How can urolithiasis be cured. Urolithiasis (urolithiasis) What causes urolithiasis

Urolithiasis (ICD-10 code N20-N23) is common among women and men. Other names for pathology are nephrolithiasis and urolithiasis. If a person has urolithiasis, this means that there are stones (stones) in the pyelocaliceal system of the kidneys. The size and number of such stones depend on the type of pathology.

Nephrolithiasis is divided into 3 types depending on how many stones are present in the urinary tract.

Distinguish:

• single;
• multiple;
• coral stones.

According to the number of relapses, nephrolithiasis happens:

• primary;
• recurrent;
• residual.

By its nature, the pathology can be:

• infectious;
• non-infectious.

Stones can form in:

• calyces of the kidneys;
• ureter;
• bladder;
• urethra.

Causes

There are many reasons that lead to urolithiasis:

1. Inactive lifestyle.
2. If you eat too salty foods, the metabolism will be difficult: the problem will contribute to the development of this pathology. You can not abuse food with a lot of protein.
3. Ecology.
4. The disease often develops against the background of a deficiency of vitamins and nutrients. It can manifest itself with a lack of calcium, potassium.
5. The predisposing factor is excess weight.
6. Bad habits.
7. Hereditary.
8. If you abuse ascorbic acid or calcium preparations, then sand will accumulate in the kidneys and urinary tract.
9. Anomaly associated with the kidneys.
10. Sometimes the pathology under consideration occurs against the background of Crohn's disease.
11. The cause of nephrolithiasis may be resection of the ileum.
12. Hyperthyroidism.

Symptoms

If the disease progresses, the person manifests distinct pain syndromes. They have different frequency and intensity. Urolithiasis can become chronic: in parallel with this disease, it will occur. If both kidneys are affected, chronic renal failure develops. In order to detect the disease in time, you should pay attention to:

1. Renal colic paroxysmal character. A person feels pain from the affected kidneys, and discomfort is given to the genital area.
2. With nephrolithiasis, nausea is manifested, in the future it can lead to vomiting.
3. Increased gas formation (flatulence) is another symptom of nephrolithiasis.
4. With such a pathology, chills can be felt.
5. The temperature rises to subfebrial levels.
6. In some patients, breathing quickens, the mouth dries.
7. Hematuria (blood clots in urine) is another sign of kidney stones.

Pathology often leads to obstructive pyelonephritis, acute. If unilateral nephrolithiasis is diagnosed, atrophy of the renal parenchyma is possible.

The manifestation of the disease depends on whether there is an infection in the body. A large stone may be present in the renal parenchyma, but urodynamics will be normal and the doctor will not detect secondary infection during diagnosis. In this case, the disease may not show symptoms.

With nephrolithiasis, most patients experience pain in the right side: uncomfortable sensations are associated with inflammation of the fibrous capsule. If there is a stone in the pelvis, the outflow of urine is disturbed.

Diagnostics

The doctor listens to the patient's complaints, without fail determines the risk factors. The following are the procedures:

• Physical examination is a palpation of the hypochondrium and the entire surface of the abdomen. This examination helps to identify pain syndrome.
• The doctor also conducts differential diagnosis. It makes it possible to distinguish renal colic from cholecystitis, acute appendicitis.
• A complete blood and urine test is required.
• If nephrolithiasis proceeds without complications, it is worth performing a chemical analysis of the stone and identifying what trace elements it consists of.

Traditional treatment

To eliminate the pain syndrome, the doctor prescribes:

• Ibuprofen, Tramadol or Indomethacin.
• Diclofenac is effective: the drug eliminates pain and reduces the likelihood of their recurrence. Diclofenac helps to get rid of swelling of the ureter.
• The doctor may prescribe thiazides: these drugs are taken in order to increase the reabsorption of trace elements.
• Citrate medicines can be used for treatment, however, but they are not effective in every case.
• Antibacterial therapy is mandatory.

Abundant fluid intake. It is important to consume 1 - 2 liters of water per day. If nephrolithiasis is diagnosed, the patient is registered with the dispensary. The average duration of therapy is 5 years. In the course of treatment, correction of metabolic failures is necessary.

The size of the calculus may not affect the nature of the treatment. When choosing a therapeutic tactic, the doctor must take into account the location of the stones, their composition, and the presence of an inflammatory process. Surgical treatment is prescribed in the event that drug therapy has not yielded results.

Alternative treatment

Alternative medicine offers many effective remedies:

• For the treatment of the pathology in question, an extract of the plant Marena dyer is used. It is necessary to take 3 tablets of this and dissolve in 100 ml of water. The medicine is taken 2 times a day, 100 ml. The course of treatment is 25 days.
• Herbal decoctions have an antiseptic effect. The first healing mixture includes 40 g of parsley, the same amount of juniper berries and bearberry leaves. 20 g of dandelion is added to the mixture. The medicine is boiled, infused for 5 minutes. You need to take 2 times a day, 150 ml.
• Carrot juice is effective in the fight against nephrolithiasis. To prepare it, you need to take carrots in the amount of 70 g and grate. You should get gruel: it is poured with 2 tbsp. water. carrot juice should be infused for 10 hours. Before taking it, it should be warmed up.

Find out even more recipes and methods for removing stones at home.

Diet

So that the disease does not give exacerbations, you need to eat right. With urolithiasis, the following are allowed:

• berries, fruits, watermelon is especially useful;
• boiled potatoes, rice, oatmeal are allowed;
• cabbage salads, cucumbers, greens;
• from drinks, decoctions of berries, herbs are shown;
• clarified juices.

So that the pathology does not give relapses and does not cause painful symptoms, it is worth giving up spicy, very salty, peppery foods. If stones are formed from uric acid, a diet is a must! It is worth eating less meat. Foods that are difficult to digest are also prohibited: chips, snacks, fast food, canned food, buns, chocolate.

Not an optional, but a mandatory item in a full recovery.

Prevention

To reduce the chance of this disease you need:

1. To avoid this disease, you need to lead an active lifestyle.
2. Ascorbic acid and medicines that contain calcium should not be abused.
3. It is important to ensure the prevention of vitamin deficiency.
4. You can't overexert yourself physically.
5. From time to time you need to massage: massage the entire abdomen, legs, back, buttocks.
6. The diet should include wholesome plant foods. It is important to give up fast food, drinks with dyes.

You can learn more about urolithiasis and how to avoid it by watching this video.

In medicine, urolithiasis is commonly called urolithiasis and is abbreviated as ICD. It is characterized by the presence of one or more stones (calculi) in one of the sections of the urinary system - the kidneys, ureter or bladder.

