Urolithiasis is the condition in which calculi are present anywhere in the urinary system, i.e. the kidneys, ureters and / or bladder.
WHAT IS THE FREQUENCY OF UROLITHIASIS?
The stone formation is the third ,in order of frequency, disease of the urinary tract, after UTIs and prostate diseases.
WHEN IS UROLITHIASIS MORE OFTEN?
Urinary calculi occur in people of any age and sex, in every race and country and are known since ancient times.
Men are affected more often than women at a ratio of 2.5: 1, with a higher incidence in the age of 30 years for men , while in women the appearance of stones is more common between the ages of 35 and 55 years . Moreover, it has been found that the probability of forming a new stone a year after the initial episode of nephrolithiasis reaches 10%, and within 5-7 years the recurrence rate is 50%.
WHY DO CALCULI FORM?
Today it is considered that the occurrence of calculi is due to:
Hereditary and birth defects.
Studies have shown that in 25% of patients that present with urolithiasis there is a presence of calculi and in other family members, which of course can be caused from the same eating habits and living conditions.
The incidence of stones is showing geographical distribution, ie in different geographical zones there are different rates of calculi. This difference is due to the climatic conditions and the content of the drinking water in minerals eg calcium.
Increased consumption of protein and animal fat causes increased incidence of urolithiasis. It is characteristic that the frequency of lithiasis increased steadily during the 20th century, with the exception of periods of the 1st and 2nd World War, which was attributed to the change of diet by reducing animal albums during the wars.
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Reduced fluid intake.
Finally, obtaining abundant liquid is still an important dietary factor in preventing the calculi.
WHAT ARE THE SYMPTOMS OF LITHIASIS ?
Calculi when causing obstruction of the urine flow appears clinically as acute pain, our known colic , that pain in the lumbar region with reflection in the lower quadrant of the abdomen. The patient who is in pain is unable to find relief in any position . As the stone approaches the bladder, the pain characteristics change and expands the area of the bladder, while strong urinary frequency and urinary urgency starts. .The pain is most often accompanied by nausea and vomiting, sweating and reflection of pain in the outside genitals (male testes and female lips of the vulva).
The kidney stones do not cause fever. If together with the above symptoms you develop fever immediately contact the doctor or the nearest emergency department.
It is important to that calculi which do not block the kidney and cause no obstruction do not cause any pain . This does not mean that they should not be treated.
HOW IS THE DIAGNOSIS OF LITHIASIS MADE?
To diagnose lithiasis you may be asked to an XRAY of the kidneys, ureters and bladder (KUB), an ultrasound that is an easy and safe examination and helps in the diagnosis of calculi and it gives additional information. In some cases there is a diagnostic problem and is recommended that intravenous urography (pyelography) .
or a CT with and without contrast should be made.
WHAT IS THE PURPOSE OF TREATING LITHIASIS;
Treatment of calculi consists in :
- treat pain
- removal of the stone
- prevent relapses.
HOW DO YOU TREAT PAIN;
The best and final treatment of a renal colic episode is the expulsion or removal of the stone.
• For renal colic painkillers typically used are the NSAIDs and opioid analgesics.
• Restrict fluid during renal colic.
• Granting a adrenergic inhibitors reduces the episodes of pain and facilitates the expulsion of stones or calculi debris after extracorporeal lithotripsy.
OBTAINING THE DECISION FOR THE TYPE OF STONE REMOVAL?
The decision on the type of treatment to remove a stone depends mainly on the size and, secondly, of the localization of the stone. At When the diameter of the stone is less than 5 mm it is discharged 85% automatically, while the chances to pass automatically a stone increase as lower are the stones in the ureter, ie as close to the bladder.
HOW LONG CAN WE WAIT FOR A STONE TO AUTOMATICALLY FALL?
The time limit of four weeks is considered a reasonable waiting time, since the kidney is not in danger at this time.
This requires good renal function, absence of fever and acute symptoms.
HOW DOES A UROLOGIST REMOVES A STONE;
The treatment of calculi is to remove the stone. For this purpose, in this era of minimally invasive therapies, surgical removal of stones by incision has, apart from a few exceptions, limited since the urological arsenal is enriched with effective and less invasive methods. Such methods are extracorporeal lithotripsy, ureteroscopy and PCNL. It is noted that the extracorporeal lithotripsy and PCNL have contraindication in pregnancy.
Extracorporeal shockwave lithotripsy appeared in 1980 and brought a true revolution in the treatment of calculi. It works best to kidney stones and the initial part of the ureter, and almost all kinds of stones can be treated by this method. In recent years it lost ground mainly due to ureteroscopy.
Ureteroscopy (flexible and semi-rigid).
The ureteroscopy is a method in which a long, thin body, ureteroscope, is advanced under direct vision through the urethra and the bladder into the ureter to the point where the stone is. Through this body introduced the lithotripter to crush the stone, but also special tongs that capture and remove it. You can use shock waves and laser if deemed necessary by the urologist. It is for most stones the election process.
Percutaneous lithotripsy is a process with very high success rates. It is indicated mainly for stones those who can not be treated with ESWL or ureteroscopy. Such cases are stones larger than 2.5 cm., Coral stones, hard stones that are highly resistant to extracorporeal lithotripsy and stones in patients with deformity of the skeleton or large obesity.
WHAT ARE THE PREVENTION MEASURES OF RECURRENCE?
Diet and fluids.
- Daily urine output> 2L is the most important and least expensive way to reduce recurrence of urinary calculi. So the daily fluid intake should be at least 2.5-3 liters.
- The patient is advised to consume fluids regularly and not concentrated in any period of 24 hours.
- Increased consumption of animal fat protein and fructose causes obesity, which is an independent predisposing factor for urolithiasis
- The consumption of calcium and citric food during meals reduces oxaluria because calcium binds the oxalate. So now it is not recommended to reduce the intake of dairy products .
- The salt is important for stone formation.
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