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Kidney stone 8 mm can pass. Kidney stones (nephrolithiasis, nephrolithiasis)

Urolithiasis used to be considered a disease of the elderly, but, unfortunately, it “gets younger” every year and kidney stones are increasingly common even in children. First of all, this is due to a decrease in physical activity, low-quality products and other factors that negatively affect metabolism.

Kidney stones have a different composition, nature of origin and size. It is on these indicators that the choice of treatment method depends.

Many who are faced with this unpleasant disease are wondering if it is possible to remove stones up to 1 cm in size in a natural way?

There is no definite answer to this question, but the fact that some people manage to get rid of stones of this size without surgery is a fact.

What factors affect the outcome of treatment

Let's look at what determines whether it is possible without surgical treatment or not.

Stone composition

This is a very important point that many people miss out of ignorance. Not all doctors try to convey to the patient that there are relatively soft formations that can be easily dissolved and excreted in the urine, these are urate stones. They can be quite large and at the same time be destroyed with the help of drugs and herbal medicine. It is about them that we are talking about when someone claims that they had a stone of 3 cm and they managed to crush it with the help of herbs.

If instead of a urate stone, there was calcium oxalate 3 cm in size, it would never have collapsed under the influence of any drugs. Therefore, we note here that oxalates are the hardest kidney stones, which are very difficult to crush even with ultrasound, not to mention herbal medicine.

Phosphate stones are also hard and sparingly soluble. But the composition of the stones is often mixed, this can facilitate their crushing.

Therefore, the composition of the kidney stone plays a decisive role in the choice of therapy.. You can find out by submitting an already released calculus for analysis or by conducting a laboratory study of urine and x-rays. In the urine, salts of those elements from which stones are formed are most often found, and an x-ray will show how dense and hard the formations are.

Physiological factors

Physiological factors, first of all, include belonging to the female or male sex. The structure of the urinary tract in women contributes to the easier passage of stones than in men. This also includes the age of the patient, the structure of the ureters. It is clear that in children the ureters are still underdeveloped and have a narrow passage, in old age the tissues are less elastic and poorly stretched.

Stone size and shape

In this article, we consider the passage of stones up to 10 mm in size, if the stone is larger than 10 mm, we strongly advise against removing it naturally.

Up to 10 mm stone can be tried to remove with the help of herbs and drugs. It is recommended to do this under the supervision of a doctor who will monitor the condition of your kidneys.

In addition to the size of the stone, its shape also plays an important role. If the stone is very spiky and has a size of 8-10 mm, then it can hardly be expected to successfully pass through the urinary tract. A smooth stone will have much more chances.

What the statistics say

According to statistics, almost all stones up to 5 mm in size come out naturally, if the therapy based on diuretics and antispasmodics, as well as drugs that can destroy certain formations, is chosen correctly.

Calculi ranging in size from 5 mm to 8 mm are more difficult to come out and complications occur more often during their removal. If the stone has already reached a size of 9-10 mm, then it is necessary to assess all the risks before starting treatment.

It is important to prevent an increase in the size of stones, to prevent urolithiasis. When deciding to remove a stone without surgical treatment, it is necessary to consider all the factors affecting its passage through the urinary tract, consult with several specialists whom you trust and be sure to control the process of stone discharge.

Important! In any case, treatment should be carried out after a full examination and under the supervision of a doctor who will monitor the condition of your kidneys by urine, blood tests and other types of diagnostics (ultrasound, CT, urography, etc.).

Rule one: Do no harm!

If, as a result of some planned examination, you suddenly found a stone in the kidney, the existence of which you did not even know, perhaps you should not touch it at all and you will live happily ever after with your "treasure" if you do not wind yourself up and try to dissolve it by any means. In the event that the stone does not bother you, it may be sufficient to simply observe if the stone does not increase in size over certain periods of time and lead a healthy lifestyle.

It is much worse if the stone or stones are discovered during an acute attack of renal colic and the situation requires immediate intervention. If the stone is larger than 10 mm, it has little chance of moving away on its own, and it must be crushed or dissolved. Here we will talk about methods of dissolving and removing stones and sand.

There are thousands of folk recipes for dissolving kidney stones. Nevertheless, official medicine classifies urolithiasis as a disease requiring surgical intervention. Often this strategy is justified, for example, in case of a large stone size, or in the event of an acute attack of renal colic, when independent stone passage is impossible for one reason or another and the patient needs emergency surgical care to save the kidney.