This disease, in addition to a possible severe course, can have negative complications up to the development of renal failure.

Urolithiasis in women is diagnosed much less frequently than in men, but despite these statistics, a considerable number of women of all ages suffer from it.

As a rule, urolithiasis is characterized by the presence of formations in one kidney or on one side of the ureter or bladder. And only in 15% of cases, calculi are present in both kidneys or on both sides of the indicated sections of the urinary system. Almost all patients have a certain type of stones - staghorn.

Causes of urolithiasis

The mechanism of the development of the disease in each woman is individual and complex. It is almost impossible to single out any specific cause of urolithiasis. However, doctors have named several external and internal factors that contribute to the appearance of insoluble compounds in the urinary system, which subsequently undergo changes - are transformed into stones.

That is why, if there is a suspicion of the presence of urolithiasis and to prevent its further development, it is necessary to undergo a series of studies, including passing a urine test.

Exogenous (external) predisposing factors

• Leading a sedentary lifestyle.
• Taking certain medications that are prescribed to treat diseases such as HIV, malignant neoplasms, pyelonephritis.
• Sedentary work.
• Wrong diet.
• The constant use of drinking water with a certain chemical composition.
• Ecology and climatic conditions of the region of residence.

Endogenous (internal) predisposing factors

• The presence of certain diseases that provoke an increase in the level of urea, oxalates, calcium and cystine in the body, as well as a change in blood pH. Such pathologies include, for example, gout, tumor neoplasms, cirrhosis of the liver.
• Violation of the digestive system organs.
• Functional disruptions of the hormonal background.
• The presence of congenital pathologies.
• Violation of the immune system.
• genetic predisposition.
• Change in the acidity of urine.
• Endocrine diseases.
• The presence of acute or chronic infection in the organs of the urinary system.

Competent specialists have reason to assert that with the simultaneous impact of several of these factors on a woman's body, there is a high probability of developing urolithiasis.

Stone classification

Depending on their composition, stones are divided into 4 classes.

When making a diagnosis, in addition to the results of studies, the symptoms of urolithiasis in women are of great importance, since they depend on the location of stones, their structure, quantitative index, shape and size. Below are the main symptoms that indicate the occurrence of urolithiasis.

1. Deterioration of general well-being

This is a fairly common manifestation, which can indicate both the development of pathological processes in the body, and minor disorders accompanied by reversible processes (for example, fatigue, lack of sleep).

Such a painful condition begins with a chill that does not stop for a long time. Most often, this indicates not only the occurrence of pathology, but also the development of pyelonephritis.

If urolithiasis is suspected, a urinalysis is recommended to be taken first. If leukocytes are found in its composition, a disappointing diagnosis is likely to be confirmed.

2. The appearance of blood in the urine

This symptom of urolithiasis in medicine is called hematuria. In some cases, the amount of blood in the urine is so small that its presence can only be detected by microscopic examination.

The situation is spectrally opposite if the urine noticeably changes its color. It can acquire a pale pink or rich red hue. This phenomenon is called macrohematuria. The presence of blood in the urine is due to the fact that dense stones with sharp edges damage the walls of the ureter.

3. Pain syndrome

The vast majority of patients suffering from urolithiasis note that the pain occurs periodically and is paroxysmal in nature. As a rule, the attack begins with aching pain, which subsequently intensifies.

4. Unexpected interruption of the urinary stream

A similar symptom signals that the stones are most likely localized in the bladder. Urination is difficult and frequent. This symptom may be "blurred" or pronounced, since urolithiasis manifests itself in women in different ways.

Depending on which part of the urinary system the stones are located, a certain character and severity of symptoms are observed.

It is important to know! - Urolithiasis can be asymptomatic and detected quite by accident, for example, when undergoing an examination of any internal organs. Stones can be in one or more parts of the urinary system for years and do not make themselves felt, do not provoke the appearance of symptoms and any discomfort.

Diagnosis of urolithiasis

The complexity of diagnosing KSD lies in the need to differentiate it (separation, identification of differences) from many other pathologies, among which are:

• The presence of stones in the gallbladder;
• Peptic ulcer in the acute stage;
• Violation of the course of pregnancy (both with uterine and ectopic development of the fetus);
• Inflammation of the appendix.

Diagnosis of urolithiasis includes:

• Examination by a specialist and collection of anamnesis. The urologist will definitely ask the patient when the first symptoms appeared, what was their nature and severity, whether she was treated for KSD before, whether there were violations of the immune system and a number of other issues;
• Biochemical and general clinical blood test;
• Laboratory study of urine. This includes biochemistry, sensitivity to antibacterial drugs, culture, degree of acidity;
  Assessment of the condition of the urinary tract;
• Examination of the kidneys using radioisotope and biochemical methods;
• Ultrasound and CT of all parts of the urinary system;
• A study that allows you to determine the degree of density of stones;
• Carrying out urography. It can be carried out by two methods - excretory (a contrast agent is injected) and survey (images of the affected areas are taken).

Treatment of urolithiasis, drugs

A conservative method of treating urolithiasis is carried out taking into account an integrated and systematic approach, it involves taking certain medications. Medications are prescribed depending on the composition of the patients:

1. Diuretic, anti-inflammatory and diphosphonates (if the stones found have a phosphate etiology). With this course of KSD, many doctors recommend home herbal treatment as an adjunct therapy;
2. Citrate suppositories, diuretics and vitamins (if the stones are of oxalate etiology);
3. Medicines that slow down the process of urea synthesis. Also, drugs are prescribed that change the degree of acidity of urine, which leads to the dissolution of stones (in the presence of stones of urate etiology).

If necessary, to stop the pain syndrome, for example, with renal colic, you can take antispasmodics and analgesics. In order to eliminate the infection, the doctor may prescribe antibiotics.

Surgical treatment

This method of treatment is required only if the urinary tract is completely blocked by large stones. In especially neglected situations, when the treatment of urolithiasis was “postponed for later” or was carried out incorrectly at home, part of the kidney tissue is removed along with the stones.

The most common and least traumatic methods of surgical intervention to remove stones from the urinary system are endoscopy and laparoscopy.

Another way to remove stones is lithotripsy - it is prescribed if the patient is contraindicated in surgical intervention. Stones are crushed using ultrasonic waves.

The main advantages are the complete absence of blood loss and a short rehabilitation period. With the help of highly sensitive sensors, the exact location of the stones is determined, which are subsequently crushed and come out on their own.

