What Is Urolithiasis?

Urolithiasis is one of the common diseases of the urinary system, second only to urinary tract infections and prostate diseases. Urinary stones can be divided into upper urinary stones (kidney, ureteral stones) and lower urinary stones (bladder, urethral stones). There are differences in the location of the stones, etiology, age, gender, stone composition and prognosis, which can be regarded as Two types of stones. Urolithiasis is a manifestation of abnormal mineralization in the human body, that is, under normal circumstances, the formation of parts that should not occur in mineralization or excessively high levels of mineralization is closely related to cell activity and metabolism in the whole body. In recent years, the concept of biomineralization and demineralization has been introduced into the research of urolithiasis formation mechanism, which will help to deepen the research of urolithiasis formation mechanism at the molecular level and prevent and cure urolithiasis correctly.

Basic Information

Visiting department: Urology
Common locations: Kidney, ureter, bladder, urethra
Common causes: Race genetics, diet and nutrition, metabolic abnormalities, drug effects, urinary tract infections, etc.

Common symptoms: Dumb pain or colic on the ipsilateral side with vomiting; interrupted urination, pain, difficulty urinating, bladder irritation

Causes of urolithiasis

The etiology of urolithiasis is complex and has not been fully elucidated so far. Most scholars believe that urinary stone formation is the result of a combination of factors.

Internal factors

(1) Race genetic factors . People of all races can develop urolithiasis, but the prevalence is different. African blacks and American blacks have fewer stones. The family rate of calculi is higher than that of non-calculus families. In addition to the close living conditions of the family members, it may also be affected by some genetic factors.

(2) Diet and nutrition People who do not like drinking water are susceptible to stones. Infants are fed prematurely with food and insufficient milk can easily cause bladder stones. Conversely, adults who eat more dairy and meat can also increase the risk of stones. The formation of stones is also related to the sudden increase in the composition of stones in the urine. The more refined the food, the higher the risk of stones. Eating too much salt and spinach can increase the risk of stones.

(3) Metabolic abnormalities Hyperparathyroidism and Cortisol can increase the risk of stones. Calculus can also be a complication of trauma or disease that has been chronically bedridden.

(4) Patients with drug ulcers can produce stones-milk-alkali syndrome by drinking a lot of milk and alkaline drugs. Stones can also contain rare silicates as a result of taking magnesium silicate. Stones can occur in the treatment of glaucoma with acetazolamide, vitamin D poisoning, extensive use of ascorbic acid (which can be converted to oxalic acid), ampicillin, ephedrine and guaifenesin, corticosteroids, and sulfa.

(5) Urinary tract infection, especially when pathogenic bacteria have the effect of decomposing urea to produce ammonia, the increase of pH value, the polymerization of mucin, the bacteria themselves and the infection products can promote the formation of stones. Foreign bodies in the urinary tract such as sutures and catheters can induce stones.

2. External factors

(1) Climate conditions, water quality, and food in the natural environment are all related to the occurrence of stones.

(2) The impact of social and environmental production levels on stones has been proven in epidemiological surveys at home and abroad.

Clinical manifestations of urolithiasis

Stones can occur in various parts of the urinary tract, and different symptoms can occur depending on the site.

Upper urinary tract stones

Patients with kidney stones and ureteral stones often have dull or cramps in the affected side of the waist and abdomen, with vomiting, and often have sudden attacks. Because the stones damage the urinary tract and cause bleeding, the urine color is red, and blood cells can be seen in the test.

Bladder stones

Typical symptoms are sudden interruption of urination, pain radiating to the distal urethra and penis head, with dysuria and bladder irritation.

Due to laborious urination and increased abdominal pressure, prolapse may occur concurrently. Terminal hematuria is often present.

3. Urethral stones

Patients often have pain in the urethra during urination, difficulty urinating, urination in drops, and severe urinary retention and severe perineal pain can occur.

Urolithiasis

Microscopic hematuria

It is an important clue for the diagnosis of this disease. Hematuria is often accompanied by colic episodes or exacerbated by strenuous activities. Patients with recurrent stones should measure blood calcium, phosphorus, uric acid, 24-hour urine output, pH, and excretion of urine calcium, phosphorus, uric acid, oxalic acid, cystine, and citric acid.

