Treatment of urticaria. Treatment of urolithiasis: effective drugs. Folk remedies for ICD
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The question of how to treat urolithiasis is dealt with not only by urological doctors, but also by surgeons who surgically remove stones from different parts of the urinary tract.
Unfortunately, no doctor can guarantee a patient a complete recovery, even if the treatment met all modern standards. If metabolic failures have occurred in the patient’s body and the process of stone formation has been started, then there is a constant threat of their new formation.
In order to avoid this, treatment of urolithiasis should be multidirectional and combined, which will ensure an impact on all links in the pathogenesis of the disease, especially in people at risk of relapse of the process.
All patients with urolithiasis should be observed annually by their attending physician, even if nothing worries him, because it is important to assess the dynamics of the disease and promptly identify any structural changes in the urinary organs.
Medical nutrition
According to the protocol for the management of a patient with urolithiasis, treatment measures begin with prescribing an appropriate dietary option. Thanks to therapeutic nutrition, you can stop the formation of new stones, as well as speed up the process of breaking down already formed stones.
The diet for urate urolithiasis is aimed at “alkalinizing” the urinary sediment. To do this, it is necessary to include fresh vegetables and fruits, berries and all dairy products in the patient’s diet.
At the same time, the consumption of fish and meat dishes, especially those prepared from fatty varieties, alcohol, champignons, spinach, offal, legumes, semi-finished products, eggs (that is, those products that contain an excess of purine bases) is sharply limited.
The volume of liquid drunk during the day should not be less than 2-2.5 liters. It is not recommended to drink drinks made from cranberries and lingonberries, as they can increase the acidity of urinary sediment.
It is advisable to carry out fasting days several times a month, during which only fruits, vegetables or dairy products are consumed.
A diet for oxalate urolithiasis implies the complete exclusion from the patient’s diet of products containing oxalic acid or substances that can serve as a source for its synthesis.
The following products are completely excluded: spinach, rhubarb, sorrel, offal, fatty meats, mushrooms, chocolate products, coffee, cocoa, smoked snacks, pickles and others.
At the same time, a sufficient amount of magnesium and potassium must be present in the diet. The diet includes cereals (pearl barley, oatmeal and buckwheat), hard-ground bread, rye bran, dried fruits, etc.
The following products are allowed: boiled fish and lean meats that are steamed or boiled, eggs, dairy products, vegetables and fruits that do not contain oxalic acid (cucumbers, pumpkin, bananas, apricots and others).
Urolithiasis of oxalate origin is treated by prescribing adequate water load (the patient should drink at least 2.5 liters of water daily)
The diet for phosphorus-calcium urolithiasis is aimed at “acidifying” the urine, which speeds up the process of removing stones from the body and prevents the precipitation of salt crystals into the urinary sediment.
The following products are excluded or maximally limited in consumption: milk and dairy products, potatoes, vegetable salads, spices, compotes and fruit preserves, etc.
It is recommended to consume fish and lean meat, vegetable fats, cereals without added milk, bread products, vegetables (pumpkin, peas, mushrooms) and fruits (sour apples, lingonberries, cranberries and compotes made from them), weak tea, etc. d.
The volume of water load per day should not be less than 3 liters. It is recommended to consume fruit drinks and compotes made from cranberries and lingonberries daily to speed up the process of changing the pH of urine to the acidic side.
Drug therapy
Symptomatic treatment is necessary to relieve pain that occurs due to muscle spasm when a stone moves through the lumen of the ureter.
For these purposes, the following drugs are used, which are administered intramuscularly or intravenously:
- No-spa 2% -2 ml;
- Papaverine 2% -2 ml;
- Analgin 50% -2 ml;
- Tramadol 1% -1 ml and others.
After the attack of renal colic has been stopped, their further use in tablet form is allowed.
Among the most common painkillers used to treat an attack of renal colic due to urolithiasis, it is worth highlighting Baralgin. It is prescribed either alone or in combination with the drugs described above, which speeds up the process of pain relief.
In Russia, novocaine blockades (paravesical, suprapubic, paravertebral, paranephric and others) have found their use.
The effect of perinephric blockade is short-lived, and if it is carried out incorrectly, there is a risk of serious complications
Pathogenetic treatment is decisive in the direct fight against the process of stone formation.
To prevent the synthesis of stones from uric acid (urates), Allopurinol tablets are used at a dose of 300 mg (100 mg 3 times a day) for a course of 2-3 weeks (under monitoring the level of uric acid in the patient’s body).
Accelerates the process of excretion of urate by the kidneys Butadione (0.1 g 4-6 times a day for 3-5 weeks).
To start the process of breaking down stones of urate origin, citrate mixtures are used, which include several components: sodium citrate, potassium citrate, ascorbic acid. The resulting solution is taken for several months with mandatory monitoring of urine pH. Instead of the citrate mixture, the patient can be prescribed Uralit (combined drug).
There are citrate mixtures that can be purchased at the pharmacy (for example, Litren powder)
Oxalaturia is eliminated by taking Allopurinol and drugs that include magnesium oxide, B vitamins (in particular B6) and A (retinol).
For urolithiasis associated with calcium metabolism disorders, medications are prescribed that can reduce its concentration by binding and forming insoluble compounds. For this purpose, Almagel is prescribed 2 tsp. 3-4 times a day for 2-3 weeks.
Many drugs contain not only chemical compounds, but also components of natural origin.
Flurbiprofen accelerates the process of excretion of free calcium, which prevents its precipitation into crystalline compounds. Its dose is 0.05 g 3 times a day.
The level of phosphates in the patient's blood is reduced by prescribing vitamin D2 (200-400 IU). Treatment with Xidofon is also carried out (1 tbsp. 3 times a day). The course of treatment is chosen individually.
To eliminate pain and other manifestations of urolithiasis at home, combined drugs are used, such as Cystenal, Spasmocystenal, Canephron, Cyston and others.
When an infectious agent is attached and the inflammatory process begins, treatment is carried out with broad-spectrum antibacterial drugs and antimicrobial agents.
Phytotherapy
In addition to conservative treatment methods, a significant role in the treatment of patients with various forms of urolithiasis is given to the use of herbal remedies. When properly combined with each other, they have effects that are not inferior to synthetic drugs.
Herbal infusions help in the fight against inflammation, the spastic component of the disease, change the pH of urine, and also have a bactericidal effect.
Each decoction or infusion of herbs is prepared individually, because the same collection can have different effects on the patient’s body and on the process of stone formation
To dissolve oxalate stones, use nettle juice (2 tablespoons 3 times a day for a month).
Urate urolithiasis can be treated with an infusion of birch leaves. To do this, take 3 tbsp. l. dry substrate, pour 300 ml of boiled water and leave for 3-4 hours, after which take 100 ml 3 times a day (course of therapy 30-40 days).
Stones of a phosphate nature will help to dissolve a decoction, which contains the following components: bean pods, corn silk, bearberry leaves, blueberry leaves. It is necessary to pour 1 tablespoon of the collection with 300 ml of boiling water, leave for 2-3 hours, strain and take 1 spoon 3 times a day.
Fresh birch sap, which should be consumed 1 glass every day for a month, will cure urolithiasis at the stage of “sand” formation.
To speed up the spontaneous passage of stones, a collection is prescribed, which includes horsetail herb, bearberry leaf, lingonberry and birch leaves, juniper fruits and licorice root.
Surgical treatment
If the stone does not manifest itself clinically, the patient does not make any complaints, and its discovery is an accidental finding, then treatment of urolithiasis continues with conservative methods. Most often, we are talking about a single formation of small size, located in one of the calyces of the kidneys, and there should be no disturbances in the functions of the organ.
However, if a small single calculus causes renal colic in a person, brings him a feeling of discomfort, or there are any signs of disruption in the functioning of the glomerular apparatus of the kidneys, then the issue of its surgical removal is decided.
Not all stones can pass out on their own, even if their size does not exceed 5-6 mm. The reason for this may be obstructive disorders in the urinary tract, the presence of inflammatory changes that impede the passage of stones, etc. In any of these cases, surgical intervention is necessary, due to which the formed calculus will be completely removed or crushed into smaller parts.
External shock wave lithotripsy
With the introduction of modern methods of minimally invasive surgical intervention, the treatment of urolithiasis has become as safe as possible and more effective.
Currently, the method of remote shock wave lithotripsy (ESWL) is widely used, the essence of which is to create a special wave pulse with a device that can crush the stone into smaller parts. Subsequently, they are washed out of the urinary tract on their own.
If the size of the stone exceeds 2 cm, then, before performing DLT, the patient is given a special catheter, with the help of which all its destroyed fragments are removed. This is necessary in order to avoid their accumulation in the ureter, which will lead to another attack of renal colic, and can also cause complications.
In order for the procedure to have maximum effect and have the least traumatic effect on surrounding tissues, it must be carried out under mandatory ultrasound or x-ray control. The shock wave should only affect the area in which the stone is located.
Contraindications to the treatment of urolithiasis using DLT:
- obesity in a patient of varying severity or severe deformation of bone structures (it is impossible to accurately determine the focus of the shock wave);
- diseases of the blood coagulation system, severe heart or lung diseases;
- inflammatory processes in the organs of the urinary system (acute pyelonephritis, cystitis and others);
- deformations of the ureter below the location of the stone (scars, strictures);
- impaired glomerular filtration of the kidneys (more than 50% of the initial values);
- acute processes in the gastrointestinal tract (pancreatitis, cholecystitis and others).
Transurethral endoscopic lithotripsy and lithoextraction
Thanks to this type of surgery, it is possible not only to destroy the stone into smaller pieces, but also to remove its remains and restore the obstruction of the ureter, if necessary.
Thanks to an endoscope inserted into the lumen of the urethra, it is possible to visualize and remove the formed calculus, as well as to clear the lumen of the ureter from the “stone path” that shock wave lithotripsy leaves behind.
This technique is not inferior in its effectiveness to DLT, however, due to the risk of complications, its use is largely limited, especially when it comes to the treatment of urolithiasis in children (since the lumen of the urethra is quite narrow, which makes it difficult to insert an endoscope).
The main complications after the procedure are as follows:
- advancement of the stone into the pyelocaliceal apparatus of the kidney;
- traumatic impact on the walls of the ureter or its perforation, which causes bleeding;
- inflammation of the kidneys (acute pyelonephritis) or prostate gland (acute prostatitis), as a result of an unrecognized infection of these structures or a violation of asepsis during the procedure;
- complete rupture of the ureter (this happens extremely rarely).
Treatment of urolithiasis with this method is indispensable for large stones or when the disease is complicated.
The essence of percutaneous nephrolithotripsy is to perform a percutaneous puncture of the pelvis in which the stone is located, to create a drainage tract, destroy the stone and remove it out.
Drainage is performed through the nephrotomy tract under mandatory ultrasound control. The stone is destroyed using different lithotripters (electric pulse, ultrasonic, pneumatic and others).
Despite the high effectiveness of the procedure, it has disadvantages, the first of which is invasiveness and trauma. Possible complications include:
- puncture of large vessels due to incorrect puncture;
- injury to organs located in the abdominal or pleural cavity;
- the formation of a large hematoma under or around the kidney capsule;
- a blood clot enters the pelvis, which threatens it with complete tamponade.
Operation open
When the above methods of surgical treatment are ineffective or their use is limited, open surgery is used.
To remove the stone, one of the following operations is used:
- ureterolithotomy;
- pyelolithotomy;
- pyelonephrolithotomy;
- nephrectomy (complete removal of an organ is resorted to in emergency situations, for example, in case of widespread kidney abscess or when it shrinks).
Carrying out open operations threatens the patient with a number of complications, such as injury to adjacent organs or the onset of massive bleeding
Spa treatment
Treatment in sanatoriums for patients suffering from one or another form of urolithiasis is balneological (therapy with mineral waters).