In the event that the stone completely blocks the outflow of urine through the ureter, an acute attack of renal colic occurs, and if the lumen of the ureter is partially blocked, but the outflow of urine is difficult to develophydronephrosis. The kidney can quickly enough completely lose its function. The situation becomes especially dangerous if the kidney is blocked for more than 2 weeks.

The smaller the stone in the kidney, the easier it is for it to pass on its own with urine. Approximately 9 out of 10 kidney stones are less than 5 mm in size, and approximately 5 out of 10 kidney stones are 5 to 10 mm. Such stones can come out on their own. Only 1 to 2 cases out of 10 require special medical intervention.

On average, kidney stones pass through the urinary tract within 1 to 3 weeks, and two-thirds of the stones pass 4 weeks after the onset of symptoms.

However, the problem is that KSD (kidney stones) is often a relapsing disease. Lithotripsy (crushing with ultrasound) is also not a panacea. The task of the patient himself is to stop and prevent stone formation. Almost half of patients diagnosed with "urolithiasis" have relapses within 5 years, especially if the patient does not take preventive measures.

Help yourself!

It is optimal if you know the chemical composition of your stones and can choose the appropriate diet and treatment based on it. However, often stones have a mixed composition. For example, as a result of a change in nutrition (for example, an increase in the proportion of animal protein during the transition from lean to meat), urates begin to accumulate on existing oxalates (“welfare stones”). When trying to dissolve urates, as a result of a shift in the pH of the urine to the alkaline side above 7, phosphates can form. That is why monotonous diets are harmful.

The nutrition of patients with urolithiasis (ICD) should be complete. You should not fanatically exclude certain foods from your diet, you will only harm your body. Forget about losing weight "for one put on 10 kg" and other fashionable ways to finally ruin your health. Sudden weight loss leads to prolapse of the kidneys (normally protected by a fatty capsule) and can provoke a shift of the stone and block the outflow of urine.

Details of nutrition for various types of stones are described in the section " Diet therapy".

To dissolve stones, there are a number ofherbal medicines, which are freely sold in pharmacies, since most of them are registered as dietary supplements. Let it not bother you

The formation of kidney stones is one of the manifestations of urolithiasis. In their structure, chemical composition, shape and size, kidney stones, or as they are also called stones, can differ dramatically from each other. It is on the totality of these data that the intensity of the manifestation of the clinical picture and the choice of treatment method depend.

The first thing to do with kidney stones is to contact a urologist. The fact is that the lack of medical care in an acute condition can result in serious kidney damage or even death. A consultation with a specialist without the presence of acute pain (in case of accidental detection of stones during a planned ultrasound or X-ray examination) is necessary to adjust the lifestyle or prescribe conservative methods of treatment. This approach will allow you to choose the most gentle method of getting rid of kidney stones.

general information

Kidney stones can have a different structure, chemical composition, size and shape. In this case, both kidneys can be affected at once, or only one of them (according to statistics, most often this is the right kidney).

The size of the calculi can vary from a few millimeters to 5 cm or more.

The chemical composition of the stones depends on the combination of salts that caused their appearance:

urate (salts of uric acid);
phosphate (calcium compounds of phosphoric acid);
oxalate (calcium compounds of oxalic acid);
carbonate (calcium salts in carbonate acid).

In addition to these types, there are also cholesterol, protein or cystine stones. But this happens very rarely.

Coral-like stones are singled out as a separate group. According to their chemical composition, they belong to carbonate compounds. But unlike ordinary calculi, they occupy the entire space of the renal pelvis, later moving to the region of the renal calyx.

The shape of a coral-like stone, especially with its large size, often completely repeats the outline of the renal pelvis

It is coral stones that are often found in both kidneys at once. Their structure and position lead to the emergence and development of renal failure, which is a life-threatening condition.

Diagnostics

The most informative and accurate methods for diagnosing kidney stones are hardware research methods, since it is almost impossible to determine kidney stones in other ways.

These visualization methods include:

Ultrasound of the kidneys, ureters and bladder;
x-ray examination methods;

An ultrasound study allows you to determine the features of the physiological structure of the kidney, the position and size of the calculi, and also to exclude diseases similar in symptoms, especially if the pain is localized on the right side (for example, appendicitis or cholecystitis). But this diagnostic method is uninformative when the stone moves into the ureter, since this area is poorly visible using an ultrasound machine.