2.X-ray inspection

It is an important basis for the diagnosis of urolithiasis. More than 90% of urinary tract stones can be visualized on plain radiographs. The size, shape, number, and location of the stones can be understood from the X-ray plain film. Observing the properties and densities of the stones can help to estimate the composition of the stones. X-ray films should be noted to exclude venous stones, lymph node calcification, aneurysm calcification, renal tuberculosis and tumor calcification.

3.B-ultrasound

Because the B-ultrasound is simple, non-invasive, and not restricted by allergy to contrast agents, it is most suitable for screening and follow-up of patients with urolithiasis. B-ultrasound has the following advantages: find stones that can be seen through X-rays; know whether there is hydronephrosis; understand the thickness of renal parenchyma; find some causes of stone formation, such as renal cystic disease, renal deformity, etc Provide differential diagnosis information, such as stones and tumors, blood clots, upper urinary stones and gallstones. It is possible to make full use of B-X-rays to find some early stones. Some cases can be combined with CT examinations, such as those with suspected tumors. MRI water imaging can show anatomy of the urinary tract, and it can help to show the urinary tract condition for those who are not visualized by intravenous urography.

Urolithiasis diagnosis

The diagnosis of urolithiasis includes the presence of stones, urinary stone complications, and the diagnosis of urolithiasis.

1. Diagnosis of the presence of urinary stones

Urolithiasis patients often seek medical attention for renal colic. If there is gross hematuria or microscopic hematuria, the disease should be highly suspected.

2. Diagnosis of urinary stone complications

The main complications after the formation of urinary stones are urinary tract infection, obstruction, impaired renal function, and the possibility of tumor formation. Patients with urinary tract infections develop fever, low back pain, pus cells in the urine, and bacterial growth in urine culture. Diagnosis is not difficult.

3. Diagnosis of Urinary Stone Causes

From the beginning contact with patients should pay attention to the cause of exploration. Understand the patient's past history, family history, residence history, occupation, job nature and history of stones. Understand the patient's diet, drinking habits, and special hobbies.

Urolithiasis Treatment

Emergency treatment

Renal colic and infection are often urgently needed. Infection must be controlled with antibacterial drugs in a timely manner, and severe cases should be hospitalized for intravenous administration. Eliminating stones to remove obstruction is the fundamental method for treating renal colic. The idea that diuresis may flush stones out lacks experimental basis. This method increases intra-renal pressure and is not conducive to protecting renal function. The use of drugs should be mainly antispasmodic, anticholinergic drugs, progesterone drugs, calcium blocking drugs can be applied. Indomethacin can inhibit the synthesis of prostaglandins and can directly affect the ureteral wall. In recent years, it has certain effects in clinical applications, but it is broken down by the liver after oral administration and cannot play a large role. It needs anal administration or intravenous infusion.

Patients with obstructive anuria due to urolithiasis need urgent treatment. The management principle is to remove obstruction, smooth drainage and prevent complications.

2. Selective treatment

The principle of selective treatment of stones should depend on the existence of the etiology and comorbidities that must be removed, and not all stones must be actively treated. For asymptomatic kidney stones, no lithotripsy can be performed temporarily, and palliative therapy such as food therapy and medicine will continue to observe.

Urolithiasis prevention

Complete removal of stones and elimination of their causes is the best preventative method. But the cause of most urolithiasis is difficult to eradicate. Therefore, long-term attention needs to be paid to prevention.

Diet stone

Develop a habit of drinking plenty of water. The daily urine output is 2000 ~ 2500ml, and the appearance is colorless or light yellow. Choose foods based on stone composition and urine analysis. Those who are over-nourished should reduce calories, especially reduce the intake of animal protein, and eat more whole grains; those with high absorption of calcium should limit dairy products, animal protein and sugar; those with high uric acid fasting animal viscera and eat less meat. High oxalic acid fasting spinach, less soy products.

2. Drug prevention stone

(1) Drugs that reduce the saturation of stone salts or acids in the urine. Thiazine drugs reduce calcium and oxalic acid, allopurinol drugs lower uric acid, thiol drugs cysteine, and orthophosphate drugs can indirectly reduce Calcium, magnesium, and citrate can complex urinary calcium. Bacterium can reduce the ammonia in urine and change the pH value during infection.

(2) Citric acid, orthophosphate, etc., which increase urinary inhibitory activity .

(3) Drugs such as acetylcysteine and alanine that interfere with the promotion of urinary mucin polymerization control .