Each water has its own gas and mineral composition. When used correctly, it is possible to influence the process of breaking down stones and their natural elimination from the body.
Mineral waters have a beneficial effect on the functioning of the gastrointestinal tract, liver, nervous system and others
The main effects of balneological treatment are as follows:
- gently accelerate the process of diuresis;
- anti-inflammatory effect;
- eliminate the spastic component from the smooth muscles of the ureters;
- adjust urine pH in the required direction.
In each specific case, only the doctor determines the need for sanatorium treatment, because there are certain contraindications for it (for example, the presence of large stones or severe concomitant diseases).
Conclusion
Unfortunately, it is impossible to completely cure urolithiasis and rid the patient of this condition. However, if you follow all medical recommendations regarding nutritional correction and lifestyle changes, you can stop the pathological process for a long time.
With urolithiasis, stones (calculi) form in the organs of the urinary system.
This disease is detected in almost half of patients who seek medical help from a nephrologist or urologist.
Formation of stones in the genitourinary system
Most often, stones form in the kidneys, but they can also occur in the ureters, bladder and urethra.
The course of the disease largely depends on the general condition of the patient, his lifestyle, and the presence of concomitant pathologies.
In order to correctly select a medicine for the treatment of urolithiasis, it is necessary to know exactly the size, location and cause of the formation of stones.
Stones in the kidneys
Urolithiasis is a disease of the whole organism, and the formation of stones is only its consequence. This process is influenced by both endogenous and exogenous factors.
Endogenous causes of the development of urolithiasis include:
- hypercalciuria, hypovitaminosis of vitamins A and D, overdose of calcium preparations;
- bacterial infection with pyelonephritis or glomerulonephritis;
- prolonged immobility after injury;
- large doses of certain medications, such as sulfonamides, tetracycline antibiotics, antacids, aspirin, ascorbic acid, glucocorticoids;
- various diseases of the urinary system that lead to disturbances in urodynamics (for example, nephroptosis, infections, neurogenic disorders of urine outflow, vesicoureteral reflux);
- systemic metabolic disorders.
Exogenous causes are a person’s lifestyle (stones are most often formed due to physical inactivity), the composition and volume of drinking water consumed, and diet.
In urolithiasis, stones are formed from a variety of salts and minerals. The generally accepted classification is based on the predominance of one or another element.
Most often, the formation of calcium oxolate and calcium phosphate stones occurs, less often - urate, cystine, xanthine and cholesterol stones.
Oxalate stones
Oxolate stones are formed when the excretion of oxolates in the urine is impaired. This can be caused by inflammatory processes in the intestines and prolonged diarrhea.
These stones are dark in color and have sharp edges.
During bacterial inflammatory processes, the formation of phosphate stones occurs. They acquire a white or gray tint and fall apart easily.
The risk of urate stone formation is high in gout and cancer treatment as a side effect of chemotherapy drugs. The main reason for the formation is the constant low pH value of urine.
They account for about 7% of cases of urolithiasis. They are usually brick-colored with a smooth surface.
As a result of malabsorption of basic amino acids (cystine, ornithine, lysine and arginine), their levels in the urine increase.
Compared to other amino acids, cystine is practically insoluble in water and precipitates. Cystine stones are subsequently formed from it.
Xanthine stones form extremely rarely with congenital enzyme deficiency. Cholesterol - for systemic disorders of cholesterol metabolism.
If urolithiasis is diagnosed, then the nature of the stone can be determined with a routine clinical urine test.
Each type of stone is characterized by a certain pH value.
Sometimes stones can also form in the bladder. This usually occurs in children and the elderly.
Symptoms
The manifestations of urolithiasis are influenced by the size, shape, number and location of stones.
If they have a smooth surface, do not injure the mucous membrane and do not interfere with the outflow of urine, then they can only be accidentally detected during an ultrasound examination of the kidneys and other organs of the urinary system.
Pain after exercise
Usually the first manifestation of urolithiasis is renal colic. Its cause is a violation of the outflow of urine from the kidney.
Obstruction of the ureter occurs due to blockage by a stone. In addition, the increased content of salts in the urine causes spasm of the muscles of its walls.
An attack of renal colic usually begins after a bumpy ride, running, jumping, lifting weights, or physical activity.
Suddenly a sharp, unbearable pain appears in the kidney area. It can radiate along the ureter to the perineum, inner thigh or leg.
Acute pain
The pain syndrome is so strong that a person is unable to tolerate it. He constantly changes his body position to try to relieve the pain.
When a stone passes into the ureter, it injures the internal mucous membrane of its walls. Therefore, blood may appear in the urine.
Very often, renal colic is accompanied by nausea, vomiting, and fever.
For some time, the pain subsides when the position of the stone changes and the outflow of urine is restored. Renal colic disappears completely when the stone leaves the body.
Urolithiasis with localization of stones in the bladder is accompanied by pain in the lower abdomen, especially when walking and physical activity.
Therefore, symptoms usually appear during the daytime. A characteristic sign is a sudden interruption of urination. Manifestations of the disease weaken when the patient assumes a horizontal position.
Diagnostics
Timely diagnosis of urolithiasis will help you choose the right treatment, the necessary medications, and determine whether antibiotics are needed.
Usually they start with a general blood test. When a bacterial infection is attached, the ESR and leukocyte level increase. A urine test is more informative.
Laboratory diagnostics
The pH level, the presence of bacteria, leukocytes, and salts are determined. When the walls of the ureter and bladder are damaged, red blood cells and transitional epithelial cells are detected.
Diagnostics
To determine the location, shape and size of the stone, ultrasound is most often performed. The value of this research method lies in its ease of implementation and the absence of contraindications.
In addition, an ultrasound examination can assess the general condition of the kidneys and the entire urinary system.
To confirm the diagnosis, X-ray examinations are done. A regular x-ray is not very informative, so to obtain a clearer picture, radiocontrast agents are administered.
This method is called excretory urography. The resulting images allow us to assess the size of the stone, its movement along the urinary tract, and the functional ability of the kidneys and bladder.
Before surgical treatment, a computed tomography or magnetic resonance imaging scan is usually performed.
Treatment
Since often the first sign of urolithiasis is an attack of renal colic, all efforts are aimed at stopping it. After the patient's condition has improved, further treatment is carried out.
Drug treatment
To facilitate the passage of stones through the urinary tract, medications are prescribed that relieve spasm of smooth muscles. First of all, it is baralgin.
The use of this medicine is most effective, since it additionally has an analgesic effect. No-spa and glucagon have an excellent antispasmodic effect on the muscles of the ureters.
Progesterone preparations also reduce the tone of the urinary tract.
Some hormones (for example, adrenaline and norepinephrine) increase smooth muscle spasm. To block their action, special drugs from the adrenergic blocking group are used.
Hormone therapy
These are drugs such as doxazosin, terazosin, alfuzosin.
The neurotransmitter acetylcholine acts selectively. It causes muscle contraction in all organs except the urinary system. Here its effect is exactly the opposite.
Medicines from the cholinomimetics group enhance its effect. These are hyoscine methyl bromide, atropine, spasmocystenal.
To stop the inflammatory process, non-steroidal anti-inflammatory drugs are used. These are ketorolac, diclofenac, and less commonly, acetylsalicylic acid.
Prescription of painkillers is mandatory. They are divided into two large groups, which differ in the strength of the analgesic effect.
These are non-narcotic analgesics (analgin, paracetamol, ibuprofen, nimesil) and narcotic (tramadol, omnopon, morphine, codeine). For severe pain, medications from the second group are used.
Sometimes a local novocaine or lidocaine blockade is performed.
If an attack of renal colic is accompanied by vomiting, then the drug metoclopramide is additionally used.
Catheterization
In order to reduce the formation of urine, take the medications desmopressin, minirin, presaynex or emosint.
In case of emergency, a combination of drugs is administered. Usually these are antispasmodic and anti-inflammatory drugs. Then, based on the patient’s condition, analgesics and antiemetics are added.
In severe cases, urine diversion is carried out using a catheter.
Usually, outside of an attack, you can take pills instead of injecting medications.
After relief of renal colic, a comprehensive examination of the patient is carried out. Based on its results, further treatment of urolithiasis is determined.
If the stones are small in size and can pass painlessly from the kidney, then a combination of medications is prescribed.
They improve renal blood circulation, increase diuresis, relieve spasm of the urinary tract and enhance their peristalsis, and prevent the development of bacterial complications.
Usually used:
- enatine or olimethine are herbal preparations that have antispasmodic, diuretic and anti-inflammatory effects;
- Rovatinex, a medicine that increases renal blood flow, has antispasmodic, anti-inflammatory and antimicrobial effects;
- cystone, these tablets have anti-inflammatory and antimicrobial effects;
- phytolysin not only has an antimicrobial, bacteriostatic and anti-inflammatory effect, but also loosens stones and facilitates their passage from the kidneys;
- palin is an antibacterial medicine.
Urate stones dissolve well with long-term use of drugs such as Uralit-U, blemarene, and margulit. These medications not only help dissolve stones, but also prevent their further formation.
You need to take these drugs for about 2 – 3 months. In this case, regular monitoring of urine pH levels is necessary. It should not exceed 7.0.
A very serious complication of urolithiasis is bacterial inflammation of the kidneys - pyelonephritis. It is characterized by a sharp increase in temperature and aching pain in the lumbar region.
Antibiotics are used to treat this disease. Typically, the causative agents of pyelonephritis are Escherichia coli and Pseudomonas aeruginosa, streptococci, and staphylococci.
Therefore, antibacterial drugs are selected taking into account their effect on these groups of microorganisms.
For infectious complications of urolithiasis, the following antibiotics are effective:
- third and fourth generation cephalosporins (ceftriaxone, sulfactam, cefotaxime, ceftazidime);
- fluoroquinolones (levofloxacin, sparfloxacin, moxifloxacin);
- sulfonamides (biseptol);
- penicillins (amoxiclav, ampicillin, piperacillin).
Treatment with antibiotics
Antibiotic use usually lasts up to two weeks. In combination with these medications, it is necessary to use drugs to restore the intestinal microflora. These are Linex, Bio-Gaya, Bifidumbacterin or Bactisubtil.
After completing the course of therapy with antibacterial agents, uroseptic drugs are prescribed. These are medications such as urolesan, canephron, furagin.
They must be taken for a long time, possibly several months. The duration of treatment is determined by the attending physician.
Herbal medicine is also very useful: decoctions of lingonberry, bearberry, birch leaves, pol-palm grass, kidney tea, horsetail, chamomile flowers, calendula.
In addition to medications, there are also instrumental methods for treating urolithiasis.
If the stones are easily dissolved, then special medications are injected directly into the kidney through a catheter.
This treatment is carried out if the size of the stones does not exceed 5 mm and they do not interfere with the normal functioning of the kidney.
Insoluble stones are removed with instruments that are inserted into the urethra, bladder or ureter through a catheter. These manipulations are carried out under ultrasound guidance.
The method of external shock wave lipotripsy involves the destruction of the stone by a shock wave. Stones up to 2 cm in size can be treated with this method of therapy.
There are contraindications to such a procedure.
These are excess body weight, diseases of the musculoskeletal system and cardiovascular system, pregnancy, acute infectious process in the genitourinary system, and impaired urine outflow.
In severe cases of urolithiasis, laparoscopic surgical treatment is indicated.
Urolithiasis (UCD) is a metabolic disease caused by various endogenous and (or) exogenous causes. It is often hereditary and is determined by the presence of a stone in the patient’s urinary system. KSD is one of the most common urological diseases, prone to relapse, and is often characterized by a persistent, severe course.