Treatment of urolithiasis at home

Effective treatment of urolithiasis in women at home consists in self-administration of medications prescribed by a doctor, vitamin and mineral complexes, performing certain physical exercises, observing a drinking regimen and an appropriate diet.

Most commonly prescribed drugs and medicines

It's important to understand!
In order for home treatment to have the most positive results and pass without the development of complications, it is necessary to strictly adhere to the instructions of your doctor.

Treatment of urolithiasis with folk remedies

For the effective treatment of urolithiasis in women, it is advisable to turn to traditional medicine methods, which should be used as additional therapy. The most effective folk remedies that will help cope with urolithiasis are:

• herbs and herbal preparations (tinctures, decoctions);
• fruits of medicinal plants;
• natural honey;
• some root crops;
• some legumes;
• milk.

Below are three effective recipes that will help dissolve stones, provoke their removal and ease the pain associated with the course of these processes.

Recipe #1

This method of removing stones consists in taking two decoctions. The first decoction is prepared from the roots of wild rose. They need to be ground with a coffee grinder to end up with 50 g of dry powder. Then pour the powder into 700 ml of water and let it boil over the fire for 15 minutes.

After that, prepare an infusion of bearberry. To do this, pour boiling water (300 ml) dried or fresh grass (about 30 g), leave for about 2 hours. Take the first remedy three times a day after meals, 300 ml. 25 minutes after its use, you should take a bearberry infusion of 100 ml.

Recipe #2

Place pre-washed and chopped yarrow (50 g) in a glass container, you can use flowers and grass. Pour the flower-herbal mixture with 250 ml of quality vodka. Seal the container and place in a dark, cool place for 7 days. At the end of the infusion period, strain the vodka through a fine strainer so that only the liquid remains. Take the remedy three times a day, 20 ml after meals.

Recipe #3

This method consists of two stages. First, mix a glass of natural honey with 10 g of calamus rhizome, ground to a powdery state. Mixing should take place by melting honey and powder in a water bath for 10 minutes. After that, mix the resulting mixture thoroughly. Do not be surprised, this remedy will have a very bitter taste.

The second step is to prepare the infusion. Mix natural honey with black radish juice, then pour vodka over the mass. Each ingredient should be 70 ml. Infuse the product in a dry, cool and dark place for 3 days.

These folk remedies should not be taken without examination and consultation with a doctor! With a large size of stones, such treatment is unacceptable!

Urolithiasis during pregnancy is a rather rare phenomenon. If the disease has no complications and is asymptomatic, it cannot adversely affect the development of the fetus and the course of pregnancy.

The situation is cardinally opposite if urolithiasis is complicated. In this case, there may be consequences such as preeclampsia, miscarriage, or premature onset of labor.

Treatment of urolithiasis in pregnant women is usually conservative and consists in following a diet that directly depends on the nature of mineral metabolism disorders in the body. If the expectant mother suffers from acute pain, she may be prescribed analgesics and antispasmodics.

For the treatment of urolithiasis during pregnancy contraindicated:

• take baths;
• use heating pads;
• apply warm compresses;
• engage in self-medication by taking folk remedies.

Surgery during pregnancy is carried out in extreme cases. Indications for this method of treatment of MCD are the presence of:

• anuria, accompanied by blockage of the urinary canals;
• septic condition;
• pyonephrosis;
• calculous pyelonephritis.

Diet for urolithiasis in women

Compliance with a certain diet is an integral part of the therapeutic program, which allows you to stop the further formation of stones in the urinary system, as well as suppress the growth of existing stones.

The diet for urolithiasis in women is based on the following principles:

• Systematic eating. Ideally, you should eat at about the same time. It is not recommended to skip meals, this can lead to increased stone formation and deterioration of well-being;
• Don't overeat. Food that enters the stomach in large volumes will only aggravate the situation;
• Drink about 2-3 liters of regular non-carbonated water per day. This will increase the amount of urine excreted;
• Do not eat excessively high-calorie foods. The energy value of the products must correspond to the energy costs that take place in reality;
• The diet should be enriched with foods rich in vitamins and amino acids.

Diet and nutrition for urolithiasis depends on the pH and composition of the calculi. Depending on them, doctors have compiled a list of products, the use of which is contraindicated in one case or another.

In the presence of phosphate stones, you can not use:

• vegetables with green skin and/or flesh;
• pumpkin, including its seeds;
• legumes;
• potato;
• any spices;
• spicy dishes;
• dairy products.

If the stones are of urate origin, you can not take:

• meat broths;
• fried and spicy dishes;
• offal;
• alcoholic drinks;
• coffee;
• chocolate, cocoa;
• animal protein.

In the presence of oxalant stones, the following should be avoided:

• dairy products;
• legumes;
• cheeses of any kind;
• nuts;
• citrus;
• strawberries and strawberries;
• lettuce leaves;
• spinach;
• sorrel;
• cocoa, coffee and tea.

Possible Complications

If for a long period of time there is no tendency to remove stones, there is a progressive inhibition of the functions of the urinary system. Among the most common complications of urolithiasis in women are:

• Anemia due to constant blood loss;
• . Such a complication may lead to the development of nephrosclerosis;
• Pyonephrosis, which is a consequence of pyelonephritis of a purulent-destructive form, which is in the terminal stage of its development. A kidney affected by pyonephrosis consists of many cavities that are filled with urine, toxic agents and purulent exudate;
• Acute renal failure. This complication occurs in rare cases when the patient is missing one kidney or has stones in both kidneys;
  Disorder of the hematopoietic functions of the kidneys;
• Paranephritis, characterized by the presence of carbuncles, pustules or abscesses in the tissues of the kidneys. This leads to development and is an indication for a surgical operation;
• Chronic inflammatory processes with foci of localization at the location of stones. In adverse situations, for example, when the patient's body becomes too cold or suffers from acute respiratory infections, the inflammatory process can go into an exacerbation stage.

Prevention of urolithiasis

1. Don't eat high calorie foods.
2. You shouldn't overeat.
3. Eliminate or limit your salt intake if possible.
4. Do not eat foods high in animal and vegetable lipids (fats).
5. Do not expose the body to hypothermia. Particular attention should be paid to the lower back.
6. Drink more still water. The minimum is 1.5 liters per day.
7. Balance your diet. Eat foods high in amino acids, vitamins and minerals.
8. Eliminate or limit the intake of fried, spicy, canned foods.

If you experience the slightest discomfort or pain in the abdomen, lower back or lower extremities, contact a urologist immediately. By adhering to preventive measures, you will minimize the risk of developing urolithiasis.

