pH, calcium, and phosphorus , Uric acid, oxalic acid, cystine, citric acid, creatinine, etc .; Analysis of stone composition; Special metabolic tests include thyroid function measurement, ammonium chloride load test, calcium load test, etc.

Diagnosis of kidney and ureteral stones

The diagnosis of kidney and ureteral stones is generally not difficult. Most cases can be confirmed through medical history, physical examination, necessary X-rays and laboratory tests. At the same time, renal function should be further checked for obstruction and infection, and the composition of the stones and possible primary causes should be estimated.

Treatment of kidney and ureteral stones

The purpose of kidney and ureteral stone treatment is not only to relieve the pain and protect the kidney function, but also to find and eliminate the cause as far as possible to prevent the recurrence of stones. According to the general condition of each patient, the size of the stones, the composition of the stones, the presence or absence of obstruction, infection, stasis, the degree of renal parenchymal damage, and the trend of recurrence of stones, the prevention and treatment plan is formulated.

Conservative treatment

(1) Drinking a lot of water Increasing the amount of drinking water can reduce the concentration of urinary stones forming components, reduce the chance of sedimentation, and promote the excretion of small stones, which is also beneficial for the drainage of infection. Therefore, patients with stones should develop a habit of drinking more water and maintain a daily urine output of more than 2000 to 3000ml.

(2) Control of urinary tract infections Stones, obstructions, and infections often form a vicious circle in the body. Therefore, when stones are combined with infection, the examination and treatment of stones should be performed under the control of infection. Magnesium ammonium phosphate stones often form in infected urine.

(3) Adjust the diet According to the composition of the stones, determine the diet. Uric acid stones should be on a low purine diet, and cystine stones should be on a low methionine diet. Fruits and vegetables can make urine alkaline, which is better for preventing uric acid and cystine stones. Meat foods make the urine acidic, which is better for preventing infected stones. For phosphate stones, a low calcium and low phosphorus diet can be used while taking aluminum hydroxide gel. Calcium-containing kidney stones avoid high calcium, high salt, high oxalic acid, high animal protein, high animal fat and high sugar, and adopt a high fiber diet.

(4) The pain should be relieved first during the onset of renal colic. For acute renal colic, abdominal distension, nausea, and vomiting, most of them can be relieved by infusion, local hot compress, and injection of atropine, morphine or pethidine. Acupuncture and ear acupuncture both have analgesic effects. Injection of indomethacin has better analgesic effect.

(5) Stone rowing treatment Most stones with a diameter of less than 0.4cm can be discharged on their own. Any stones with a diameter of 0.4 to 0.6cm or individually up to 1.0cm have a smooth surface without obvious obstruction and infection symptoms. Combined with therapy, it is possible to excrete.

(6) Stone- Solving Therapy Pure uric acid stones have better dissolving effect with oral drugs. If a nephrostomy can dissolve uric acid stones with alkaline drugs, the effect is also better. Drink plenty of water to keep the daily urine volume above 3000ml, adjust the urine pH to 6.5 to 7.0, limit the high purine diet, and take allopurinol, which may dissolve the stones. Note that when using allopurinol, be careful of its renal toxicity, especially for those with poor renal function, adjust its dose according to creatinine clearance. Cystine stones Dissolve the stones with oral drugs and pass through the nephrostomy. Dissolving cystine stones with drugs has a good effect. In addition to drinking water regularly at day and night, daily up to 3000 ~ 4000ml, low methionine diet, alkaline urine to pH 7.0 ~ 7.5, D-penicillamine or Thiola can be used.

2. Surgical treatment

The purpose of the surgical treatment is to remove the stones. The isolated stones have a significant effect. The more frequent and recurrent kidney stones are, the better.

(1) Surgical treatment The indications are relative. It is generally believed that stones with a diameter greater than 1.0cm have a lower chance of self-discharge, especially the common oxalic stones, which are difficult to discharge due to the non-smooth surface. Obstruction caused by stones that affect renal function, or those who are not effective after non-surgical treatment, should be considered surgical treatment. In recent years, due to the development of extracorporeal shock wave lithotripsy and intraluminal urology, the indications for surgery have changed.

(2) Principles of surgical treatment For bilateral kidney stones Generally, the simple and safe side of the operation should be taken first. In principle, if the total renal function is still good, the side with severe obstruction should be performed first; if the total renal function is poor, the side with better renal function should be selected first. If stones are difficult to remove and the patient is seriously ill, ureteral intubation can be performed through cystoscopy, and the pelvis is drained or nephrostomy is performed first. If necessary, it can be treated with artificial kidney or peritoneal dialysis before surgery. One side of kidney stones and the other side of ureteral stones should be treated with ureteral lithotripsy. Bilateral ureteral stones should be taken first from the severely obstructed side. For kidney stones with primary urinary tract obstruction, such as those with a narrow pelvic ureteral junction, pelvic aneurysm is required to correct the obstruction while taking the stone. Patients with renal calculi with primary hyperthyroidism should undergo parathyroid surgery first, and some renal calculi can dissolve on their own. For acute obstructive anuria due to stones, after the removal of the obstruction by surgical stones, attention should be paid to the prevention and treatment of water-electrolyte and acid-base metabolism disorders in the polyuria phase.

(3) Surgical method: stone removal by renal pelvis or sinus. The advantages are less bleeding, fewer complications, and the best effect on a single kidney stone. There are many small stones in the renal pelvis that can be removed by clot pyelotomy. In recent years, by using this technique combined with lithotripsy during the operation, more complicated kidney cast stones can be removed. In this operation, care should be taken not to damage the pelvic ureteral junction to avoid postoperative stenosis. Renal parenchyma incision and stone removal method is to make a "Brodel" line with less blood vessels on the outer and posterior sides of the kidney or make a radial incision on the dorsal side of the kidney, or even make a small incision on the dilated small calf to remove the renal pelvis and the small calf. Kidney stones. Multiple nephrectomy for partial stones Renal one-pole partial resection can be used when it is difficult to remove the kidney. Nephrectomy Severe staghorn or massive stones with severe hydronephrosis or pus in the kidney, and nephrectomy should be considered when the contralateral kidney is normal. In recent years, nephrectomy due to kidney stones has gradually decreased. ureteral incision and stone surgery Immediately before surgery, the urinary X-ray film should be taken to confirm that there is no change in the location of the stone. Upper and middle ureteral calculi are easier to operate than lower calculi, with fewer complications. The stone incision of the ureter is aimed at the normal ureteral site above the stone, and the stone is pushed up and removed to avoid postoperative stenosis. After taking the stone, a catheter was also used to explore the distal end for obstruction. The prognosis of isolated stones is more good.

3. Extracorporeal shock wave lithotripsy (ESWL) and intraluminal urology

Since the 1980s, considerable progress has been made in the treatment of urolithiasis, and ESWL, percutaneous nephrolithotomy (PCNL), and ureterolithotomy have begun. Its indications are relative and should be mastered according to the specific conditions of the technology and equipment of each medical unit.