The incidence of urolithiasis in the world ranges from 0.5 to 5.3%; in Russia, this figure is on average 38.2% of all urological patients. The disease can be diagnosed in both a seven-month-old child and an elderly person, but in 68% of cases, ICD develops in working age (20-60 years). Bilateral urolithiasis is diagnosed in 15 - 30% of patients with urolithiasis. There are regions where this disease is particularly common and endemic. Such regions in Russia are: the North Caucasus, the Urals, the Volga region, the Don and Kama basins. According to many researchers and the State Statistics Committee of the Russian Federation, today there is an increase in the incidence of urolithiasis among all groups of the population.
Stones are more often formed in males; in women, severe forms of the disease are more common, for example coral nephrolithiasis, when the stone occupies almost the entire abdominal cavity system of the kidney. To be fair, it should be noted that thanks to modern technologies for the diagnosis and treatment of urolithiasis, the prevalence of coral nephrolithiasis has decreased significantly in recent years, while the proportion of other, milder forms of this disease has increased, which is associated with the increasing influence of a number of unfavorable external environmental factors on the body person. The increase in the incidence of urolithiasis is provoked, among other factors, by the conditions of modern life: physical inactivity leading to disturbances in phosphorus-calcium metabolism, the nature of nutrition (abundance of protein in food or a monotonous diet). All of the above allowed us to call this disease, associated with metabolic disorders in the body, a disease of civilization. A number of other factors also predispose to the development of ICD: climatic, geographical and living conditions, profession and inherited genetic factors.
Among the causes of the formation of kidney stones, more or less pronounced changes of a local nature may dominate: urinary tract infection, anatomical and pathological changes in the upper urinary tract, nephroptosis and others leading to disruption of the normal outflow of urine from the kidneys, as well as metabolic and vascular disorders in the kidney .
There is currently no unified concept of the etiopathogenesis of urolithiasis. KSD is considered a polyetiological disease associated with complex physicochemical processes occurring both in the body as a whole and at the level of the urinary system and being both congenital and acquired in nature. At the same time, in each specific case, with a thorough and thorough examination of the patient and collection of anamnesis, it is possible to identify the factors that underlie the development of ICD. Since attempts to explain the development of urolithiasis by any one cause have been unsuccessful, in each specific case, before prescribing treatment, it is necessary to conduct a comprehensive examination in order to determine the cause of the development of the disease in a given patient.
The most advanced is the etiopathogenetic scheme of the stone formation process, which is generally accepted and includes causes of endogenous and exogenous origin. The mechanism of stone formation depends on a number of physicochemical processes and goes through a number of stages, from saturation and supersaturation of urine with salts to the phases of enucleation, crystallization and crystal growth to the acquisition of clinically significant sizes, when these processes are not hampered (or are completely absent) by mechanisms of inhibition of crystal growth .
The addition of a urinary infection significantly aggravates the course of the disease. It can be considered as an important additional local factor that provokes the emergence and maintenance of the chronic (recurrent) course of urolithiasis due to the adverse effect on the urine of metabolic products of a number of microorganisms, which contribute to its sharp alkalization and the rapid formation of amorphous phosphate crystals, and in the presence of a crystallization nucleus - to the rapid growth of the stone .
The most studied endogenous cause of calcium metabolism disorder (the basis of most urinary stones) is dysfunction of the parathyroid glands. Thus, in coral or often recurrent nephrolithiasis, hyperparathyroidism is an etiopathogenetic factor in at least 30 - 40% of cases.
Climatic, environmental and food exogenous factors (nitrates, sulfates and other compounds contained in mineral fertilizers, as well as pesticides and penetrating into the body with water and food) can have a direct toxic or indirect effect on the human body, causing metabolic disorders in biological environments . As a result, they can lead to dysfunction of the nephron and, in particular, its tubular apparatus (tubulopathies), which is accompanied by an increase in the level of stone-forming substances in the blood serum and urine. Similar changes occur in patients with diseases of the gastrointestinal tract or with fractures of long bones, prolonged immobilization, etc.
In turn, an increase in the concentration of stone-forming substances in the blood serum and, as a consequence, an inevitable increase in their excretion by the kidneys leads to a supersaturation of the urine with them, which can manifest itself in the formation of salt crystals and microlites, which undoubtedly create favorable conditions for the formation of urinary stones. In many people, the urine is often oversaturated with stone-forming substances, but they do not form stones, that is, the mere fact of oversaturation of urine (crystalluria and microliths in the urine) is not enough to diagnose urolithiasis, for the development of which some other factors are also necessary. It has been established that a number of substances affect the colloidal stability of urine, help maintain salts in a dissolved state and prevent their crystallization. Substances that maintain urine salts in a dissolved state and prevent their precipitation include: hypuric acid, xanthine, sodium chloride, citrates, magnesium, inorganic pyrophosphate, inorganic ions of zinc, manganese, cobalt, etc. Even in small concentrations, these substances inhibit crystallization, however, in the vast majority of patients with urolithiasis they are absent or present in insufficiently small quantities. So, if under normal conditions magnesium ions bind up to 40% of oxalic acid in the urine, then their deficiency is manifested by the formation of calcium oxalate crystals.
In other words, the metastable state of salt in a saturated solution can easily be disturbed, and if local factors are also present, the growth of crystals and microlites occurs due to the deposition of more and more salts on them, as on the core, which in turn leads to the formation directly stone and ICD.
One of the main factors that maintain the metabolic state of most salts in balance, which can be successfully influenced, is the concentration of hydrogen ions, expressed in pH values of urine and normally ranging from 5.6 to 6.0.
Currently, the mineralogical classification of urinary stones is accepted throughout the world. 70-80% of urinary stones are inorganic calcium compounds: oxalates (wedelite, wevelite); phosphates (whitlockite, brushite, apatite, carbonate-patite, hydroxyapatite), calcium carbonate. Magnesium-containing stones occur in 5 - 10% of cases (newerite, struvite, magnesium ammonium phosphate monohydrate) and are often combined with infection in the urine. Uric acid stones account for up to 10 - 15% of all urinary stones (ammonium urate, sodium urate, uric acid dihydrate), and the older the patient, the more often uric acid stones occur. Less common than others are protein stones - 0.4-0.6% of cases (cystine, xanthine, etc.), indicating a violation of the metabolism of the corresponding amino acids in the patient’s body. However, stones in their pure form are detected in no more than 40% of cases. In other cases, stones of mixed (polymineral) composition (in various variants) are formed in the urine, and the formation of stones is characterized by parallel metabolic and often infectious processes.
Diagnosis of nephrourethrolithiasis is based on the patient’s complaints and medical history. The disease manifests itself most clearly (paroxysmal, intractable renal colic) with small (up to 1.0 cm) stones of the kidneys and ureters, while coral-shaped and large stones can exist asymptomatically for a long time (sometimes until the kidney completely dies). Ultrasound and X-ray examination allows us to diagnose stones in the urinary tract in almost 100% of cases. Based on the analysis of the data obtained during the examination, a treatment strategy is developed, which must be strictly individual, that is, selected taking into account the clinical course of the disease.
The course of ICD is extremely diverse. In some patients, this disease is an unpleasant one-time episode, but often KSD progresses persistently, with frequent relapses, or takes a protracted, chronic course. In the absence of clinical observation and treatment, the disease can lead to kidney death, pyonephrosis, chronic renal failure, disability and even death of the patient. The high prevalence of the disease and the possibility of serious, life-threatening complications for patients indicate the importance of this problem in terms of its timely diagnosis and treatment.
The effectiveness of treatment based on biochemical studies of the blood and urine of patients is not in doubt among any clinician. Thus, a 10-year study showed that relapse of the disease (after removal of the stone) in patients who did not receive adequate treatment and were left without observation was observed in 78.5% of cases, while in people who received anti-relapse treatment, the frequency of disease recurrence was in 3 times less (21.5%). Careful clinical observation and examination of patients over a long period of time after spontaneous passage of stones or their removal in various ways made it possible to establish that the main factor in the relapse of the disease is severe metabolic disorders in the body of patients and urinary tract infection.
Knowledge of the chemical structure of removed stones is extremely necessary not only from the standpoint of developing conservative anti-relapse treatment, but also in terms of choosing various modern methods for their removal.
Therefore, examination and subsequent treatment of patients must be carried out in accordance with a strictly defined algorithm. The doctor should not limit himself only to stone removal in one way or another (DLT, endosurgery, open surgery); measures to prevent (metaphylaxis) relapses of the disease are also mandatory. Unfortunately, most patients, and some doctors still do not understand that surgical methods for removing stones are not methods of treating urolithiasis and are themselves fraught with the emergence of additional complicating factors that can aggravate the course of the disease.
In recent decades, significant progress has been made in the treatment of urolithiasis. Doctors have learned to destroy and remove stones of all types, regardless of their size and chemical composition, without the use of surgical incisions. The introduction of extracorporeal shock wave lithotripsy (ESW) into urological practice has significantly increased the efficiency of stone removal in most patients with urolithiasis and minimized the number of complications in comparison with the open surgical method. EBRT is undoubtedly a less invasive method. Due to its relative simplicity, DLT has become widespread in many countries of the world; with its help, it is possible to relieve up to 80% of patients from kidney and ureteral stones. Even those patients who were denied surgery due to concomitant diseases (heart attack, stroke, ischemic heart disease, etc.) can today get rid of stones in the kidneys and ureters. The youngest patient in whom EBRT was successfully used was 9 months old. Thanks to the use of DLT, it became possible for the first time to remove stones on an outpatient basis. Currently, up to 40% of patients with urolithiasis are treated on an outpatient basis. The periods of hospitalization and recovery after radiotherapy are shorter compared to similar periods after various open operations; the incidence and severity of postoperative complications and postoperative mortality decreased significantly. However, this method has certain contraindications: disorders of the blood coagulation system, acute concomitant diseases, inflammatory processes in the kidney and organic changes in the upper urinary tract and pronounced decreases in kidney function. Therefore, the final decision on the possibility of using DLT can only be made by specialists from urological clinics involved in the treatment of urolithiasis.
However, it should be noted that as a result of DLT, unlike other methods, the stone does not come out entirely, but the destroyed fragments pass away on their own; in rare cases, this process is complicated by blockage of the ureter, renal colic and acute pyelonephritis. All this requires mandatory monitoring of patients in a clinic. Percutaneous and transurethral endoscopic removal of stones from the kidneys and ureters can be considered as “moderately traumatic” methods. They are no less effective than DLT, and in addition to simultaneous stone removal, in some cases they can eliminate the cause of stone formation (ureteral stricture). Open surgery for this disease has not lost its clinical significance and is used when it is necessary to simultaneously perform reconstruction of the urinary tract, as well as in the most severe form of urolithiasis, such as coral nephrolithiasis. All three methods often complement each other, and therefore the acquisition of a lithotripter alone is not enough to begin treating patients with urolithiasis, unless two other methods are used in the clinic, as stipulated in the regulatory documents of the Ministry of Health of the Russian Federation.
KSD should be considered primarily as a surgical disease, since in order to rid patients of stones it is often necessary to resort to one or another surgical method of removing them. The exception is stones consisting of uric acid salts - urates, which can be successfully dissolved with citrate mixtures (uralite U, blemarene, etc.). Therapy with citrate mixtures for 2 to 3 months often leads to complete dissolution of such stones. For stones of a different composition, stone-dissolving therapy is ineffective and treatment is symptomatic until surgical removal. Drug therapy for urolithiasis is used in symptomatic therapy - until stones are removed - or stone expulsion therapy - when they are small in size (up to 0.5 cm), when they can pass away on their own.
Removing a stone or its spontaneous passage from the urinary tract does not exclude the possibility of a relapse of this disease, since the main processes leading to the formation of stones are, as a rule, not eliminated. Therefore, the effectiveness of treatment for urolithiasis in general largely depends on the effectiveness of complex treatment of the patient at the outpatient stage, which is still the weakest link.
At this stage, if there are indications for treatment, nutritionists, endocrinologists, nephrologists, etc. should be involved.
