urolithiasis
Introduction
Introduction Urinary calculi are one of the most common urological diseases. More men than women, about 4 to 5:1. The formation mechanism has not been fully elucidated and there are many doctrines. The recurrence rate is high. There is no ideal preventive method for most stones. The incidence of urolithiasis is regional. It is more common in the south of the Yangtze River in China. The north is relatively rare. In the past 30 years, the incidence of upper urinary tract (kidney, ureter) stones has increased significantly in China, and lower urinary tract (bladder) stones have become increasingly rare. In bladder stones, primary stones are significantly less than secondary stones. In the past decade, the treatment of urinary calculi has developed rapidly, and about 90% of urinary calculi can no longer be treated with traditional open surgery.
Cause
Cause
Factors affecting the formation of urinary tract stones: Many factors affect the formation of urinary tract stones. Salts that form stone crystals in the urine are supersaturated, and the inhibition of crystal forming substances and the presence of nuclear matrix in the urine are the main factors for the formation of stones.
(1) Epidemiological factors:
Includes factors such as age, gender, occupation, socioeconomic status, dietary composition and structure, water intake, climate, metabolism, and genetics. Upper urinary tract stones occur in 20 to 50 years old. More men than women. The peak age of onset in men is 35 years. Women have two peaks, 30 and 55 years old. During the Second World War, the incidence of upper urinary tract stones decreased, and the incidence during the interstitial period and in the past four decades increased significantly, suggesting that it was related to changes in economic income and dietary structure. Experiments have shown that the animal protein and refined sugar in the diet increase, and the cellulose is reduced, which promotes the formation of upper urinary tract stones. Drinking plenty of water dilutes the urine and reduces the formation of crystals in the urine. Relatively high temperature environment and reduced activity are also influencing factors, but occupation, climate and so on are not the sole determinants.
(2) Urine factors:
1. Too much stone material is discharged: the amount of calcium, oxalic acid and uric acid in the urine increases. Long-term bed rest, hyperparathyroidism (resorbable hypercalciuria), idiopathic hypercalciuria (absorbed hypercalciuria - intestinal absorption of calcium or renal hypercalciuria - tubular reabsorption Calcium reduction), other metabolic abnormalities and renal tubular acidosis, etc., all increase urinary calcium excretion. Gout, urine continues to be acidic, chronic diarrhea and thiazide diuretics increase uric acid excretion, increased endogenous synthetic oxalic acid or increased absorption of oxalic acid in the intestine, can cause high oxalic aciduria.
2. Urine acidity is reduced and pH is increased.
3. Reduced urine output, increasing the concentration of salts and organic matter.
4. The amount of crystal forming substances in the urine is reduced, such as citric acid, pyrophosphate, magnesium, acid mucopolysaccharides, and some trace elements.
(3) Abnormal anatomical structure:
Such as urinary tract obstruction, resulting in crystal or matrix deposition in poor drainage, urine retention secondary urinary tract infection, is conducive to the formation of stones.
(4) Urinary tract infections:
The cause of most calcium oxalate stones is unknown. Calcium phosphate and ammonium magnesium phosphate stones are associated with infection and obstruction. Uric acid stones are related to gout. Cystine stones are a rare familial hereditary disease caused by the excretion of large amounts of cystine in the urine.
Examine
an examination
Related inspection
Ureaplasma urealyticum urinary tract dialysis Ureaplasma urealyticum Ureaplasma urealytic pyelography (IVP)
According to the anatomical site, there are several types: renal pelvis, ureter, bladder, urethra stones, renal pelvis and ureter, typical symptoms of urinary tract irritation (dysuria, urgency, frequent urination), may be associated with hematuria, complete obstruction after urinary tract Urine reflux can cause retrograde infections such as fever, exertion, drowsiness and irritability. The urine is forced to kidney, the kidney begins to necrosis, kidney failure, and uremia.
The incidence of urinary calculi is higher in men than in women. Renal and ureteral stones are more common in young adults aged 20 to 40, accounting for about 70%. Bladder and urethra stones occur mostly in children under 10 years old and elderly patients over 50 years old. . After urinary tract obstruction and infection caused by urolithiasis, renal function damage is greater, especially when the urinary tract long-term obstruction and isolated renal obstruction are more serious, the treatment is more complicated, and severe cases can be life-threatening.
Diagnosis
Differential diagnosis
When urinary calculi form acute urinary tract obstruction, the clinical manifestations are more typical, and the diagnosis is not difficult. Primary urinary calculi are often confused with certain diseases. The diseases that must be identified are:
1. Urethral stricture urethral stricture:
The main symptoms are dysuria, weak urine flow, interruption or drip, and frequent urination, urgency, dysuria and urethral secretions. Some traumatic urethral strictures may also affect the urethral induration. Urethral stricture often has no history of renal colic and history of urinary sandstone, but has its primary cause, such as injury, inflammation or congenital, iatrogenic reasons; its dysuria is not sudden; urethral exploration can be narrow The site was blocked; the X-ray plain film had no stone shadow, and the urethral angiography showed a narrow segment.
2. Non-specific urethritis:
In non-specific urethritis, there may be dysuria, frequent urination, urgency, and urethral secretions. Chronic non-specific urethritis may be associated with urethral stricture and dysuria. Non-specific urethritis has no history of renal colic or urinary sandstone, no acute dysuria, urethral percussion can not touch the induration, X-ray examination without stone shadow.
3. Urethral injury:
Urethral injury may have urethral bleeding, urinary pain and dysuria, urinary retention, and urethral secretions when infected.
Urethral injury generally has a clear history of injury, often accompanied by extravasation of urine, local skin swelling, subcutaneous hemorrhage, trial insertion of the catheter is not easy to insert into the bladder, and a few drops of blood can be drawn from the catheter, X-ray film can be seen in pelvic fractures and other signs No stone shadows.
4. Urethral fistula:
Due to urethral sphincter spasm, there may be symptoms such as urethral pain and dysuria, often caused by mental stress and local irritation.
Urethral tract without urinary sandstone history and urinary frequency urgency and other symptoms, can not sputum and urethral induration, urethra exploration can pass normally, X-ray examination without abnormalities, symptoms can be alleviated with sedatives.
5. Foreign body of the urethra:
When foreign bodies in the urethra cause urethral obstruction, dysuria may occur, and even urinary retention may occur. When foreign body irritation or secondary infection occurs, there may be frequent urination, urgency, dysuria and hematuria. However, the cause can be found. X-ray examination shows filling defects in the urethra, and foreign bodies can be seen by urethroscopic examination. According to the anatomical site, there are several types: renal pelvis, ureter, bladder, urethra stones, renal pelvis and ureter, typical symptoms of urinary tract irritation (dysuria, urgency, frequent urination), may be associated with hematuria, complete obstruction after urinary tract Urine reflux can cause retrograde infections such as fever, exertion, drowsiness and irritability. The urine is forced to kidney, the kidney begins to necrosis, kidney failure, and uremia.