The use of examinations using x-rays is more informative.

First of all, an overview picture is taken, on which you can determine the number, size and location of calculi.

Computed tomography (CT) with contrast may be required if results are questionable. In this case, the contrast agent is injected through a vein or directly through the urogenital catheter. Then a series of pictures is taken. This approach not only helps to identify all stones and more clearly consider their shape and determine the boundaries, but also to assess the function of the kidneys and ureters.

MRI is mainly used to assess damage to the kidney and adjacent tissues, as well as to determine the chemical composition of the stone, based on its density values.

Differences in the images obtained when using different methods for detecting kidney stones make it possible to determine the composition and nature of their origin.

For example, protein, cystine and urate stones are not visible on x-rays, but are determined by ultrasound.

Laboratory methods for examining urine can only provide additional information with an already diagnosed diagnosis.

In this case, an important role is played by the determination of the level of acidity and the detection of additional inclusions in the urine. A shift in the acid balance to the alkaline side indicates that the kidney stone most likely has a phosphate composition, and to the acidic one, that the calculus is urate. The presence of bacteria or leukocytes indicates an inflammatory process of the urinary system.

At the initial examination, before the start of all studies, the doctor must collect a complete history (the nature and localization of pain, how abruptly it begins and subsides, the presence of problems with urination, etc.).

All this information is necessary to select the most effective and complete treatment.

Treatment

Therapy for nephrolithiasis is aimed at removing stones from the kidney by any available means.

Conventionally, treatment methods can be divided into:

conservative (the use of drugs that help the stones come out naturally);
non-invasive (grinding stones to small particles with their subsequent release);
minimally invasive (use of endoscopic, laparoscopic manipulations);
open surgery.

One or another method is chosen individually and depends on the position, size and other parameters of the stone.

The use of a conservative method of treatment is possible if the kidney stone is 5 mm or less. The general principle of this type of therapy is the appointment of an increased volume of fluid intake and dietary adjustments. For greater efficiency, it is recommended to take drugs with a diuretic, antispasmodic, and, if necessary, analgesic, antibacterial and anti-inflammatory action. At the same time, the appointment of specific drugs that dissolve stones depends on the identified chemical composition of the calculus, since some salt compounds are difficult to dissolve.

A non-invasive technique () is used if the stone is small and provided that this type of calculus lends itself to non-contact crushing. To do this, a special device under the control of an X-ray unit is used to influence the stones (most often with ultrasound) in order to achieve a decrease in their diameter for a safe exit through the ureters.

Remote lithotripsy is considered the most preferable among the others, since there are no risks of complications inherent in any surgical intervention.

With a low efficiency of this method, crushing of stones by the contact method through a skin puncture (nephrolithotripsy) can be recommended. To do this, an incision is made on the skin in the kidney area with a diameter of not more than 1 cm, through which a nephroscope is inserted. Next, the stone is crushed and all fragments are removed, after which the entire intrarenal space is examined and drainage is established. Usually the drainage system is removed already on the second day after the operation.

Endoscopy and laparoscopy are a few more methods that have found their place in the treatment of kidney stones. They allow you to perform all the actions available during a conventional operation, but at the same time avoid the associated complications and consequences. Instruments are inserted through small incisions and all manipulations are performed with additional instruments brought through an endoscope or laparoscope.

At the time of the operation, the surgeon removes the stones, and if necessary, can install a stent or ureteral catheter

Open surgery is indicated if doctors find staghorn formations, kidney blockage, a large stone, or significant bleeding. Currently, this method is used less and less due to the development of minimally invasive surgery.

Diet and drinking regimen for kidney stones

With small sizes (sand and calculi less than 3 millimeters) and without signs of stone movement, observation in dynamics can be assigned.
Then the doctors recommended compliance with a certain regimen of drinking and eating, which will stop the growth of the calculus, and also help to remove it in a physiological way.