The complex of therapeutic measures aimed at correcting metabolic disorders of stone-forming substances in the body includes: diet therapy, maintaining adequate water balance, antibacterial therapy, herbal medicine, physiotherapeutic and balneological procedures, physical therapy, and sanatorium-resort treatment.
Diet therapy depends primarily on the composition of the removed stones and identified metabolic disorders. However, we can recommend some general principles in maintaining diet and water balance: maximum limitation of the total volume of food with its variety, limiting the consumption of food rich in stone-forming substances, drinking fluid in an amount that allows you to maintain the daily amount of urine from 1.5 to 2.5 liters. Part of the liquid can be taken in the form of cranberry or lingonberry fruit drinks, or mineral water.
Before prescribing preventive treatment, it is necessary to conduct an examination to determine the functional state of the kidneys, liver, serum concentration and renal daily excretion of stone-forming substances and the microbiological state of the urinary system. Monitoring the effectiveness of treatment in the first year of observation is carried out once every 3 months and consists of ultrasound of the kidneys, biochemical analysis of blood and urine for the functional state of the kidneys and the state of metabolism of stone-forming substances. In the presence of an infectious-inflammatory process in the urinary system, a microbiological analysis of urine is performed once every 3 months to determine the sensitivity of the microflora to antibacterial drugs. Subsequently, comprehensive monitoring is carried out once every 6 months.
When choosing a drug for a patient with ICD, the doctor must answer the following questions:
1. Does the patient have any concomitant diseases that may affect the choice of ICD medications? 2. What is the functional state of the kidneys, liver and other organs, which may affect the choice of therapy? 3. What is the possible impact of medications prescribed to the patient on the course of ICD? 4. What is the price/effectiveness status for the selected drug?
During the treatment process, it is also necessary to check once every 3 months in the 1st year of observation, and subsequently once every six months:
- does the patient follow the diet and physical activity regimen recommended for urolithiasis;
- whether the medications you are taking are effective;
- whether the patient is taking medications in adequate (target) doses;
- what are the side effects of the prescribed medications.
If the patient refuses the prescribed treatment, the reason is determined.
Drug therapy for urolithiasis is aimed at preventing stone recurrence; prevention of stone recurrence and growth; treatment (litholysis).
Drug therapy (treatment) is prescribed for the following conditions: after open surgery; after DLT; after nephrolitholapaxy; after instrumental stone removal; after spontaneous passage of a stone; with the “accidental” discovery of a kidney stone.
Pharmacotherapy aimed at correcting metabolic disorders is prescribed according to indications based on examination data of the patient. The number of treatment courses during the year is determined individually, under medical and laboratory supervision.
Drugs that are used for all forms of KSD include: angioprotectors, antiplatelet agents, anti-inflammatory, antibacterial, antiazotemic, diuretics, stone expellants and herbal preparations, analgesics, antispasmodics.
The conditions for drug correction of metabolic disorders may be as follows.
- Endogenous creatinine clearance is within normal limits; liver tests are within normal limits.
- Clearance of endogenous creatinine is reduced: dipyridamole 1 table. 3 times a day for a month or pentoxifylline 1 tablet. 3 times a day - 1 month.
- The clearance of endogenous creatinine is reduced, the concentration of urea and/or creatinine in the blood is increased: dipyridamole, 1 table. 3 times a day - 1 month or pentoxifylline 1 tablet. 3 times a day - 1 month, Lespenefril 1 dess. spoon 3 times a day - 1 month.
The duration of treatment can be set individually, according to the indications.
If a biochemical examination of the patient reveals a triad of signs: hypercalcemia, hypophosphatemia and hypercalciuria, then an endocrinological examination for hyperparathyroidism is indicated. In the absence of the specified complex of metabolic disorders, if there is a bilateral form of urolithiasis or rapidly recurrent stone formation (within several months), the patient is also advised to determine the serum concentration of ionized calcium, conduct the Howard test and examine the parathyroid glands using ultrasound. If the Howard test is positive and hyperplasia of the parathyroid glands is detected, surgical treatment is performed to detect and remove them. In case of an infectious-inflammatory process in the urinary system, antibacterial treatment is prescribed after determining the results of urine culture, antibiogram, and endogenous creatinine clearance. Herbal medicine is indicated for infectious and inflammatory processes in the urinary system in patients with urolithiasis during and after treatment with antibacterial chemotherapy and in the absence of microflora sensitivity to them. During herbal medicine, herbs that have a diuretic and anti-inflammatory effect are used: the duration of the course of treatment from 1 to 3 months is determined individually (the effectiveness of treatment is 60 - 70%). Efficiency criterion: increase in urine volume, decrease in leukocyturia.
To correct disorders of purine metabolism and urate stones, the following groups of drugs are used: xanthine oxidase inhibitors - 1 month (92% effectiveness); uricuretics - 1 - 3 months; citrate mixtures - 1 - 6 months. Daily fluid intake for this form of urolithiasis is desirable in an amount of at least 2 - 2.5 liters. Diet therapy consists of limiting the intake of fried and smoked meat, meat broths, offal, legumes, coffee, chocolate, alcohol, and excluding spicy foods. Treatment effectiveness criterion: reduction or normalization of serum concentration and/or daily renal excretion of uric acid.
For hyperuricuria, xanthine oxidase inhibitors are used - 1 course of treatment for a month (80% effective) or uricuretics + citrate mixtures: 1 course of treatment - from 1 to 3 months (90% effective). Effectiveness criterion: decrease in serum uric acid concentration, increase in urine pH to the range of 6.2 - 6.8 (urine alkalinization). When using citrate mixtures, 1 course of treatment is prescribed lasting from 1 to 3 months (efficacy 96%). Effectiveness criterion: increasing urine pH to the range of 6.2-6.8 (urine alkalinization).
If urine pH is below 5.8, crystalluria of uric acid or urate, citrate mixtures are prescribed under the control of a general urinalysis: the duration of the course (1 - 6 months) is set individually (100% effective). Efficiency criterion: increasing urine pH to 6.2 - 6.8 (urine alkalinization). For the purpose of litholysis of uric acid kidney stones, citrate mixtures are prescribed for 1 - 3 - 6 months (efficiency 83 - 99%), or uriuretics in combination with citrate mixtures for 1 - 3 months (efficiency 83 - 99%). Efficiency criterion: partial or complete litholysis.
To correct disorders of oxalic acid metabolism and calcium oxalate stones, the following groups of drugs are used: B vitamins, thiazides, diphosphonates, magnesium oxide, citrate mixtures. Daily fluid intake is at least 2 - 2.5 liters. The diet includes limiting the consumption of milk, cheese, chocolate, sorrel, lettuce, black currants, strawberries, strong tea, and cocoa. For hyperoxaluria and oxalate crystalluria, vitamin B6 is prescribed 0.02 g 3 times a day orally for a month (efficacy 86%); magnesium oxide 0.3 g 3 times a day for a month (efficacy 82%). Efficacy criterion: reduction or normalization of daily renal excretion of oxalates.
For hypercalciuria, thiazides are prescribed, the course of treatment is 1 month (100% effective), or diphosphonates (Xidifon), the course of treatment is 1 month (60% effective). Efficiency criterion: reduction or normalization of daily excretion of total calcium, reduction in the degree of oxalate crystalluria.
To correct metabolic disorders caused by calcium phosphate stones, the following groups of mandatory medications are used: diphosphonates, diuretics, antiazotemic, anti-inflammatory, stone-expelling drugs and herbal preparations, acid balance correction agents.
The daily fluid intake for calcium phosphate urolithiasis should be at least 2 - 2.5 liters. The diet includes limiting the consumption of milk, cheese, and fish products. If there is hypercalciuria, diphosphonates are used, the course of treatment is 1 month (efficacy 45 - 50%). Efficiency criterion: reduction in the degree of phosphate crystalluria. For phosphate crystalluria, diuretics and anti-inflammatory drugs, as well as herbal preparations, are effective; the course of treatment is 1 - 3 months (efficacy - 40 - 45%). Efficiency criterion: reduction in the degree of phosphate crystalluria.
In order to correct metabolic disorders due to cystine stones, the daily fluid intake should be at least 3 liters. Citrate mixtures are used, the course of treatment is 1 - 6 months (efficacy - 60%). The criterion for effectiveness is a decrease in cystine crystalluria.
Sanatorium-resort treatment is indicated for urolithiasis both during the absence of a stone (after its removal or spontaneous passage) and in the presence of a stone. It is permissible in the presence of small kidney stones, if their size and shape, as well as the condition of the upper urinary tract, allow us to hope for their spontaneous passage under the influence of the diuretic effect of mineral waters.
For patients with uric acid and calcium oxalate urolithiasis with an acidic urine reaction, treatment with mineral waters is indicated at the resorts: Zheleznovodsk (Slavyanovskaya, Smirnovskaya), Essentuki (No. 4, 17), Pyatigorsk, etc. with low-mineralized alkaline mineral waters. For calcium oxalate urolithiasis, treatment at the Truskavets (Naftusya) resort is also indicated, where the mineral water is slightly acidic and low-mineralized. For calcium phosphate urolithiasis, caused by a disorder of phosphorus-calcium metabolism and, as a rule, an alkaline reaction of urine, resorts are indicated: Pyatigorsk, Kislovodsk, Truskavets, etc., where the mineral water is slightly acidic in nature. For cystine stones, the following resorts are recommended: Zheleznovodsk, Essentuki, Pyatigorsk. Treatment at the above resorts is possible at any time of the year. Drinking similar bottled mineral waters does not replace a stay at the resort. For therapeutic and prophylactic purposes, these waters can be drunk no more than 0.5 liters per day, under strict laboratory control of the metabolism of stone-forming substances.
Contraindications to sanatorium-resort treatment are: acute inflammatory diseases of the genitourinary system (pyelonephritis, cystitis, prostatitis, epididymitis, etc.); chronic kidney disease with severe renal failure; urolithiasis in the presence of stones that require surgical removal; hydronephrosis; pyonephrosis; tuberculosis of the genitourinary system and any systems and organs; macrohematuria of any origin; diseases manifested by difficulty urinating (benign prostatic hyperplasia, urethral stricture).
If there is concomitant pyelonephritis, it must be treated. It should be noted that only when a stone is removed from the kidney and upper urinary tract in one way or another, the necessary conditions are created for the complete elimination of urinary infection. For this purpose, antibacterial therapy is prescribed, which is advisable to carry out according to the results of urine cultures for flora, the degree of bacteriuria and sensitivity to antibacterial drugs against the background of drugs that improve microcirculation (pentoxifylline), disaggregants (chimes, persantine), calcium antagonists (verapamil, etc.).
Thus, no method of treating ICD can be considered in isolation from the others, and the treatment of such patients should only be comprehensive. After stone removal, patients need clinical observation and consultation with a urologist for 5 years, since this factor significantly affects the long-term results of treatment. At the same time, they are prescribed conservative therapy aimed at eliminating the infection and correcting metabolic disorders based on laboratory data, which must be carried out at least once every 6 months. Timely referral of the patient for consultation to a clinic specializing in the treatment of patients with urolithiasis will help to avoid advanced forms of urolithiasis and obtain missing information about the tactics of further treatment.
N. K. Dzeranov, Doctor of Medical Sciences, Research Institute of Urology, Ministry of Health of the Russian Federation, Moscow
Percutaneous nephrolitholapaxy
Percutaneous nephrolitholapaxy (PCNL) will always occupy its niche in the treatment of urolithiasis. With the constant development of optics and stone fragmentation techniques, PCNL remains an effective method with the least difficulties in its use. According to many years of experience, the indications for PCNL are the following: contraindications or ineffectiveness of ELT, coral stones, large or small in size and weight, cystitis stones, abnormal kidneys or features of the patient’s anatomy, transplanted kidney.