Urolithiasis (urolithiasis) is a disease that occurs as a result of a metabolic disorder, in which an insoluble precipitate forms in the urine in the form of sand (up to 1 mm in diameter) or stones (from 1 mm to 25 mm or more). Stones settle in the urinary tract, which disrupts the normal outflow of urine and causes renal colic and inflammation.

According to medical statistics, urolithiasis ranks second in frequency among all urological diseases, and third among urological diseases leading to death. Urolithiasis affects people of all ages, including children, but the main age group is people between the ages of 25 and 45. The disease is more common in men than in women, but women are more likely to be diagnosed with severe forms of the disease. It is also known that stones are more often formed in the right kidney than in the left, and in approximately 20% of cases both kidneys are involved in the pathological process.

Causes of urolithiasis

Many factors play a role in the occurrence of urolithiasis, while the mechanism of stone formation and its causes have not been fully elucidated. It is known that the leading role is given to the structural features of the tubular system of the kidneys, when the anatomical structure of the kidney itself contributes to the occurrence of congestion. At the same time, for the formation of stones, the influence of external factors, mainly diet, as well as the conditions of the drinking regime, is also necessary. Also, in the development of urolithiasis, diseases of the genitourinary system, endocrine pathologies (especially diseases of the parathyroid glands that directly affect metabolic processes involving calcium), long-term use of certain drugs (sulfonamides, tetracyclines, glucocorticoids, aspirin, etc.) play a role.

Types of urolithiasis

Various metabolic disorders cause the formation of stones that differ in their chemical composition. The chemical composition of the stones is important, since the medical tactics in the treatment of urolithiasis, as well as the correction of the diet to prevent relapses, depend on this.

The following stones are formed in the urinary tract:

• Stones based on calcium compounds (oxalates, phosphates, carbonates);
• Stones based on uric acid salts (urates);
• Stones formed by magnesium salts;
• Protein stones (cystine, xanthine, cholesterol).

The main share falls on calcium compounds (about 2/3 of all stones), protein stones are the least common. Urates are the only group that can be dissolved. These stones are more common in older people. Stones consisting of magnesium salts are most often accompanied by inflammation.

Stones in urolithiasis can form in any part of the urinary tract. Depending on where they are located, the following forms of the disease are distinguished:

• Nephrolithiasis - in the kidneys;
• Ureterolithiasis - in the ureters;
• Cystolithiasis - in the bladder.

Urolithiasis is initially asymptomatic. The first signs of urolithiasis are detected either by chance, during the examination, or with a sudden onset of renal colic. Renal colic - a severe pain attack, often the main symptom of urolithiasis, and sometimes the only one, occurs as a result of a spasm of the urinary duct, or its obstruction by a stone.

The attack begins acutely, with a sharp pain, the localization of which depends on the localization of the stone. The pain is intense, can radiate to the groin, lower abdomen, lower back. Urination becomes painful and rapid, blood (hematuria) is found in the urine. There is nausea, sometimes vomiting. The patient rushes about in search of a position that would bring relief, but does not find such a position. An attack of renal colic can take place with a subsidence and exacerbation of pain, and end with either the removal of a stone, or subsidence of colic, or a developed complication.

It should be noted that the severity of signs of urolithiasis is not always associated with the size of the stones. Sometimes stones of small size, not exceeding 2 mm, can cause severe colic, while there are cases of severe kidney damage, when multiple stones fused into coral-like formations do not lead to colic, but are discovered by chance or when complications of urolithiasis begin.

Diagnosis of urolithiasis

Diagnosis of urolithiasis occurs on the basis of the characteristic clinical picture of renal colic and ultrasound data. Computed tomography and magnetic resonance urography are also informative. A detailed analysis of urine is carried out, using functional tests (according to Zimnitsky, Nechiporenko, etc.). Mandatory bacteriological examination of urine. Radiography has now lost its leading place in the diagnosis of urolithiasis, but is still used as an additional method.

Treatment of urolithiasis

An attack of renal colic is removed with the help of antispasmodic and analgesic drugs. The main treatment of urolithiasis is carried out in the absence of acute manifestations.

Urolithiasis is considered a surgical disease, but urolithiasis caused by urate formation can be treated with drugs that dissolve these stones. Other types of stones require mechanical removal.

Treatment of urolithiasis is carried out using two main methods: lithotripsy and surgery. External shock wave lithotripsy is an effective method of treating urolithiasis, in which stones in the urinary ducts are broken using a shock wave and then excreted in the urine. The method has proved to be excellent, thanks to it, the indications for surgical intervention in the treatment of urolithiasis have significantly narrowed.

Operations with which the treatment of urolithiasis is carried out are divided into open and endoscopic, as well as organ-preserving and radical. A radical operation is the removal of a kidney if it has lost its function. The method of preference in choosing the surgical treatment of urolithiasis is endoscopic techniques that allow the removal of stones without making an incision in the abdominal cavity.

Prevention of urolithiasis

Prevention of urolithiasis is a necessary condition for a complete cure, since without it relapses are inevitable. The basis for the prevention of urolithiasis is a diet that normalizes metabolism and the biochemical composition of urine, as well as compliance with the drinking regimen. The diet for urolithiasis is developed depending on the chemical composition of the stones. So, with oxalates, dairy products, chocolate are excluded from the diet, and with urate stones, eating meat is limited. An extremely important condition is the intake of a sufficient amount of water - 1.5 - 2 liters per day.

Video from YouTube on the topic of the article:

Among the most common diseases in the practice of a urological doctor, with which patients seek an appointment, is urolithiasis. Moreover, they often learn about the existence of this pathology in themselves only when there is a movement of the formed calculus along the urethra (from the pyelocaliceal apparatus of the kidney to the underlying sections).

The disease is metabolic in nature, that is, its occurrence is preceded by various biochemical malfunctions in the body. Such a condition in its development requires the presence of several causes and predisposing factors at once, which together can become an impetus for the onset of the pathological process.

In medicine, the disease is also called "urolithiasis". Unfortunately, the disease is registered not only among patients of older age groups, it can occur in a child, while the cause of its occurrence is not always clear.

If we consider the gender of urolithiasis, then the process is most often recorded in males (3-4 times), while both kidneys are equally often affected. The average age of patients with this pathology is 45-50 years.

Disease classification

The classification of urolithiasis is based not only on the causes of its occurrence and clinical variants of the course, but also on the main characteristics of stones.

According to the composition of the components included in the stones, it is customary to distinguish:

• stones of inorganic origin (calcium, calcium oxalate, calcium phosphate, magnesium-containing and others);
• stones of organic origin (urate, cystine and others);
• mixed (polymineral).

