Urolithiasis

Urolithiasis (urolithiasis) – the disease resulting from disbolism at which in urine the insoluble deposit in the form of sand (to 1 mm in the diameter) or stones is formed (from 1 mm to 25 mm and more). Stones settle in urinary tract that breaks normal outflow of urine and serves as an origin of renal colic and inflammatory process.

According to medical statistics, the urolithiasis is on the second place on frequency among all urological diseases, and on the third place among the urological diseases leading to death. The urolithiasis strikes people of any age, including children, but the main age group - aged people from 25 to 45 years. The disease meets at men more often, than at women, however diagnose severe forms of a disease for women more often. It is also known that stones are more often formed in a right kidney, than in left, and approximately both kidneys are involved in 20% of cases in pathological process.

Urolithiasis reasons

In emergence of an urolithiasis the set of factors plays a role, at the same time up to the end the mechanism of formation of stones and its reason are not found out. It is known that the leading role is assigned to features of a structure of canalicular system of kidneys when the anatomical structure of a kidney promotes emergence of developments of stagnation. At the same time formation of stones requires also influence of external factors, mainly, of a diet, and also conditions of the drinking mode. Also in development of an urolithiasis diseases of urinogenital system, endocrine pathologies (especially the diseases of epithelial bodies directly influencing exchange processes with calcium participation), long reception of some medicinal substances play a role (streptocides, tetracyclines, glucocorticoids, aspirin, etc.).

Types of an urolithiasis

Various disturbances of exchange processes cause formation of the stones differing on the chemical composition. Chemical composition of concrements is important as medical tactics in treatment of an urolithiasis, and also correction of a diet for prevention of a recurrence depends on it.

In urinary tract the following concrements are formed:

• Stones on the basis of compounds of calcium (oxalates, phosphates, carbonates);
• Stones on the basis of salts of uric acid (urates);
• The stones formed by magnesium salts;
• Proteinaceous stones (tsistinovy, ksantinovy, cholesteric).

The main share is the share of compounds of calcium (about 2/3 all stones), proteinaceous stones meet most less often. Urates – the only group which gives in to dissolution. These stones come to light at elderly people more often. The stones consisting of magnesium salts most often are followed by an inflammation.

Stones at an urolithiasis can be formed in any department of urinary tract. Depending on where they are, distinguish the following forms of a disease:

• Nephrolithiasis – in kidneys;
• Ureterolithiasis – in ureters;
• Cystolithiasis – in a bladder.

Urolithiasis symptoms

The urolithiasis proceeds asymptomatically in the beginning. The first signs of an urolithiasis are found or is accidental, during inspection, or at suddenly come renal colic. Renal colic – the strong painful attack which is often the main symptom of an urolithiasis, and sometimes and the only thing, results from a spasm of an urinary channel, or its obstruction by a stone.

The attack sharply, begins with sharp pain which localization depends on localization of a stone. The megalgia, can give to a groin, a stomach bottom, a waist. The urination becomes painful and speeded up, in urine blood (hamaturia) is found. There is nausea, sometimes vomiting. The patient rushes about in search of situation which would give relief, but does not find such situation. The attack of renal colic can pass with a zatikhaniye and an exacerbation of pain and to end with either removal of a stone, or subsiding of colic, or the developed complication.

It is necessary to notice that expressiveness of signs of an urolithiasis is not always connected with the size of stones. Sometimes the concrements of the small sizes which are not exceeding 2 mm can cause the most severe colic whereas cases of severe damage of kidneys when the multiple stones which grew together in korallovidny educations do not lead to colic meet, and are found accidentally or when urolithiasis complications begin.

Diagnosis of an urolithiasis

Diagnosis of an urolithiasis happens on the basis of a characteristic clinical picture of renal colic and data of ultrasonography. Also computer tomography and magnetic and resonant urography are informative. Carry out the developed analysis of urine, using functional trials (across Zimnitsky, Nechiporenko, etc.). The bacteriological research of urine is obligatory. The X-ray analysis lost now the leading place in diagnosis of an urolithiasis, however is still used as an additional method.

Treatment of an urolithiasis

The attack of renal colic is removed by means of drugs of spasmolytic and analgeziruyushchy action. The main treatment of an urolithiasis is carried out to lack of acute manifestations.

The urolithiasis is considered a surgical disease, however the urolithiasis caused by formation of urates it is possible to treat medicamentally, accepting the drugs dissolving these stones. Other types of concrements demand mechanical removal.

Treatment of an urolithiasis is performed by means of two main methods: lithotripsies and surgical. A remote shock and wave lithotripsy - an effective method of treatment of an urolithiasis at which stones in urinary channels break by means of a shock wave and then are removed with urine. The method perfectly proved, thanks to it indications to an operative measure at treatment of an urolithiasis were considerably narrowed.

Operations by means of which treatment of an urolithiasis is performed share on open and endoscopic, and also on organ-preserving and radical. Radical operation is removal of a kidney if it lost the function. A preference method in the choice of surgical treatment of an urolithiasis are the endoscopic techniques allowing to carry out a removing calculus without making a section in an abdominal cavity.

Prevention of an urolithiasis

Prevention of an urolithiasis is a necessary condition of full treatment as without it a recurrence is inevitable. A basis of prevention of an urolithiasis is observance of the diet normalizing a metabolism and biochemical composition of urine, and also observance of the drinking mode. The diet at an urolithiasis is developed depending on chemical composition of stones. So, at oxalates exclude dairy products, chocolate from food, and at uratny stones limit consumption meat. Extremely important condition is reception of enough water – 1,5 – 2 l a day.