PCNL is the most effective method of intervention. Cystine stones are hard and soft. Soft stones are more resistant to shock wave therapy. It was assumed that in the presence of cystine staghorn stones, it would be sufficient to fragment the stones and treat with medication. However, this treatment is ineffective against recurrent stones. For optimal results, these patients should undergo PCNL.
(Segura J.V. Percutaneous treatment of nephrolithiasis // Digital Urology Journal).
Urolithiasis disease(renal stone disease, nephrolithiasis) - the formation of hard concretions (stones) of various natures in the calyxes and pelvis of the kidneys (pyelocalyceal system - PLS).
Urolithiasis (UCD) develops as a result of metabolic disorders and the acidic properties of urine. Salts are constantly present in urine in dissolved form. Under certain conditions, they begin to precipitate, first forming crystals, which can then turn into quite large stones (several centimeters). Small stones (so-called sand) gradually descend along with urine through the ureter into the bladder, and then come out when urinating. This process is usually accompanied by pain when urinating, the intensity of which depends on the size and shape of the stones being removed.
The formation of stones is provoked by various infections of the urinary system, stagnation of urine, impaired metabolism of uric and oxalic acids, phosphorus, and calcium.
Stones differ in their nature of formation:
- phosphates- are formed from insoluble calcium phosphate and other phosphorus salts, due to increased function of the parathyroid gland, due to bone damage, due to hypervitaminosis D. Phosphates are formed during an alkaline reaction of urine (pH more than 7.0);
- oxalates- are formed from salts of oxalic acid, which is associated with excessive formation of oxalates in the body and/or excessive intake of oxalic acid and substances that form oxalates as a result of metabolic reactions. Oxalates are formed when urine is acidic (pH about 5.5). The solubility of oxalates is enhanced by the presence of magnesium ions in the urine;
- urates- stones from uric acid salts are formed when purine metabolism is disrupted and when there is an excessive intake of purine bases from food. Urates are formed when urine is very acidic (pH less than 5.5). At a pH above 6.2, urates dissolve.
Symptoms of ICD
- The classic symptom of ICD is an attack renal colic, which occurs when a stone leaves the kidney and travels down the ureter. During an attack, the patient feels acute intense pain in the lumbar region, which may be accompanied by vomiting, frequent urination, and fever;
- between attacks of renal colic, the patient feels a dull pain in the lower back, which intensifies with long walking, shaking, or lifting heavy objects;
- large stones, which are obviously larger than the diameter of the ureter, as a rule, hardly manifest themselves, sometimes making themselves felt by dull, unexpressed pain in the lumbar region. Such stones are discovered by chance during an ultrasound of the kidneys.
Complications of ICD:
- kidney block;
- development of renal failure.
If you experience periodic pain in the lumbar region, you should consult a therapist to find out its causes. During renal colic, it is necessary to call an ambulance to receive urgent medical care. From my own experience, I can say that I withstood an attack of renal colic for no more than 10 minutes, after which I was hospitalized by ambulance to a medical hospital.
Treatment of urolithiasis
To make an accurate diagnosis, an in-depth study of the condition of the urinary system may be necessary; for this purpose, additional examination methods are prescribed (except for a general medical examination and routine tests):
- determination of phosphorus and calcium levels in the blood;
- intravenous urography;
- cystoscopy;
- Ultrasound of the kidneys;
First of all, treatment of urolithiasis is aimed at relieving a painful attack of renal colic and spontaneous passage of stones: heat on the lower back, hot baths, drinking plenty of fluids, antispasmodics. If treatment is ineffective, the patient must be hospitalized in a hospital.
If conservative therapy is ineffective, catheterization of the ureter is indicated, performed by cystoscopy. In the event of the development of complications such as kidney blockage, purulent pyelonephritis, surgery is performed to remove stones from the kidney or ureter, and drainage of the urinary tract.
At the moment, bloodless operations to remove stones - laser lithotripsy - are widely used in medical practice. The operation is performed under general anesthesia. A flexible hollow hose equipped with a light source and a video camera is inserted into the patient through the urinary tract. The image from the video camera is displayed on the monitor. The surgeon advances the hose, monitoring the progress of the process on the monitor, through the urinary tract, bladder, ureter to the place where the stone is located. When the flexible system has reached the desired location, a source of laser radiation is applied to the stone and, under the influence of high concentrated energy of the laser beam, the stone is crushed into small pieces, which can independently leave the patient’s body. If the stone is small, it is removed entirely, for example, using a Dormia loop (tested on myself). The main advantage of such surgical interventions is their high efficiency (in most cases, the patient is completely and guaranteed to get rid of stones), a relatively low likelihood of complications, short hospitalization time (the patient is usually discharged from the hospital 3-5 days after surgery). Disadvantages include the relatively high cost and low prevalence of medical institutions that perform such operations.
Diet for ICD
The choice of medications and diet to prevent recurrent stone formation depends on the composition of the stones and the nature of their formation.
Phosphate stones
- foods rich in calcium that have an alkalizing effect are limited: vegetables, fruits, dairy products;
- recommended foods that change the reaction of urine to the acidic side and drinking plenty of fluids: meat, fish, grains, legumes, pumpkin, green peas, cranberries, sour apples, lingonberries.
Oxalate stones
- foods rich in oxalic acid are excluded: beans, green beans, leafy greens, nuts, rhubarb, citrus fruits, sorrel, spinach, cocoa, chocolate;
- products containing a lot of calcium are limited: cheese, cottage cheese, milk;
- A balanced diet is recommended with the obligatory inclusion in the diet of products that help remove oxalates from the body: watermelon, melon, apples, pears, plums, dogwood, light grapes, decoction of apple peels; as well as foods rich in magnesium: cereals, bran.
Urate stones
- broths, soups and sauces of meat, fish, mushrooms, meat by-products, minced meat, smoked products, veal, venison, goose, chicken, partridge meat, sardine, mackerel, herring, cod, trout, anchovies, sprats, mussels, shrimp are excluded;
- consumption of beef, other types of meat products after boiling, duck, pork lard, soybeans, peas, beans, lentils, asparagus, cauliflower, sorrel, spinach is limited;
- Dairy products, eggs, cereals and pasta, most vegetables, fruits, berries, and nuts are recommended.
You should know! When cooking meat and fish, approximately half of the purines they contain go into the broth, therefore, after boiling, the meat or fish is caught and used to prepare various dishes, and the broth, rich in purine, is poured out.
Important! The above strict dietary recommendations should be followed for no more than 1.5-2 months, after which the diet should be gradually expanded from previously limiting foods. Otherwise, the acidity of urine may shift in the opposite direction, which will lead to the formation of stones of a different nature. If the corresponding salts (urates, phosphates, oxalates) appear in the urine, it is necessary to return to the previous diet for 1.5-2 months, etc.
Medicines for ICD
Medications are taken as prescribed by a doctor and under his supervision:
- drugs to prevent stone formation: allopurinol, blemarene, hydrochlorothiazide, magnesium oxide, magnesium citrate, sodium citrate, urodan;
- antispasmodics: no-spa, spazoverine, belladonna preparations, papaverine, cystenal.
Folk remedies for ICD
For uric acid diathesis and urate stones:
- Pour 10 g of the collection into 0.25 liters of boiling water, heat in a water bath for 10 minutes, leave in a warm place for 2 hours, strain, take half a glass warm 3 times a day half an hour before meals for 1.5-2 months. Composition of the collection (in equal proportions): lingonberry leaves, knotweed grass, curly parsley root, calamus rhizome, corn silk;
- It is necessary to include in your daily diet apples and carrots in any form, cucumbers, pumpkin, fruits and juices of strawberries, lingonberries.
For oxalate and phosphate stones:
- Pour 10 g of the collection into 0.25 liters of boiling water, heat in a water bath for 10 minutes, leave in a warm place for 2 hours, strain, take half a glass warm 3 times a day half an hour before meals for 1.5-2 months. Composition of the collection (in equal proportions): common barberry flowers, sandy immortelle flowers, lingonberry leaves, black elderberry flowers, common heather herb, melilot herb, madder root, motherwort herb;
- the diet should be supplemented with berry and fruit juices, apples, quinces, pears, grapes, apricots, currants;
- 5 tbsp. apple peels per 1 liter of boiling water, leave for 1 hour, strain, drink 2 glasses a day with sugar or honey;
- Pour 30 g of the collection into 1 liter of boiling water, leave in a warm place for half an hour, strain, and take warm for an hour. Composition of the collection (in equal proportions): silver birch leaves, prickly steelhead root, common juniper fruits, peppermint leaves, greater celandine herb, cinquefoil herb.
To relieve renal colic, use a hot bath with a water temperature of about 39°C for 10 minutes, after which the patient should remain in a warm bed for at least 2 hours and constantly drink large amounts of fluid (at least 1.5 liters). If renal colic does not stop, calling an ambulance is necessary. From my own experience, it will hurt so much that you will rush to the hospital yourself (toothache compared to renal colic is “little flowers”).
ATTENTION! The information provided on this site is for reference only. Only a specialist doctor in a specific field can make a diagnosis and prescribe treatment.
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At the slightest suspicion of the presence of stones or sand in the kidneys, you should immediately consult a doctor. In this case, drugs for the treatment of urolithiasis play a major role. Based on the general state of health and the course of the disease, the attending physician will prescribe a list of necessary medications. Taking medications helps the stones pass quickly, while minimizing symptoms. Self-medication in this case is prohibited, as it provokes complications in the human body.
The first symptom of the presence of stones or sand in the organs of the genitourinary system is pain. When formations emerge or move, it reaches its highest degree. To relieve colic, drug intervention is required. To do this, the attending physician prescribes antispasmodic drugs and analgesics. For people prone to urolithiasis, such medications should always be present in the home medicine cabinet, since colic is sudden and cramping in nature. More often than others, Papaverine is prescribed for kidney stones. The medicine relieves muscle spasm of organs and blood vessels. It has a minimum of contraindications and side effects on the body. Approved for use by pregnant and lactating women.
Antibiotics and anti-inflammatory drugs
Fluoroquinolones
The fluoroquinolones group are drugs that have been used since the 60s. The difference from other antibacterial agents is the effect on highly drug-resistant strains of microorganisms. Their principle of operation is based on changing and blocking the DNA of bacteria. Medicines from the fluoroquinolones group, widely used for urolithiasis, are:
- "Ofloxacin" has a negative effect on microbial cells, preventing them from dividing, which leads to the death of the bacterium. It has a number of contraindications. Prohibited for use by pregnant and lactating women, as well as children. This is associated with many adverse reactions.
- Lomefloxacin is a broad-spectrum antimicrobial drug. Its substances are integrated into the DNA of the microorganism and destroy cells from the inside. The product is effective for diseases of the urinary system, including the presence of stones. The dosage is calculated by the doctor based on test results and the course of the disease. Prohibited during pregnancy and breastfeeding, as well as for persons under 18 years of age.
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Cephalosporins
Cephalosporins represent the most extensive group of drugs in terms of the number of drugs. Their action is aimed at creating disturbances in the structure of the bacterial cell wall. Low toxicity and high results have led to the frequent use of these antibiotics in medicine. Medicines for urolithiasis from the cephalosporin group:
- "Ceftazidime" is a drug of the 3rd generation. Effective for severe infections when the underlying cause is unknown. Injections are allowed for children from birth. Before prescribing, pregnant and lactating women should weigh the possible consequences.
- "Cefepime" belongs to the IV generation drugs. It has an effect on almost all types of bacteria. If the causative agent of the disease is not identified, then the Cefepime injection is recommended as a universal drug, including for urolithiasis. In pediatrics, use begins at 2 months. Pregnant women are prescribed the drug subject to careful monitoring.
