— How common is urolithiasis in Russians?
– Up to 10% of the adult population may be stone carriers; Some do not know it because they have no symptoms, while others show clinical signs of the disease. It is believed that men suffer more often, but our practice shows that there is no big difference in the number of patients of different genders, but there is a difference in age.
Kidney stones are most often found in people between the ages of 20 and 50, but in rare cases children and very old people can also get sick.
— What symptoms indicate the presence of kidney stones?
— Most of the time, there is pain in the lumbar region on one side, sometimes on both sides at the same time. This is one of those severe pains that cannot be confused with anything. Patients often describe it as “dagger-like.”
Sometimes the formed stone remains in the kidney for years and does not grow – it can only cause pain when it impairs urine output, that is, when it blocks the ureter or renal pelvis. In this case, the kidney swells and renal colic occurs.
If the stone is localized in the lower parts of the ureters, pain occurs in the lower abdomen, radiating to the groin area.
— Is pain the only symptom?
– NO. Frequent urination, nausea, vomiting, intestinal paresis, reflex anuria (failure of urine to flow into the bladder) are also possible, and bloody urination may also occur.
In some cases, we can talk about pyelonephritis, which is an inflammatory disease of the kidney tissue of bacterial origin. One of the risks of developing chronic pyelonephritis is urolithiasis. The person may then develop a fever – the very condition that requires immediate medical attention.
– Can a person have kidney stones even though he does not have renal colic?
– Yes, in rare cases. In some patients, large stones form that almost completely cover the pyelocalyceal system of the kidney. This form of urolithiasis is called coral nephrolithiasis and is not characterized by renal colic. Patients may present with nonspecific complaints such as increased fatigue, weakness, and possible mild pain in the lumbar region. Patients then develop the pyelonephritis we discussed. Gradually, kidney function decreases and kidney failure progresses.
— Are the reasons for the development of the disease known?
– Exact reasons have not been determined. It is believed that this is a metabolic pathology.
The likelihood of developing urolithiasis increases if a person leads a sedentary lifestyle, which leads to disruption of phosphorus-calcium metabolism. The occurrence of urolithiasis can be triggered by dietary habits, for example, excessive protein, sour and spicy foods that increase the acidity of the urine.
If a person consumes a lot of dairy products containing calcium, there is a high risk of developing urolithiasis.
The risk of developing the disease also increases in the presence of inflammatory diseases, especially in the kidneys. The infection can enter the urinary tract and cause secondary inflammation there, which can lead to stone formation.
Also, urolithiasis occurs in the presence of abnormalities in the development of the urinary system, for example, if a person has only one kidney.
— How do kidney stones form?
— During chemistry classes at school, laboratory work is done with a supersaturated solution, when sugar or salt is added to the solution and at some point the crystallization process begins. To greatly simplify, the same thing happens in the kidneys.
— What types of stones are usually identified and does the method of treatment depend on the composition of the stone?
– There are many classifications. Let’s take the main ones – these are oxalate (from calcium salts and oxalic acid), urate (from uric acid salts) and phosphate (from phosphoric acid salts). They differ in composition, but the compositions are rarely pure – most often they are mixed. We determine the composition using the biochemical analysis of the stone that breaks off spontaneously or is removed by doctors.
Now about treatment. If we are talking about urate stones, it is believed that they can be dissolved with the help of special drugs. The other two types are practically insoluble.
—Which of these stone types is the most dangerous?
“Actually, we are more afraid of the stone’s location and size, not its composition.
There are stones called coral stones that resemble coral. They can “grow” throughout the entire length of the bud and are often difficult to eliminate; We do this in several stages.
— Do you need to change your diet in some way depending on the type of stones detected?
– Yes. For example, in the presence of oxalate stones, it is necessary to ensure very good fluid circulation (consumption should reach 2-2.5 liters per day). In some cases, you should limit dairy products, salty snacks, chocolate, figs, currants, blueberries, sweets, jam, candies, cocoa, strong coffee and much more.
For urate stones, we recommend eating lean meat, fish, grains in moderation in any meal form, and soup. It is indicated to include fasting days (dairy products, vegetables, fruits) with an increase in the daily amount of fluid intake, at least once every 7-10 days. At the same time, meat and broths of young animals and birds, salty cheeses and legumes are excluded or limited from the diet.
For phosphate stones, which are mostly “sour”, meat products are naturally indicated within reasonable limits. In addition, a number of vegetables, fruits and berries have a diuretic effect, and this quality can be successfully used in the treatment of urolithiasis. These include watermelon, eggplant, banana, pear, melon, strawberry, cabbage, cranberry, gooseberry, carrot, lettuce, currant, pumpkin, dill, blueberry, etc. is included.
— How is urolithiasis treated today?
— In addition to diet and drug prescription, surgical treatment methods are also used. We use these in cases where the stone may cause complications or has reached large sizes (more than 6 mm). Globally, we distinguish between endoscopic operations (insertion of instruments through natural openings in the body) and remote lithotripsy (remote destruction of stones using different types of energy).
Let’s start with the simplest thing for the patient; this is extracorporeal lithotripsy. It is indicated when the patient has stones up to 15 mm that we can localize, that is, visible on x-ray and ultrasound.
— How is lithotripsy performed?
“This is shockwave therapy, where the person is placed in a special device and the doctor crushes the stones with a shock wave using x-rays or ultrasound in a way that does not damage adjacent tissues.
The advantages of this surgery are that we do not make any incisions, do not anesthetize the patient, and only provide mild pain relief. There are almost no complications after surgery, and “sand” and stone fragments are excreted with urine.
In the case of endoscopic surgery, we bring an instrument – the endoscope – directly to the stone along the urinary tract, through the urethra, bladder and ureter. This is a modern approach but is more focused on bladder stones or ureteral stones as well as small stones in the renal pelvis. If the stone is located deep in the kidney, another device called a fiberscope is used.
By bending this tool in a controlled manner, the surgeon can pass into the renal container and break the stone there. However, these methods are not used for inflammation in the urinary tract, scars in the ureter and prostate adenoma.
Another interesting method is percutaneous nephrolitholapaxy.
– When is it used?
— Remember when we talked about coral-shaped stones? This is how they are removed. Previously, open and traumatic operations were used to treat large stones, including staghorn kidney stones. They hypothesized that there were larger cuts in the renal pelvis and damage to the parenchyma of the organ, after which the urination function was severely affected.
Today, for this purpose, a hole is made in the kidney from behind with a thin needle under ultrasound or x-ray control. This passage widens a little and an optical device is passed there to destroy the stone. This method allows you to successfully remove large stones up to 5-6 cm in size.
— Are laparoscopic operations performed?
– Yes. In this case, the instruments are inserted into the abdominal cavity as in open surgery, the renal pelvis or ureter is cut, the stone is removed, and then everything is stitched.
But honestly, as the head of the department, I can say that there is almost no need for such operations lately. They are very traumatic and can cause serious complications.
— Is the risk of recurrence of stones eliminated after surgical treatment?
—No type of surgical treatment excludes the recurrence of urolithiasis. We cannot guarantee that by removing a stone it will not form again.
Urolithiasis should be considered a chronic, long-term disease prone to relapse. Therefore, it is important to change your lifestyle, move more, improve your nutrition and visit the doctor regularly.