Practice diagnosis and treatment of urinary stones

2021-03-25 12:00 AM

Stones often appear in cases of mild dehydration, perhaps due to an increased concentration of the urine

Stones in the kidney, ureter or bladder, caused by precipitation of salts and minerals in the urine. The formation of urinary stones is related to the environment. The proportion of kidney stones and ureteral stones is often higher than bladder stones in developed countries, while the proportion of bladder stones is quite high in developing countries. Urinary stones often recur. The number of patients who relapse within 7 years after treatment accounts for 70%.

Reason

The specific cause is unknown, but the incidence seems to be related to sex. The rate of disease in men is 3 times higher than that of women.

Stones often appear in cases of mild dehydration, perhaps due to an increased concentration of the urine. Therefore, the disease is most common in the summer, when the weather is hot.

Stones also often appear after bedridden, sedentary due to disease ...

Calcium oxalate and phosphate stones account for 70% of the cases of kidney stones and ureteral stones. Oxalate is a metabolic product of the body, still present normally in the urine, when combined with calcium, it forms a poorly soluble salt. When there is a lot of oxalate in food and drinking water, the oxalate concentration in the urine will increase and stones will be produced. Calcium oxalate stones may also be the first sign of a metabolic disorder caused by hyperthyroidism.

About 20% of urinary stones are caused by infection, often accompanied by a urinary tract infection. The stone composition includes calcium, magnesium, and ammonium phosphate. The urine is alkaline, containing more ammonium due to the effect of bacteria on urea in the urine. Kidney stones caused by infection can sometimes be very large, occupy the entire tubes and the upper part of the ureter, kidney pelvis, shaped like an elk.

Uric acid stones only account for about 5%, common in patients with gout, cancer or chronic dehydration. Cystin stones are very rare, appear in a genetic metabolic disease that causes cystin to urinate.

A poor diet, low in protein and phosphate, often causes bladder stones. As a result, bladder stones often have a high prevalence in poor or developing countries.

Urinary congestion, or chronic infection, also causes bladder stones, and is a major cause of bladder stones cases in developed countries. The composition of a bladder stone may vary depending on the alkalinity or acidity of the urine.

Diagnose

Kidney or ureter stones are often characterized by unilateral lumbar cramping, accompanied by vomiting. Diagnosis is confirmed by microscopic haematuria. Undiagnosed back pain or low back pain can all be caused by stones.

If symptoms of pain are severe, it is urgent to perform a urine sample analysis immediately for blood cells. UIV scans during pain can show the exact location of the stones, the function of the kidneys, and the blockages.

If pain is not severe, perform the following diagnostic tests one by one:

Mid-stream urine sample sent for microscopy and bacterial culture.

An abdominal x-ray is not prepared. About 90% of urinary tract stones can be seen on X-rays.

Ultrasound check results.

Complete blood count and erythrocyte sedimentation rate.

Determination of electrolytes, urea, creatinine, urate.

Determination of calcium, phosphate and alkaline phosphate content.

If possible, analyse the stone's chemical composition.

In the following cases, immediate referral to specialist treatment should be considered:

The symptoms indicate that the stone is present, but there is absolutely no condition for any definitive diagnostic tests to be performed.

UIV scans showed blockages.

Diagnosis confirmed that the stone is too large to automatically pass through the urinary tract.

Severe kidney cramps have not responded to treatment.

There are signs of impaired kidney function.

Accompanied by infection.

Treatment

Immediate treatment of nephrotic pain with pain relievers, sedatives and bed rest If the pain is not much, it is possible to use nonsteroidal anti-inflammatory drugs in the form of oral tablets or oral pethidine.

If drug support is needed to resolve the symptoms, diclofenac 75mg intramuscularly (or 100mg anal) or pethidine 100mg intramuscularly, if necessary combined with prochlorperazine 12.5mg intramuscularly to reduce vomiting.

Instruct patients to drink plenty of water to increase the ability to remove stones out of the ureter, bladder, or urethra. Most cases of gravel less than 5mm in size are discharged without any intervention.

The cases of stones are too large or accompanied by serious infections, may need a specialist referral to consider removing the stone by surgery, to avoid damage to the kidneys. However, with advanced technology, most stones can be crushed and removed with a cystoscope or with a gravel ultrasound. Therefore, surgery to remove stones usually only applies to those cases of stones that are too large.

Urinary stones have a high recurrence rate. After treatment, it is necessary to guide patients on measures to be applied regularly to reduce the risk of recurrence.