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Aminoglycosides
The aminoglycoside group was discovered in the 1940s. The mechanism of action of medications is a targeted disruption of protein synthesis in microorganisms. The downside is the relatively small list of susceptible bacteria. Treatment of urolithiasis is carried out with the following drugs:
- Amikacin has many indications for use, including stones in the genitourinary system. Before starting use, you should determine the reaction of the pathogen to the antibiotic. The dosage and number of doses is determined by the attending physician. The drug is administered intramuscularly. Used in pediatrics to treat newborns and premature babies, the body's reaction should be carefully monitored. Contraindicated for liver problems.
- "Gentamicin" is active against many bacteria, therefore it is widely used for therapeutic purposes. Available in powder form for dilution and further administration into a muscle or vein. In pediatrics it is used only in severe cases.
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Carbapenems
The active ingredients of drugs belonging to the carbapenem group destroy the cell walls of bacteria, which leads to their death. This effect contributes to an active influence on many types of microorganisms. Effective pharmacotherapy for urolithiasis with carbapenems includes:
- Meropenem is prescribed for a number of diseases caused by bacteria. Used by injection into a vein. It is prohibited for use by children under 3 months, pregnant and lactating women. Prescribe with caution to people with gastrointestinal problems. The dose is calculated by the attending physician.
- The combination “Imipenem” + “Cilastatin” is prescribed for a number of infectious diseases. Prohibited for use by people with liver problems, pregnant and nursing mothers, and children under 3 months. Available in powder form for preparation of a solution and further administration into a vein using a dropper.
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Anti-inflammatory nonsteroidal drugs
Non-steroidal anti-inflammatory drugs have the ability to reduce pain, body temperature, relieve inflammation and fever. The advantage of their use is the minimum of negative reactions from the body. If there are stones in the organs, it makes sense to prescribe them to combat the resulting inflammation. The most famous are:
- Diclofenac is an analgesic and anti-inflammatory drug. It also has the property of lowering body temperature. Contraindicated for disorders of the gastrointestinal tract. Your doctor will help determine the dosage and duration of use.
- "Ketoprofen" has the effects inherent in anti-inflammatory non-steroidal drugs, including painkillers. It has several release forms, which helps to correctly calculate and use the prescribed dose. Prohibited when carrying a child and during breastfeeding.
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Diuretics
The main function of the kidneys is to process and remove excess fluid and salts of harmful substances from the body. It is swelling that becomes the first symptom of a malfunction of the organ. Diuretics for kidney stones can only be prescribed by the attending physician, provided that the formations are small in size. For correct and effective treatment with diuretics, the nature of the stones must be determined. Thus, for formations of calcium and phosphate types, potassium-sparing diuretics or infusions of medicinal plants will be effective. Thiazide diuretics are used to treat oxalate stones. In addition to the nature of the stones, an important factor is the general health and stage of the disease. In the initial stages, good results can be achieved by consuming foods with diuretic properties.
What should I take from preparations containing herbal ingredients?
Synthetic drugs for urolithiasis show good results and are among the most effective. However, along with this, they have many contraindications and negative consequences for the body. Analogues of such medicines are products based on herbal components. When using them, good results are observed with a minimum of adverse reactions. The advantages of such drugs include permission for use by children and pregnant women. Their negative side is the possible intolerance to the herbs and plants that are included in the composition. Therefore, it is recommended to consult a doctor before use.
Canephron tablets consist of a combination of medicinal plants that effectively fight inflammatory processes in the genitourinary system. When diagnosed with urolithiasis, the drug is prescribed to remove crushed stones and sand. In addition to the anti-inflammatory effect, the tablets help relieve muscle spasms and remove excess fluid from the body. "Canephron" is prescribed as an independent medicine or as an adjunct to general therapy. The dosage and frequency of administration are determined by the attending physician based on laboratory tests and general medical history. The maximum daily dose is 6 tablets for adults and 3 for children over 10 years of age. Due to the herbal composition, these tablets for urolithiasis are prescribed to pregnant and lactating women. Patients with diabetes mellitus should take it with caution.
"Cyston" for urolithiasis
"Cyston" belongs to a group of drugs with antiseptic properties. In addition, its effectiveness has been proven in removing stones and sand from the genitourinary system. Used as an adjunct to primary therapy for infectious diseases. The completely natural composition of the medication explains the absence of contraindications to it. However, before taking it, you should make sure that you are not allergic to its ingredients. Otherwise, itching, spots and rashes on the skin may occur. The average dosage for an adult is 2 tablets 2-3 times a day. Children under 18 years of age can use the product only under the supervision of a pediatrician.
The drug has diuretic, analgesic and anti-inflammatory properties. It is used as a medicine for the treatment of urolithiasis. Contraindications are kidney problems and stomach ulcers. Available in the form of drops, which are applied to a piece of sugar before use. The dosage is calculated by the attending physician; on average, it is 3-4 drops during remission and up to 10 during an attack. With the approval of a doctor, the drug is approved for pregnant and lactating women.
"Enatin" for the treatment of urolithiasis
The drug has a combined effect, helps relieve the inflammatory process, improves the release of bile and excess fluid, and also relieves muscle spasms. Effective for the treatment and prevention of urolithiasis. It is prohibited to prescribe medication for peptic ulcers, problems with urination and impaired kidney function. Release form: capsules, taken up to 5 times a day before meals. To prevent illness, 1 pill per day is enough.
“Phytolysin” has antimicrobial, antispasmodic, anti-inflammatory and other effects on the body. The herbal components included in the preparations effectively fight stones and sand in the organs of the genitourinary system, therefore the product is prescribed as a medicine for urolithiasis of the kidneys. The medication has a number of contraindications, the implementation of which will minimize adverse reactions. “Fitolysin” is produced in the form of a paste, which is diluted in water at room temperature immediately before use. If desired, you can add honey or other sweetener. The drug is used in pediatrics, even for newborns. Self-use of the product is unacceptable, as it can lead to negative reactions in the body.
"Avisan" - a drug for stones
The product is intended to relieve muscle spasms. Thanks to the composition, it promotes the movement of stones and their easy exit. Contraindications include problems with the cardiovascular system and individual intolerance to the components. Possible side symptoms include indigestion, but this is not a reason to discontinue the drug. The correct dosage and duration of use is determined by the attending physician.
The drug has properties aimed at removing stones from the genitourinary system. Along with taking Artemizol, it is recommended to follow a diet for urolithiasis. The release form is drops, which are applied to a piece of sugar before taking. The average duration of treatment is up to 20 days. The exact dosage and time of administration are determined by the attending physician.
Pathological processes in the kidneys are diagnosed more and more often with age. When the first symptoms of urolithiasis appear, it is very important to contact a urologist who can choose the right medications for the treatment of urolithiasis. With the help of drug therapy, it is possible to prevent the dangerous consequences and complications of the disease.
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General information
Urologists have identified infectious and non-infectious kidney pathologies. Infectious processes develop as a result of the introduction of infectious agents in an ascending manner; they are a consequence of cystitis, urethritis and other diseases. They can also develop as a result of infections in other organs, moving to the kidneys along with the bloodstream. More often, women suffer from such diseases; men are mainly diagnosed with complications and severe urolithiasis.
Medicines for urolithiasis are selected depending on the source of infection and the type of pathogen, the duration of the pathological process and the severity of symptoms.
The main goals of therapeutic intervention are:
- getting rid of the cause of the disease - eliminating the inflammatory process, dissolving and removing sand and stones;
- elimination of the severity of clinical manifestations so that the kidney restores its functions;
- prevention of the occurrence of diseases in the future (immune-strengthening therapy, vitamin therapy).
Antibiotics
An antibiotic for urolithiasis is necessary in order to achieve maximum effectiveness from the therapeutic effect. Antibiotics used in treatment must have the following properties:
- antimicrobial activity against pathogens;
- eliminating barriers to microbial resistance;
- creation of active components in urine and blood fluid.
Antibacterial drugs used in therapy are divided into several main categories. They are prescribed by urologists, taking into account the provoking factor in the development of the disease and the stage of its development. The fluoroquinolone category is represented by the following drugs: Ciprofloxacin, Levofloxacin, Maxifloxacin. Another category of drugs are sulfonamides: Biseptol, Sulfadimezin. The group of nitrofurans includes: Furadonin, Furamag. Aminopenicillins include: Ampicillin, Amoxiclav.
Currently, urologists less frequently prescribe aminopenicillins, nitrofurans and tetracyclines, since pathogens quickly develop resistance to them. All dosages and duration of therapy are prescribed only by the attending physician, taking into account the severity of the disease and the severity of symptoms. Long-term use of an antibiotic can cause pathogens to become resistant to it.
Stone-dissolving drugs
Urolithiasis is also treated with the help of medications to dissolve kidney stones. These medications, citrates, reduce the acidity of urine. If you maintain the acid-base balance in the body at a high level for a long time, this helps the stones gradually dissolve. The duration of medication is determined by the diameter of the stones; on average, therapy lasts at least three months (in some cases up to seven months).
Stone-dissolving agents are also used to prevent further formation of sand or stones. At the same time, you should monitor how the stones dissolve using ultrasound, radiography, and computed tomography. When carrying out therapy, it is necessary to drink plenty of fluids - more than two liters during the day; it is also important to maintain proper nutrition (exclude fried, fatty, salty, spicy foods).
The following drugs belong to the category of citrates: Tiopronin, Biliurin, Blemaren. Blemaren is an effervescent tablet or granular powder. It contains potassium or sodium citrates. This drug dissolves stones, regardless of their type. Dimensions - no more than three millimeters. Otherwise, a radical solution to the problem is indicated.
Antispasmodics
To cure kidney stones, myotropic or neurotropic drugs are additionally used. With their help, a relaxing effect is exerted on the smooth muscles of the urinary canals, against the background of which their function is restored. Antispasmodics are also used if renal colic worsens. With the help of antispasmodic drugs you can achieve the following results:
- improve microcirculation of blood fluid, as blood vessels dilate after consuming drugs;
- remove hidden swelling from tissues;
- expand the lumen of the urinary tract, so that stones will be removed quickly and painlessly.
Neurotropic medications prevent spasm of smooth muscles and the appearance of unpleasant sensations, as they suppress nerve impulses that stimulate contraction of smooth muscle tissue. These drugs include: Platiphylline, Scopolamine.
Myotropic drugs have a relaxing effect on muscle fibers, thereby relieving spasms. The effect of such medications lasts on average no more than three hours, so they are prescribed two or three times a day. The most common medications in this category are: No-shpa, Papaverine, Eufillin, Dibazol. Urolithiasis is often treated with No-shpa; it is a safe medication for the body and works quickly. Urologists prescribe myotropic drugs for acute urolithiasis in the form of intravenous droppers in the morning and evening, so they will quickly relieve pain.
An effective drug is Tamsulosin. It reduces muscle tone and improves detrusor function. It is prescribed once a day. Do not use in case of severe liver diseases or in the presence of hypertension. For renal colic, which is accompanied by urolithiasis, analgesics and antispasmodics are used: Maxigan, Spasmalgon, Trigan. One tablet is prescribed twice a day.
Diuretics
A diuretic medication is necessary in order to restore normal liver function, quickly remove pathogens, and remove stones during exacerbation of urolithiasis. Diuretics vary in their mode of action. The most common are: Furosemide, Torasemide, Diuver. But more often, urologists prefer to prescribe diuretics of herbal origin. Medicinal plants have a mild effect, they are safe, there are no adverse reactions. Most often they contain: Bearberry, corn silk, birch buds.
Herbal infusions with the listed herbs not only have diuretic properties, but are also antiseptic. They are prescribed in courses of 14 days, after which they take a break of a month and take them again. Kidney tea has a mild diuretic effect.
Painkillers
Analgesics that are used to treat urolithiasis belong to the category of alkanoic acids or to the group of non-steroidal anti-inflammatory drugs. They relieve pain and eliminate inflammation. The drugs in the group of non-steroidal anti-inflammatory drugs include: Diclofenac, Indomethacin, Ibuprofen.