By the number of stones in the organs of the urinary tract:

• single stone (single calculus);
• multiple stones;
• coral stone.

By localization of the process:

• stones (or stone) in calyces (one or both kidneys);
• stone in the pelvis;
• a stone located at different levels of the ureter (upper, middle or lower third);
• stone in the lumen of the bladder;
• stone in the urethra (urethra).

Due to occurrence:

• primary urolithiasis (first time);
• recurrent urolithiasis (formation of new stones);
• residual urolithiasis (presence in the patient's urinary tract of stones or their parts, which could not be eliminated during the treatment).

By the nature of the flow:

• uninfected;
• infected.

Causes

As mentioned above, in order to start the process of stone formation, the patient must have several reasons. This means that the disease is polyetiological.

The disease is based on a variety of metabolic disorders, which leads to the formation of stones of the corresponding nature (urate, oxalate, phosphate, mixed, etc.)

It is worth highlighting the main causes of urolithiasis:

With congenital defects of the ureters, the risk of developing KSD increases many times

• A burdened family history (the presence of proven urolithiasis in the next of kin on the paternal or maternal side).
• Daily consumption of monotonous, unbalanced and unvitaminated food. Preference in the diet for fatty, fried and spicy-salty foods. Irrational eating, overeating before bed, etc.
• Insufficient level of water load, namely a small amount of liquid drunk (less than 2 liters per day).
• Living in places with a very hot climate or working in a hot workshop or in poorly ventilated areas, which leads to constant dehydration of the body and a strong concentration of urinary sediment.
• Violation of metabolic processes in people with overweight or obesity of varying degrees, as well as a low level of daily physical and motor activity.
• Uncontrolled intake of a number of drugs (vitamin D, ascorbic acid, sulfa drugs, hormones, etc.).
• Pathological processes or anomalies in the development of the organs of the urinary system (for example, congenital or acquired narrowing of the urethra, reflux of urine from the bladder into the lumen of the ureters, horseshoe kidney, and others).
• Kidney diseases of various nature (nephropathy, chronic form of pyelonephritis or glomerulonephritis, cancerous or tuberculous processes in the organ), as well as their severe injury.
• Diseases of other organs and systems. First of all, we are talking about diseases of the endocrine nature (hyperthyroidism, Kohn's disease, hyperparathyroidism, etc.). Violations in the gastrointestinal tract system are important (for example, the patient has surgery on different parts of the ileum with resection). Chronic inflammatory processes in the pelvic organs often cause congestion and infection of the urinary sediment.

The cause of prolonged stagnation of urine can be an inflammatory process in the tissues of the prostate gland.

Local risk factors for the disease include:

• prolonged stagnation of urine for various reasons (impaired urine outflow due to urethral strictures, pathological bends of the ureter or urethra, compression of the pathways from the outside by a growing tumor or hematoma, etc.);
• change in the reaction of urine towards its oxidation or alkalization;
• the introduction of infectious agents into different parts of the urinary tract.

Development mechanism

Despite the fact that the disease is very common and has been known in medicine for more than a hundred years, there is still no common understanding of all the mechanisms of stone formation.

The main links of pathogenesis are the following:

• under the influence of various factors and microorganisms, the processes of regeneration of the epithelial layer lining the organs of the urinary system are disrupted, its desquamation occurs;
• colloidal substances present in the body of a healthy person acquire a lipophobic structure, which accelerates the process of their “gluing” to each other and the formation of crystalline masses;
• there is an imbalance between the processes of formation of small calculi and the mechanisms aimed at their natural splitting (of particular importance is the reaction of the urinary sediment).

Symptoms

Symptoms of urolithiasis, as a rule, occur only at the time of the movement of the formed stone along the urinary tract. The pathological condition is characterized by a triad of clinical manifestations:

• pain sensations of varying severity;
• changes in the urinary sediment (the appearance of blood, pus and other components);
• violation of the process of excretion of urine, up to complete anuria (obstructive genesis).

The pain syndrome can be constant or coming, the degree of its severity varies from aching and pulling pains to unbearable renal colic, which requires emergency hospitalization of the patient in a hospital.

The first signs of renal colic occur suddenly, as a rule, against the background of complete well-being. Sometimes an attack provokes physical activity or a large amount of fluid drunk. Its occurrence is associated with a strong irritation of the nerve fibers of the solar and mesenteric plexus.

Complaints of a dysuric nature join the pain symptoms: frequent and painful urination, violation of the processes of emptying the bladder. Patients complain of general weakness, decreased performance, feeling of nausea and vomiting at the peak of pain (it does not bring any relief).

Signs of urolithiasis in the latent period are mild or absent altogether. Some patients note the appearance of periodic unpleasant or pulling-aching sensations in the lower back on one or both sides. Most often they are preceded by physical or water stress on the body.

In more than 70% of cases, infectious agents attach, which causes inflammatory changes in the tissues of the kidney or other parts of the urinary tract (pyelonephritis, cystitis, and others).

The presence of a stone at different levels of the urinary tract affects the manifestation of pain

The severity of symptoms of urolithiasis, depending on the localization of the calculus, is as follows:

• If the stone is localized in the pyelocaliceal apparatus of the kidney, then the patient has aching pains in the lumbar region of the corresponding side. Pain is associated with a change in body position and movement of the patient. Often there are traces of blood in the urine.
• With the localization of the calculus at different levels of the ureter, the pain shifts to the inguinal region, its irradiation to the surface of the thigh and genitals is characteristic. There are complaints of frequent and painful urination. When the stone completely blocks the lumen of one of the ureters, the pain syndrome becomes unbearable (renal colic).
• The presence of a calculus in the lumen of the bladder is accompanied by pain in the lower abdomen, while the pain radiates to the genitals, perineum or rectum. There are typical dysuric disorders: frequent and painful urination, which can be interrupted suddenly (symptom of "interruption of the jet").

Often, patients go to the doctor with a stone that has already passed away, which is an indisputable sign of urolithiasis.

Urolithiasis in children and pregnant women

The main reasons for starting the process in babies and pregnant women are:

• violations in the mode and nature of nutrition;
• imperfection or weakening of the body's own protective properties, which leads to metabolic disorders;
• in pregnant women, congestion in the urinary tract plays a role due to pressure on it by the growing uterus.

In general, the symptoms and principles of treatment of urolithiasis in this category of patients do not have significant differences, which is explained by the unity of etiology and pathogenesis.

In childhood, diagnosis can be difficult, since it is difficult for a child to explain to parents and a doctor what complaints bother him and what exactly hurts him. Therefore, it is very important to pay attention to any deviations in the child's body.