Drinking water must go through several stages of purification, which significantly reduces the risk of accelerated growth of calculi

The basic principles of lifestyle when detecting kidney stones:

the daily volume of liquid should not be less than 2 liters;
with oxalate stones, greens (especially sorrel and spinach), chocolate, dairy products, strawberries, figs, tea should be excluded from your menu and the consumption of vegetables and broths should be limited;
if urate stones are found in the kidneys, then products containing protein (legumes, meat), as well as grapes, coffee and cocoa are excluded. The lack of protein can be filled with seafood;
with phosphate stones, it is forbidden to eat fish and seafood, as well as dairy and sour-milk products;
the daily amount of food should be divided into 5-6 meals;
the use of certain herbal infusions is allowed, but their composition must be agreed with the doctor;
a prerequisite for the drinking regimen is the use of 200-300 ml of water before bedtime and each time after nighttime urination to reduce the concentration of salts in the urine.

The use of folk methods of dissolving or removing stones (including uncontrolled intake of diuretics) without proper diagnosis and contrary to the prescribed treatment can result in acute renal failure, blockage or rupture of the ureter, internal bleeding or deep injuries of the mucous membrane of the ureter and urethra.

Kidney stones are a serious pathology that requires treatment and constant monitoring. Lack of attention to this problem can be fraught with disability or even death.

It should be noted that the first symptoms indicating the occurrence of kidney stones include piercing acute pain in the lower back, as well as the lateral sections of the abdomen. This pain is called renal colic. It is so pronounced that the sick person is not able to find a comfortable position, no matter how hard he tries. As a rule, spasm and increased peristalsis of the urinary tract contribute to the appearance of this pain syndrome. Often the pain goes to the hips, genitals, inguinal and suprapubic areas. In addition, nausea, frequent urination, vomiting and bloating may be added.

Very often, for the relief of pain, experts resort to the help of narcotic drugs. Often, such intense pain is associated with the movement of a stone from the kidneys, which subsequently stopped in some part of the ureter. In the event that the pain syndrome in the lower back is not sharp, dull in nature, then the cause is a fairly large stone that has stood in the way of the outflow of urine. In addition, the patient may observe an admixture of blood in the urinary secretions. The fact is that sometimes after an attack of renal colic, small stones can themselves come out with urine, which provokes damage directly to the mucous membrane of the urinary tract.

If the stone has formed in the renal pelvis, then the pain is localized in the inguinal region. It should be borne in mind that in rare cases, urolithiasis can proceed completely without any pain syndrome and not differ in certain symptoms. True, there is a risk of unpleasant consequences in the form of kidney infection. After all, in the body, as a rule, nothing passes without a trace.

What are the causes of urolithiasis

The main reasons for the appearance of urolithiasis are: violation of water-salt metabolism, hard water and food overloaded with minerals, infection in the kidneys, changes in the acid-base balance, stagnation of urine, long-term dehydration of the body, the presence of an inflammatory process in the mucous membranes of the kidneys.

What is the treatment for urolithiasis

Currently, this disease is treated conservatively, as well as an operative method. Conservative medical therapy consists of following a special diet and using a variety of medications based on the clinical picture of the disease. In addition, the use of antibacterial drugs is often recommended. Allocate herbal medicines that help slow down the process of stone formation. These include: Fitolizin, Prolit, Cyston, Cystenal. However, before using these medications, it is imperative to consult a doctor. In addition, painkillers and antispasmodics are prescribed. Surgical treatment methods include: crushing of kidney stones and surgery. Basically, this technique is used in the presence of stones of large diameter, due to which there was a blockage of the urinary tract, and it is not possible to remove them on their own.

Kidney duplication symptoms

Kidney duplication has practically no specific symptoms. A person can for many years without suspecting that he has a congenital anomaly of the kidney, without experiencing any inconvenience in connection with this. This is especially common with incomplete doubling.

With complete doubling of the kidney, the risk of certain diseases increases. One of these diseases is pyelonephritis, an inflammation that affects the parenchyma and renal calyces. Possible hydronephrosis - pathological expansion of the renal pelvis. The risk of stones

- this is a manifestation of urolithiasis, characterized by the formation of salt stones (stones) in the kidneys. Accompanied by aching pain in the lower back, bouts of renal colic, hematuria, pyuria. Diagnosis requires the study of biochemical parameters of urine and blood, ultrasound of the kidneys, excretory urography, radioisotope nephroscintigraphy. Treatment of nephrolithiasis may include conservative therapy aimed at dissolving stones, or their surgical removal (pyelolithotomy, nephrolithotomy, nephrolithotripsy).