Such medications can be used for a long time. Baralgin is considered another effective drug for treating urolithiasis. It relieves pain and dilates blood vessels. Urologists prescribe it more often than other drugs.
Herbal medicines
When prescribing therapy, doctors additionally recommend the use of herbal medicines. They help cure diseases and prevent their exacerbations in the future. The most popular among this category are: Canephron, Cyston, Urolesan, Gentos, Fitolysin.
Canephron is an effective anti-inflammatory, diuretic and antispasmodic drug. With its help, stone crushing occurs faster. Only such a therapeutic effect occurs after prolonged use of the product. It also restores kidney function, relieves pain, and eliminates the inflammatory process. After starting therapy, a person feels relief within a few days. Canephron contains the following plants: Rosemary, Centaury, Lovage. The anti-inflammatory drug is available in the form of tablets (for patients over 7 years of age), drops (for patients under 7 years of age). The duration of treatment is 60 days.
Cyston – the base contains medicinal plants and mumiyo. It has bactericidal properties, increases the body’s natural defenses, and prevents the formation of stones. Often prescribed during treatment with antibacterial drugs. Can be used as a preventative medicine. Recommended doses are two units in the morning and evening.
Nephroleptin is a modern medicine for urolithiasis. It contains: Propolis, Licorice root, Bear's Ears, Lingonberry leaves, Knotweed herb. Has the following properties:
- diuretic;
- anti-inflammatory;
- restorative.
Since the composition contains the listed active components, the medicine is prescribed with caution in childhood and during pregnancy. The duration of therapy is at least three weeks.
In terms of its properties, it is identical to the above drugs, only its release form is a paste, it contains the following medicinal plants:
- Horsetail;
- onion peel;
- Fenugreek;
- Parsley;
- Wheatgrass;
- avian Highlander;
- Lovage.
It also contains essential extracts and pine oil. A teaspoon of paste is stirred in a glass of slightly warmed water. To achieve a lasting effect, you need to take Phytolysin for two months. With its help, both therapy and prevention of pathological processes in the organs of the urinary system are carried out.
All herbal remedies are not intended as a stand-alone treatment for any kidney disease. They must be taken with other medications prescribed by your doctor. In each specific case, a different treatment regimen is prescribed; all prescriptions are carried out only after preliminary diagnosis.
It is also important to take measures to strengthen the body's immune system. For this, doctors prescribe immunomodulatory medications, multivitamin complexes, which also contain trace elements (calcium, potassium, sodium). This way, the body’s natural protective functions will better resist infectious and viral agents that can cause inflammatory processes in the organs of the urinary system. To prevent the formation of stones and sand in the kidneys, proper nutrition and adherence to the drinking regime are important.
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The question of how to treat urolithiasis is dealt with not only by urological doctors, but also by surgeons who surgically remove stones from different parts of the urinary tract.
Unfortunately, no doctor can guarantee a patient a complete recovery, even if the treatment met all modern standards. If metabolic failures have occurred in the patient’s body and the process of stone formation has been started, then there is a constant threat of their new formation.
In order to avoid this, treatment of urolithiasis should be multidirectional and combined, which will ensure an impact on all links in the pathogenesis of the disease, especially in people at risk of relapse of the process.
Medical nutrition
According to the protocol for the management of a patient with urolithiasis, treatment measures begin with prescribing an appropriate dietary option. Thanks to therapeutic nutrition, you can stop the formation of new stones, as well as speed up the process of breaking down already formed stones.
The diet for urate urolithiasis is aimed at “alkalinizing” the urinary sediment. To do this, it is necessary to include fresh vegetables and fruits, berries and all dairy products in the patient’s diet.
At the same time, the consumption of fish and meat dishes, especially those prepared from fatty varieties, alcohol, champignons, spinach, offal, legumes, semi-finished products, eggs (that is, those products that contain an excess of purine bases) is sharply limited.
The volume of liquid drunk during the day should not be less than 2-2.5 liters. It is not recommended to drink drinks made from cranberries and lingonberries, as they can increase the acidity of urinary sediment.
A diet for oxalate urolithiasis implies the complete exclusion from the patient’s diet of products containing oxalic acid or substances that can serve as a source for its synthesis.
The following products are completely excluded: spinach, rhubarb, sorrel, offal, fatty meats, mushrooms, chocolate products, coffee, cocoa, smoked snacks, pickles and others.
At the same time, a sufficient amount of magnesium and potassium must be present in the diet. The diet includes cereals (pearl barley, oatmeal and buckwheat), hard-ground bread, rye bran, dried fruits, etc.
The following products are allowed: boiled fish and lean meats that are steamed or boiled, eggs, dairy products, vegetables and fruits that do not contain oxalic acid (cucumbers, pumpkin, bananas, apricots and others).
The diet for phosphorus-calcium urolithiasis is aimed at “acidifying” the urine, which speeds up the process of removing stones from the body and prevents the precipitation of salt crystals into the urinary sediment.
The following products are excluded or maximally limited in consumption: milk and dairy products, potatoes, vegetable salads, spices, compotes and fruit preserves, etc.
It is recommended to consume fish and lean meat, vegetable fats, cereals without added milk, bread products, vegetables (pumpkin, peas, mushrooms) and fruits (sour apples, lingonberries, cranberries and compotes made from them), weak tea, etc. d.
The volume of water load per day should not be less than 3 liters. It is recommended to consume fruit drinks and compotes made from cranberries and lingonberries daily to speed up the process of changing the pH of urine to the acidic side.
Drug therapy
Symptomatic treatment is necessary to relieve pain that occurs due to muscle spasm when a stone moves through the lumen of the ureter.
For these purposes, the following drugs are used, which are administered intramuscularly or intravenously:
- No-spa 2% -2 ml;
- Papaverine 2% -2 ml;
- Analgin 50% -2 ml;
- Tramadol 1% -1 ml and others.
After the attack of renal colic has been stopped, their further use in tablet form is allowed.
Among the most common painkillers used to treat an attack of renal colic due to urolithiasis, it is worth highlighting Baralgin. It is prescribed either alone or in combination with the drugs described above, which speeds up the process of pain relief.
In Russia, novocaine blockades (paravesical, suprapubic, paravertebral, paranephric and others) have found their use.
Pathogenetic treatment is decisive in the direct fight against the process of stone formation.
To prevent the synthesis of stones from uric acid (urates), Allopurinol tablets are used at a dose of 300 mg (100 mg 3 times a day) for a course of 2-3 weeks (under monitoring the level of uric acid in the patient’s body).
Accelerates the process of excretion of urate by the kidneys Butadione (0.1 g 4-6 times a day for 3-5 weeks).
To start the process of breaking down stones of urate origin, citrate mixtures are used, which include several components: sodium citrate, potassium citrate, ascorbic acid. The resulting solution is taken for several months with mandatory monitoring of urine pH. Instead of the citrate mixture, the patient can be prescribed Uralit (combined drug).
Oxalaturia is eliminated by taking Allopurinol and drugs that include magnesium oxide, B vitamins (in particular B6) and A (retinol).
For urolithiasis associated with calcium metabolism disorders, medications are prescribed that can reduce its concentration by binding and forming insoluble compounds. For this purpose, Almagel is prescribed 2 tsp. 3-4 times a day for 2-3 weeks.
Flurbiprofen accelerates the process of excretion of free calcium, which prevents its precipitation into crystalline compounds. Its dose is 0.05 g 3 times a day.
The level of phosphates in the patient's blood is reduced by prescribing vitamin D2 (200-400 IU). Treatment with Xidofon is also carried out (1 tbsp. 3 times a day). The course of treatment is chosen individually.
To eliminate pain and other manifestations of urolithiasis at home, combined drugs are used, such as Cystenal, Spasmocystenal, Canephron, Cyston and others.
When an infectious agent is attached and the inflammatory process begins, treatment is carried out with broad-spectrum antibacterial drugs and antimicrobial agents.
Phytotherapy
In addition to conservative treatment methods, a significant role in the treatment of patients with various forms of urolithiasis is given to the use of herbal remedies. When properly combined with each other, they have effects that are not inferior to synthetic drugs.
Herbal infusions help in the fight against inflammation, the spastic component of the disease, change the pH of urine, and also have a bactericidal effect.
To dissolve oxalate stones, use nettle juice (2 tablespoons 3 times a day for a month).
Urate urolithiasis can be treated with an infusion of birch leaves. To do this, take 3 tbsp. l. dry substrate, pour 300 ml of boiled water and leave for 3-4 hours, after which take 100 ml 3 times a day (course of therapy 30-40 days).
Stones of a phosphate nature will help to dissolve a decoction, which contains the following components: bean pods, corn silk, bearberry leaves, blueberry leaves. It is necessary to pour 1 tablespoon of the collection with 300 ml of boiling water, leave for 2-3 hours, strain and take 1 spoon 3 times a day.
To speed up the spontaneous passage of stones, a collection is prescribed, which includes horsetail herb, bearberry leaf, lingonberry and birch leaves, juniper fruits and licorice root.
Surgical treatment
If the stone does not manifest itself clinically, the patient does not make any complaints, and its discovery is an accidental finding, then treatment of urolithiasis continues with conservative methods. Most often, we are talking about a single formation of small size, located in one of the calyces of the kidneys, and there should be no disturbances in the functions of the organ.
Not all stones can pass out on their own, even if their size does not exceed 5-6 mm. The reason for this may be obstructive disorders in the urinary tract, the presence of inflammatory changes that impede the passage of stones, etc. In any of these cases, surgical intervention is necessary, due to which the formed calculus will be completely removed or crushed into smaller parts.
External shock wave lithotripsy
With the introduction of modern methods of minimally invasive surgical intervention, the treatment of urolithiasis has become as safe as possible and more effective.
Currently, the method of remote shock wave lithotripsy (ESWL) is widely used, the essence of which is to create a special wave pulse with a device that can crush the stone into smaller parts. Subsequently, they are washed out of the urinary tract on their own.
If the size of the stone exceeds 2 cm, then, before performing DLT, the patient is given a special catheter, with the help of which all its destroyed fragments are removed. This is necessary in order to avoid their accumulation in the ureter, which will lead to another attack of renal colic, and can also cause complications.
In order for the procedure to have maximum effect and have the least traumatic effect on surrounding tissues, it must be carried out under mandatory ultrasound or x-ray control. The shock wave should only affect the area in which the stone is located.
Contraindications to the treatment of urolithiasis using DLT:
- obesity in a patient of varying severity or severe deformation of bone structures (it is impossible to accurately determine the focus of the shock wave);
- diseases of the blood coagulation system, severe heart or lung diseases;
- inflammatory processes in the organs of the urinary system (acute pyelonephritis, cystitis and others);
- deformations of the ureter below the location of the stone (scars, strictures);
- impaired glomerular filtration of the kidneys (more than 50% of the initial values);
- acute processes in the gastrointestinal tract (pancreatitis, cholecystitis and others).
Transurethral endoscopic lithotripsy and lithoextraction
Thanks to this type of surgery, it is possible not only to destroy the stone into smaller pieces, but also to remove its remains and restore the obstruction of the ureter, if necessary.
Thanks to an endoscope inserted into the lumen of the urethra, it is possible to visualize and remove the formed calculus, as well as to clear the lumen of the ureter from the “stone path” that shock wave lithotripsy leaves behind.
This technique is not inferior in its effectiveness to DLT, however, due to the risk of complications, its use is largely limited, especially when it comes to the treatment of urolithiasis in children (since the lumen of the urethra is quite narrow, which makes it difficult to insert an endoscope).