Symptoms of urolithiasis in women in position may be atypical

Often, an attack of renal colic is perceived as the onset of labor, which leads to erroneous hospitalization in the maternity ward.

Complications

The most common adverse outcomes of the disease are the following pathological processes:

• inflammation of the affected kidney against the background of blockage of the urinary duct (obstructive form of pyelonephritis);
• calculous pyonephrosis (most often, purulent cavities in the tissues of the kidney occur with a recurrent form of urolithiasis);
• acute renal failure (observed in patients with urolithiasis of a single kidney);
• rupture of the wall of the ureter, bladder or urethra with the development of a septic condition in the patient;
• cicatricial deformities of the lumen of the ureter and others.

The most common complication of urolithiasis is an inflammatory process in the kidney (acute pyelonephritis)

Diagnostic principles

Clinical examination of the patient

Diagnosis of urolithiasis, like any other disease, is impossible without a carefully collected history. In this case, special attention must be paid to all risk factors that can serve as an impetus for the onset of the disease.

During an objective examination, the doctor determines the zone of greatest pain, as well as other pathological symptoms characteristic of the process (tension of the muscles of the anterior abdominal wall, a positive symptom of tapping, and others).

Laboratory diagnostics

All patients need to undergo the following examination:

• complete blood count (there are signs of an inflammatory process, the ESR and the number of leukocytes increase);
• general urine analysis (the pH of the urinary sediment changes, the number of leukocytes increases - leukocyturia, blood cells appear - micro- or macrohematuria, salt crystals or bacterial agents of various origins are detected);
• biochemical blood test (determine the level of protein and its fractions, free and bound calcium, creatinine and other indicators);
• daily urinalysis (they evaluate the content of calcium, urates, oxalates and other substances in urine);
• sowing urine on nutrient media.

It is necessary to study the biochemical composition of the obtained stones using X-ray diffractometry and infrared spectrophotometry

Methods of instrumental diagnostics

All patients who have a suspicion of urolithiasis undergo instrumental studies:

• overview x-ray image, including the projection area of ​​the kidneys, ureters and bladder (allows visualization of only X-ray positive calculi);
• excretory (intravenous) urography is performed only after the complete elimination of an attack of renal colic (the method helps the doctor in assessing the anatomical and functional state of the urinary tract);
• Ultrasound of the kidneys (allows you to visualize all the structures of the organ, the state of the parenchyma and pelvicalyceal apparatus, the presence of stones, abscesses or other pathological foci);
• CT or MRI of the kidneys (it is the most informative in relation to other diagnostic procedures, it is indispensable if the stone was not detected in previous studies).

Differential diagnosis of renal colic and other diseases

Often the doctor of the emergency department, to which the patient was brought with an attack of renal colic, has to carry out a rather difficult diagnosis of this process with other diseases that have similar clinical and laboratory symptoms.

Most often we are talking about the following pathological conditions:

• acute appendicitis (positive symptoms of Shchetkin-Blumberg, Sitkovsky and others, pronounced leukocytosis and temperature reaction are characteristic);
• an attack of acute pancreatitis (repeated diarrhea, girdle pain, vomiting that does not bring relief to the patient, amylase increases in the blood and urine);
• peptic ulcer of the stomach or duodenum, complicated by perforation ("dagger" nature of pain, board-shaped abdomen, the appearance of a tympanic sound over the abdomen);
• ectopic pregnancy (history of menstrual irregularities or prolonged delay, severe pallor of the patient, severe pain in the lower abdomen);
• exacerbation of destructive processes in the spine (pain is associated with movement, paravertebral points of greatest pain are determined, there is a restriction in the mobility of the spinal column, an X-ray picture of destructive changes is characteristic).

In order to confirm or exclude any of the above diseases, a clinical and laboratory study is required for the patient, as well as consultations of narrow specialists (surgeon, gynecologist, gastroenterologist, and others).

Basic principles of treatment

It is necessary to treat any form of urolithiasis in a complex way, that is, therapy should be aimed not only at eliminating the unpleasant symptoms of the disease, but it is also necessary to block the main pathogenetic links of its occurrence.

The treatment of urolithiasis is not an easy task, because the success of the measures taken is largely determined by the patient's adherence to therapy and compliance with all medical recommendations. You can read more about the basic principles of treating the disease.

First of all, any treatment of urolithiasis begins with the appointment of an appropriate dietary "medical" nutrition option for the patient, the choice of which is determined by the biochemical composition of the calculi.

The general principles of nutrition are as follows:

• from the patient's diet, those products that contain prohibited substances are completely excluded or maximally limited (for example, with calcium urolithiasis, milk and dairy products are excluded);
• it is necessary to do several unloading days during the month (fruit or vegetable, but only from those that are allowed for a particular patient);
• it is imperative to optimize the amount of water load, that is, consume at least 2-2.5 liters of fluid during the day.

Drug treatment is aimed at eliminating the pain syndrome, removing the inflammatory and spastic component, normalizing the pH of the urinary sediment, restoring diuresis, etc.

To do this, prescribe broad-spectrum antibiotics, anti-inflammatory drugs, antispasmodics and painkillers, etc.

The choice of phytocollection depends on the nature of metabolic disorders, since different types of herbs are needed for different forms of urolithiasis.

Surgical treatment is carried out in cases where there is no effect of the ongoing conservative measures, the presence of a large calculus, or a pronounced deterioration in the patient's well-being.

Surgery is carried out in several ways:

• remote shock wave lithotripsy;
• endoscopic intervention (transurethral lithotripsy);
• percutaneous nephrolithotripsy;
• open (cavitary) operation (ureterolithotomy, pyelolithotomy and others).

The choice of surgical method is determined by the size and number of stones, their location in the urinary tract, the patient's condition and the presence of concomitant diseases

Sanatorium-and-spa treatment is prescribed for all patients who have no contraindications to it, as well as outside the acute period of the disease. Patients are treated with mineral waters of appropriate acidity (balneological therapy).

Prevention of urolithiasis

In order to minimize the risk of developing the disease in patients at risk, it is necessary to adhere to the following measures:

• nutrition should be complete, rational and sufficiently fortified;
• it is better to completely exclude “food garbage” from the diet, namely fast food and semi-finished products;
• it is important to drink a sufficient amount of fluid daily (at least 2-2.5 liters);
• work in hot shops or hot rooms is not recommended, sleep and rest should be full;
• particular importance is given to the timely diagnosis and treatment of any diseases of the urinary tract, as well as other body systems (endocrinopathy, gastrointestinal diseases, etc.).

When overweight, attention is paid to its correction, and the level of daily physical activity is expanding.

Conclusion

The diagnosis of urolithiasis can sometimes be established only thanks to the methods of radiation or X-ray diagnostics. This means that the process is latent for a long time, which can cause all sorts of complications.

If your next of kin have a history of repeated episodes of renal colic, then you should not delay your examination. Thanks to modern diagnostics, even the smallest stones can be detected, which are quite easily amenable to adequate treatment.

Urolithiasis disease- symptoms and treatment

What is urolithiasis? We will analyze the causes of occurrence, diagnosis and treatment methods in the article of Dr. A. E. Rotov, a urologist with an experience of 19 years.

Definition of disease. Causes of the disease

Urolithiasis disease- one of the oldest diseases that has haunted a person for thousands of years and has not lost its relevance to this day. The famous ancient doctors Hippocrates and Avicenna described this disease and even performed surgical operations to remove stones (it’s terrible to imagine yourself in the place of their unfortunate patients!). Many powerful people and great minds, including Peter the Great, Napoleon, Newton, could not avoid this disease. In the modern world, unfortunately, we are seeing a steady increase in the incidence of urolithiasis (UCD), which is associated with poor nutrition, poor ecology, poor-quality drinking water, physical inactivity and other "benefits" of civilization.

According to statistics, KSD ranks second in the structure of urological diseases in Russia, second only to infectious and inflammatory diseases of the genitourinary system. The relevance of our topic is associated not only with the high prevalence of urolithiasis, but also with the unpredictability of its course, and with the risk of serious complications. Many people are not aware of the presence of kidney stones until the first attack of renal colic, which occurs against the background of "full health". If timely and qualified assistance in this case is late, then the consequences can be the most sad, up to the loss of a kidney.

What are causes of urinary stones? We have already mentioned some of them.

• hereditary predisposition - attention to those who had people with urolithiasis in their family;
• congenital or acquired metabolic disorders;
• irrational nutrition, excessive consumption of animal and vegetable protein, lack of vegetables and fruits, some vitamins and microelements;
• insufficient fluid intake (the minimum recommended daily intake for a healthy person is 1.5 liters, for a patient with urolithiasis - at least 2.5 liters), poor-quality "hard" water;
• sedentary lifestyle;
• unfavorable environmental factors: dry hot climate, frequent overheating, etc.

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of urolithiasis

The pain is initially localized in the lumbar region, extending down the abdomen, sometimes to the genitals, often accompanied by nausea and vomiting. The pain is so severe that the patient “cannot find a place for himself”, rushes about until the ambulance arrives. A frequent companion of renal colic is the admixture of blood in the urine, therefore, when such attacks occur, it is recommended to urinate in a jar to control the color of urine and the passage of stones.

Large or staghorn kidney stones can be manifested by prolonged dull, aching pain of low intensity in the lumbar region and also by the admixture of blood in the urine, especially after exercise or long walking / running.

In the later stages, when kidney function is impaired and chronic renal failure develops, general well-being suffers, weakness, fatigue occur, and appetite worsens. During this period, blood pressure often rises, headaches bother.

When the inflammatory process is attached, there is an increase in body temperature (sometimes to high numbers, over 38-39 degrees), accompanied by chills.

The pathogenesis of urolithiasis

The insidiousness of this disease is that for a long time a person may not be aware of the formation of stones in his kidneys, that is, the disease proceeds secretly. Manifestation occurs at the moment when the stone begins to move, disrupting the natural outflow of urine, which is accompanied by an attack of intense pain, called renal colic. Usually, an attack occurs after physical exertion, a long journey (especially by train), and drinking alcohol. Often these factors are encountered on vacation, threatening to turn the vacation into a struggle for survival (in the literal sense).

Complications of urolithiasis

Despite the successes achieved in the fight against stones thanks to modern technologies, complications of urolithiasis still occur in the practice of a urologist. These include persistent obstruction of the outflow of urine from the kidney (hydronephrosis) and inflammation of the kidney (pyelonephritis). With hydronephrosis, an obstruction to the outflow of urine leads to an expansion of the cavitary system of the kidney and to a gradual inhibition of its functional state (up to complete atrophy). The insidiousness lies in the fact that at this stage the pain, as a rule, already subsides, and the person practically does not feel anything and, accordingly, does not go to the doctor. A terrible complication of urolithiasis is acute pyelonephritis, which can pass into a purulent phase in a short time, which may require urgent surgical intervention, up to the removal of the affected kidney. The recurrent nature of stone formation in the absence of adequate treatment leads to a chronic inflammatory process - chronic pyelonephritis, which usually affects both kidneys. The outcome of prolonged inflammation may be a loss of functional activity, wrinkling of the kidneys with the development of chronic renal failure and the need for hemodialysis.

Diagnosis of urolithiasis

For the timely detection of stones, it is enough to undergo an ultrasound of the kidneys annually. In the event of an attack of renal colic, ultrasound is also the main diagnostic method, however, computed tomography of the urinary system (even without intravenous contrast) has a higher sensitivity, allowing up to 95% of stones to be detected.

Excretory (or intravenous) urography provides valuable information on the anatomical features of the kidneys and upper urinary tract. Stones that do not contain calcium salts (for example, urate or cystine) are not visible on x-ray film (therefore they are called x-ray negative).

Laboratory studies (general analysis of morning urine, biochemical analysis of blood and daily urine) allow us to identify a concomitant inflammatory process (pyelonephritis), assess the functional state of the kidneys, the presence of metabolic disorders, and an increased concentration of stone-forming salts and minerals.

Treatment of urolithiasis

Treatment of urolithiasis depends on the size and location of the stone (kidney, ureter or bladder), the condition and characteristics of the urinary tract (for example, narrowing or fixed bends that make it difficult for the stone to pass), and the presence of complications. In mild cases, if the stones are small (usually up to 5 mm), drug stone expulsion therapy with the appointment of diuretics, antispasmodics and painkillers can be used. Herbal products are widely used. To accelerate the independent discharge of stones, it is recommended to drink plenty of fluids in combination with physical activity.

Some types of urinary stones (for example, urates) lend themselves well to dissolution using the so-called citrate mixtures (Blemarin or Uralit-U). This method is based on an increase in the solubility of urate stones when the acidity of urine (pH) shifts to the alkaline side. The dissolution process is quite long and laborious, requires regular monitoring of pH (indicator strips are included with the package), but with the right approach, it allows you to completely get rid of stones without additional intervention.