The main complications after the procedure are as follows:
- advancement of the stone into the pyelocaliceal apparatus of the kidney;
- traumatic impact on the walls of the ureter or its perforation, which causes bleeding;
- inflammation of the kidneys (acute pyelonephritis) or prostate gland (acute prostatitis), as a result of an unrecognized infection of these structures or a violation of asepsis during the procedure;
- complete rupture of the ureter (this happens extremely rarely).
Percutaneous nephrolithotripsy
Treatment of urolithiasis with this method is indispensable for large stones or when the disease is complicated.
Drainage is performed through the nephrotomy tract under mandatory ultrasound control. The stone is destroyed using different lithotripters (electric pulse, ultrasonic, pneumatic and others).
Despite the high effectiveness of the procedure, it has disadvantages, the first of which is invasiveness and trauma. Possible complications include:
- puncture of large vessels due to incorrect puncture;
- injury to organs located in the abdominal or pleural cavity;
- the formation of a large hematoma under or around the kidney capsule;
- a blood clot enters the pelvis, which threatens it with complete tamponade.
Operation open
When the above methods of surgical treatment are ineffective or their use is limited, open surgery is used.
To remove the stone, one of the following operations is used:
- ureterolithotomy;
- pyelolithotomy;
- pyelonephrolithotomy;
- nephrectomy (complete removal of an organ is resorted to in emergency situations, for example, in case of widespread kidney abscess or when it shrinks).
Spa treatment
Treatment in sanatoriums for patients suffering from one or another form of urolithiasis is balneological (therapy with mineral waters).
Each water has its own gas and mineral composition. When used correctly, it is possible to influence the process of breaking down stones and their natural elimination from the body.
The main effects of balneological treatment are as follows:
- gently accelerate the process of diuresis;
- anti-inflammatory effect;
- eliminate the spastic component from the smooth muscles of the ureters;
- adjust urine pH in the required direction.
In each specific case, only the doctor determines the need for sanatorium treatment, because there are certain contraindications for it (for example, the presence of large stones or severe concomitant diseases).
Conclusion
Unfortunately, it is impossible to completely cure urolithiasis and rid the patient of this condition. However, if you follow all medical recommendations regarding nutritional correction and lifestyle changes, you can stop the pathological process for a long time.
Drugs for the treatment of urolithiasis are prescribed by urologists taking into account the severity of the pathological process, the presence of renal colic, inflammation, and the type of stones. Medicines, as a rule, are selected on an individual basis, taking into account all the subtleties of the pathology in each individual case. Typically, specialists include antibacterial components in the treatment regimen that eliminate infectious inflammation in the kidneys and urinary tract and help reduce swelling of the organ parenchyma.
The prescription of medications for the correction of the pathological process is preceded by a thorough diagnosis with determination of the type of stones, their composition and size. Based on the results obtained, doctors distinguish several types of stones, according to their chemical content:
- stones containing potassium, which are based on phosphates and oxalates, forming durable formations that are difficult to crush with medication;
- stones formed through the impact of infectious agents on urine, which are destroyed with the help of medications that promote alkalization of urine;
- uric acid stones that require an alkaline environment.
Therapy aimed at dissolving and crushing kidney stones has several important goals:
- reducing the size of stones, which will allow them to be released gently through the urinary tract;
- normalization of metabolic processes, helping to prevent the formation of new stones and an increase in existing ones;
- elimination of inflammation in the kidney area and elimination of local swelling of soft tissues;
- impact and normalization of local hemodynamics;
- strengthening the immune system and stimulating the supporting mechanisms of the human body.
Treatment of urolithiasis with medications is indicated for patients in the following clinical cases:
- for stones up to 0.6 cm in diameter, which are not capable of disrupting normal urodynamics and blocking the urinary tract;
- frequent effective renal colic, which lasts no more than one day and is easily relieved with medications;
- the presence of sand in the kidneys;
- urates, the amounts of which are assessed as critical;
- the addition of pathogenic microflora with the development of an infectious process in the kidney parenchyma.
Modern stone-dissolving and stone-expelling preparations
Stone-dissolving medications for kidney stones are the basis of treatment for the pathological condition. Modern medicine has a set of medications that gradually dissolve stone formations, which allows them to freely leave the renal tubular system. Among the most popular drugs with a similar mechanism of action among doctors and their patients are Allopurinol, Methionol, Blemaren solution, Magurlite, as well as benzoic and boric acid, ammonium chloride.
Unfortunately, such therapy does not always achieve the expected effect, which is explained by the peculiarities of the chemical composition of the stones or problems with the absorption of drugs. In this scenario, experts suggest that patients take advantage of stone-expelling drug forms, which are currently considered to be most effective against renal stones. Treatment of urolithiasis in a similar way is allowed only if the patient has stones whose diameter does not exceed 6 mm. If everything is done correctly, then the patient can expect that after the first course of therapy, about 2/3 of the rocky formations and sand will be gone.
The most effective means of combating urolithiasis, facilitating the rapid removal of kidney stones, are considered to be:
- Progesterone, which affects alpha-adrenergic receptors of the ureters, reduces the muscle tone of the medial shell and expands the diameter of the passages;
- smooth muscle relaxant Glucagon, which relaxes the muscle fibers of the ureters and facilitates the easy movement of stones through their lumen;
- alpha blockers, which relax the smooth muscle fibers of the ureters;
- Ca-channel blockers, the action of which is aimed at relieving spasm, which increases the likelihood of unhindered passage of stones through the ureters;
- non-steroidal anti-inflammatory dosage forms that relieve pain and reduce local swelling of tissues.
The presence of small stones is an absolute indication for stimulating their spontaneous passage. In addition to the listed means of expelling stones, in modern medical practice, doctors use a technique using drugs containing terpenes. Chemical compounds of this series have a pronounced antispasmodic effect, are endowed with sedative qualities and are able to influence the microbial flora due to bacteriostatic activity.
Terpenes are common and well-known medical forms that have a number of undeniable advantages that allow you to almost always make a choice in their favor:
- increase the daily amount of urine;
- help improve blood supply and microcirculation in the urinary organs;
- have a bacteriostatic effect;
- eliminates spasticity of smooth muscles of the urinary tract;
- improves the peristaltic activity of the pathways along which stones move.
Among the most popular drugs in this series are:
- Palin, which has a pronounced antibacterial effect;
- Fitolysin paste, which is prescribed mainly in the postoperative period, as a drug that prevents relapses of the disease;
- Canephron is a herbal medicine that improves the patient’s general condition and enhances the discharge of small formations;
- effective tablet preparations for stones Enatin and Olimethine;
- Cystine is a medicine based on herbal components that helps remove excess uric acid from the body, which is involved in the formation of stones.
Dependence of the effectiveness of dissolving therapy on the type of stones and their composition
With what type of stones does their complete dissolution become possible? Stones consisting of uric acid salts, that is, urates, are perfectly amenable to drug dissolution. In order to get rid of such formations, a therapy regimen is used aimed at alkalinizing urine using citrate mixtures or potassium bicarbonate. Before starting such treatment, the doctor must make sure that patients have no contraindications, including pyelonephritis in the acute phase, impaired renal function, and unsatisfactory urodynamics.
Citrate solutions should be prepared immediately before use. An adequate dosage of such drugs is 10 ml three times a day. This treatment regimen allows you to achieve the desired result in the form of getting rid of stones within 3-4 months from the start of therapy. Citrate preparations should be taken under the control of urine pH, which should not exceed 6.3-6.8.
It is important to remember that the dissolution of urate stones with medications always requires reinforcement in the form of a special diet with a limitation of foods that contain purine bases. Oxidation of urine is facilitated by the exclusion of their daily menu of meat, vegetable oil, cocoa, chocolate and coffee. At the same time, you should drink plenty of fluids (about 2.5-3 liters per day for an adult).
Antibiotics in the treatment of urolithiasis
Very often, urolithiasis is accompanied by the addition of bacterial microflora, which causes inflammation of the renal parenchyma and gradually destroys it. That is why, when determining kidney stones, it is advisable to use antibacterial drugs that eliminate foci of infection and have a powerful anti-inflammatory effect. Most often, doctors prescribe antibiotics from the following groups:
- fluoroquinolones (“Ofloxacin”, “Lomifloxacin”), which are an effective means of combating infectious agents;
- aminoglycosides (“Gentamicin”, “Amikacin”) - drugs that disrupt protein synthesis in bacteria, thereby preventing their growth and reproduction;
- cephalosporins (Cefazolin, Cefepin) are antibiotics that have four generations of drugs with different activities against bacteria of one type or another.
It should be noted that complete sanitation of the source of infection in the kidney with urolithiasis is impossible, especially if the stone disrupts urodynamics. Therefore, antibacterial therapy takes place as preoperative preparation and for the prevention of infectious complications in the postoperative period.
Anti-inflammatory therapy
A direct indication for the prescription of nonsteroidal anti-inflammatory drugs for urolithiasis is the presence of an inflammatory process in the kidney tissues with all its consequences, namely pain, swelling of the parenchyma, dysuria, and the like. Drugs from the NSAID group very rarely cause negative reactions from internal organs and have effects such as:
- pain relief;
- normalization of temperature indicators;
- elimination of local edema;
- improvement of ureteric patency.
Non-steroidal anti-inflammatory drugs are recommended to be used only after prescription by the attending physician.
Which painkillers are best?
Analgesic therapy is an important point in the treatment of exacerbations of nephrolithiasis, which are accompanied by intense pain in the lumbar and abdominal areas, provoked by renal colic. When stones move through the ureters, pain relief cannot be avoided without medication. To relieve pain, urologists use analgesic drugs and antispasmodic drugs, which are equally effective in eliminating the pathological symptom, but have a different mechanism of action. Doctors often prefer to combine these medications to enhance the analgesic effect.
Antispasmodic drugs for urolithiasis can eliminate muscle spasms and thereby relieve a person from debilitating pain that complicates the passage of stones through the urinary tract. In the acute period, antispasmodics are recommended to be used in the form of injections, but in their absence, the use of tablet forms of drugs is allowed. As a rule, in therapeutic practice, renal colic is relieved by intramuscular injection of No-shpa or Spasmalgon to the patient.
During an attack of renal colic, doctors prescribe narcotic and non-narcotic analgesics to patients. Opium drugs include Papaverine, known to many, which relieves spasms of smooth muscles and blocks the activity of pain receptors. The most popular non-narcotic analgesic is Baralgin, which can be administered intramuscularly and intravenously. In the period between attacks, people suffering from urolithiasis should not relax, waiting for the next episode of the disease. The medicine cabinet of such patients must certainly contain drugs that can quickly eliminate the symptoms of colic, which tends to occur suddenly against the background of complete well-being.
Diuretics
The function of the kidneys involves constant filtration of blood and removal from the body, along with urine, of various metabolites, metal salts, toxins, and the like. If the kidney cannot cope with its responsibilities, fluid accumulates in its parenchyma and provokes the development of edema. It is this disorder that is one of the first manifestations of dysfunction of the main urinary organ and a signal that it is time to visit a specialist in order to diagnose diseases that have caused a deterioration in general health.
It is advisable to prescribe diuretics for small stones that are not capable of creating a situation with blockage of the urinary tract. Also for such therapy, the composition of the stones and their ability to dissolve are of great importance. Potassium-sparing diuretics are prescribed to patients prone to the formation of phosphate or calcium stones. Whereas oxalates require the use of thiazide diuretics.
Any diuretic drug for urolithiasis can be replaced with a herbal remedy in the form of a herbal decoction or tincture. It must be remembered that medications with a diuretic effect can only be used with the permission of the attending physician and after clarifying all the nuances of the disease, as well as assessing the risks of developing its complications.
We should not forget that the treatment of urolithiasis must be comprehensive, so drug therapy alone is not sufficient in this case. Patients suffering from stone formation, after drug correction, are necessarily recommended to undergo a course of sanatorium treatment with mineral waters under laboratory control of the metabolism involved in the process of stone formation.
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