(or non-contact crushing of stones) is a unique method of getting rid of stones in the kidneys and ureters, when the stones are destroyed directly in the body without the introduction of tools. Crushing is carried out using a special apparatus - a lithotripter.

Previously, due to their high cost, such complexes were installed only in large scientific centers and hospitals, but today the method is more accessible, including in commercial clinics. A modern apparatus for remote lithotripsy is a fairly compact shock wave generator combined with a stone aiming device. Structurally, ultrasonic or X-ray guidance is possible. At the same time, ultrasonic guidance compares favorably with the absence of ionizing radiation (radiation exposure) and the possibility of continuous monitoring of the destruction of the stone in real time. In addition, with the help of ultrasound, you can aim at radio-negative stones (that is, invisible to x-rays). The crushing procedure usually takes no more than an hour and does not require serious anesthesia. Recently, remote lithotripsy is performed on an outpatient basis, that is, without hospitalization.

During crushing, the stone under the action of shock waves is destroyed into small fragments, which then independently depart along the natural urinary tract. To facilitate and speed up this process, antispasmodic and diuretic drugs are often prescribed. Remote lithotripsy can effectively destroy kidney stones of relatively low density up to 2 cm in size.

When a stone gets stuck in the ureter and blocks the outflow of urine, which is manifested by recurrent attacks of renal colic, poorly removed with conventional drugs, endoscopic intervention is used to quickly remove the stone and restore urine outflow - transurethral contact lithotripsy. As the name implies, in this operation, performed through the urethra (urethra), an instrument under vision control is brought directly to the stone and the latter is destroyed by contact - with a laser, ultrasound or pneumatic probe.

The advantage of contact lithotripsy is the complete destruction and removal of the stone immediately during the operation, the restoration of the outflow of urine and the absence of the stage of fragments discharge. In some cases, for additional drainage of the upper urinary tract, a plastic catheter (internal stent) is inserted into the ureter after surgery. Contact lithotripsy is usually performed under spinal anesthesia and requires a short hospital stay. An additional advantage of transurethral lithotripsy is the ability to simultaneously eliminate narrowing or fixed bends of the ureter below the stone, which can be an insurmountable obstacle to the passage of stones (or even fragments after remote crushing).

Large and dense kidney stones, which cannot be destroyed by remote lithotripsy, are now removed through a small puncture in the lower back. This operation is called percutaneous nephrolithotripsy. Under ultrasound and X-ray guidance, an instrument is inserted into the kidney through a puncture, with the help of which, under the control of vision, the stone is destroyed and the fragments are extracted. As with transurethral contact lithotripsy, destruction is achieved with a laser, ultrasound, or a pneumatic probe. This method can destroy stones of any size and density. True, in some cases, for this you have to make additional punctures. The operation often ends with the installation of a thin drainage tube (nephrostomy) into the kidney through the existing puncture, which is removed after a few days. Percutaneous nephrolithotripsy is usually performed under general anesthesia and requires hospitalization for 3 to 5 days. The most modern modification of this operation is minipercutaneous laser nephrolithotripsy. The main difference is the use of miniature instruments with a diameter of about 5 mm, which is about half the size of traditional ones. Thus, the puncture in the skin becomes almost invisible, the recovery period is reduced, as well as the likelihood of complications.

Another modern and minimally invasive method for removing stones from the kidneys and ureters is flexible transurethral contact lithotripsy (or fibroureteronephrolithotripsy, or retrograde intrarenal surgery). The main advantage of this method is the absence of incisions and punctures, that is, damage to the skin. A flexible miniature instrument, equipped with an active-movable tip with a high-quality video camera, is inserted through the natural urinary tract (urethra). Depending on the task, the instrument is passed into the ureter or into the kidney, brought to the stone. The latter is destroyed by a laser into “dust” (dusting effect), which does not require the extraction of fragments - they are washed off by a liquid current during the operation. This method is ideal for relatively small and dense kidney stones, especially multiple, located in different cups. The flexibility of the fibroureterorenoscope allows it to be passed through constrictions and fixed bends without risk of injury. The main disadvantage of this technology is the very high cost of equipment. Therefore, not all even large urological centers have a fibroureterorenoscope in their arsenal.

Laparoscopy for kidney and ureter stones is used quite rarely, mainly when urolithiasis is combined with urinary tract anomalies (for example, a large pelvis stone and narrowing of the ureteropelvic segment), when it is necessary to simultaneously remove the stone and eliminate the anomaly.

Thus, as we see, today open operations (that is, performed through a skin incision) are almost completely replaced from the arsenal of means for removing urinary stones. This made it possible to make the surgical treatment of urolithiasis quick, easy and safe, which is especially important, given the tendency of the disease to relapse.

Forecast. Prevention

Proper and timely treatment allows you to quickly and safely get rid of the stone and prevent complications. Given the tendency of the disease to relapse, special attention should be paid to preventing the recurrence of stones.

The trend towards an increase in the incidence of urolithiasis observed in recent years determines the importance of preventing this disease. This is of particular importance in people with a hereditary predisposition to the formation of urinary stones.

The main methods of prevention are:

• drinking enough fluid (at least 1.5 liters per day for a healthy person and at least 2.5 liters for patients with urolithiasis);
• proper balanced nutrition with sufficient intake of fiber, vegetables and fruits, vitamins and microelements;
• regular physical activity, sports.

Patients with urolithiasis must necessarily determine the composition of urinary stones. The most reliable way is the chemical analysis of the detached (or removed) stone. Depending on the composition (urates, phosphates or oxalates), the doctor will select the appropriate diet and medication.

Diet is very important in preventing the recurrence of kidney stones. All patients with urolithiasis are recommended to limit table salt to 5-6 grams per day (food is cooked without salt and salted already on a plate), restriction of animal and vegetable protein (up to 1 gram per kg of body weight). With urate stones (that is, consisting of salts of uric acid), in addition to the above dietary restrictions, dark beers, red wine, pickles, smoked meats, offal, coffee, cocoa and chocolate are not recommended.

With a bilateral recurrent nature of stone formation, when serious metabolic disorders in the body are expected, it is necessary to try to establish and, if possible, eliminate these disorders. For this purpose, a biochemical analysis of daily urine for calcium, phosphates, urates, citrates and oxalates, a biochemical blood test (calcium, phosphorus, magnesium, parathyroid hormone) are often prescribed. It is also very important to regularly, 1-2 times a year, do an ultrasound of the kidneys, which will allow you to identify small stones at an early stage, when they can be removed with medication, without resorting to complex and expensive interventions.