General information

Kidney stones (renal stones, nephrolithiasis) are a common pathology. Specialists in the field of practical urology quite often encounter nephrolithiasis, and stones can form in both children and adults. Males predominate among patients; stones are more often detected in the right kidney, in 15% of cases bilateral localization of stones occurs.

Acquired disorders of salt metabolism can be due to external (exogenous) and internal (endogenous) causes. Among the external factors, the greatest importance is given to climatic conditions and the drinking regime and diet. It is known that in hot climates with increased sweating and a certain degree of dehydration of the body, the concentration of salts in the urine increases, which leads to the formation of kidney stones. Dehydration of the body can be caused by poisoning or an infectious disease that occurs with vomiting and diarrhea.

In the northern regions, the factors of stone formation can be a deficiency of vitamins A and D, a lack of ultraviolet radiation, the predominance of fish and meat in the diet. The use of drinking water with a high content of lime salts, food addiction to spicy, sour, salty also leads to alkalization or acidification of urine and precipitation from salts.

Among the internal factors, hyperfunction of the parathyroid glands is distinguished - hyperparathyroidism. The increased work of the parathyroid glands increases the content of phosphates in the urine and the leaching of calcium from the bone tissue. Similar disorders of mineral metabolism can occur with osteoporosis, osteomyelitis, bone fractures, spinal injuries, spinal cord injuries. Endogenous factors also include diseases of the gastrointestinal tract - gastritis, peptic ulcer, colitis, leading to acid-base imbalance, increased excretion of calcium salts, weakening of the barrier functions of the liver and changes in the composition of urine.

Pathogenesis

The formation of kidney stones occurs as a result of a complex physicochemical process in violation of the colloidal balance and changes in the renal parenchyma. A well-known role belongs to unfavorable local conditions in the urinary tract - infections (pyelonephritis, nephrotuberculosis, cystitis, urethritis), prostatitis, kidney anomalies, hydronephrosis, prostate adenoma, diverticulitis and other pathological processes that disrupt the passage of urine.

Slowing down the outflow of urine from the kidney causes stagnation in the pyelocaliceal system, oversaturation of urine with various salts and their precipitation, delay in the excretion of sand and microliths with urine. In turn, the infectious process developing against the background of urostasis leads to the ingress of inflammatory substrates into the urine - bacteria, mucus, pus, protein. These substances are involved in the formation of the primary nucleus of the future calculus, around which salts crystallize, which are present in excess in the urine.

From a group of molecules, a so-called elementary cell is formed - a micelle, which serves as the initial core of the stone. The “building” material for the nucleus can be amorphous sediments, fibrin threads, bacteria, cellular detritus, foreign bodies present in the urine. Further development of the process of stone formation depends on the concentration and ratio of salts in the urine, urine pH, the qualitative and quantitative composition of urinary colloids.

Most often, stone formation begins in the renal papillae. Initially, microliths form inside the collecting ducts, most of which do not stay in the kidneys and are freely washed out by urine. When the chemical properties of urine change (high concentration, pH shift, etc.), crystallization processes occur, leading to retention of microliths in the tubules and encrustation of papillae. In the future, the stone may continue to "grow" in the kidney or descend into the urinary tract.

Classification

According to the chemical composition, there are several types of stones found in the kidneys:

Oxalates. Composed of calcium salts of oxalic acid. They have a dense structure, black-gray color, prickly uneven surface. They can form in both acidic and alkaline urine.
Phosphates. Calculi consisting of calcium salts of phosphoric acid. By consistency, they are soft, crumbling, with a smooth or slightly rough surface, whitish-grayish in color. They form with alkaline urine, grow quite quickly, especially in the presence of infection (pyelonephritis).
Urats. Represented by crystals of salts of uric acid. Their structure is dense, the color is from light yellow to brick red, the surface is smooth or finely punctate. Occurs with acidic urine.
Carbonates. Calculi are formed during the precipitation of calcium salts of carbonic (carbonate) acid. They are soft, light, smooth, can have a different shape.
cystine stones. The composition contains sulfur compounds of the amino acid cystine. Calculi have a softish consistency, smooth surface, rounded shape, yellowish-white color.
Protein stones. Formed mainly by fibrin with an admixture of bacteria and salts. The structure is soft, flat, small in size, white in color.
cholesterol stones. Rarely seen; formed from cholesterol, have a soft crumbling texture, black color.

Sometimes in the kidneys, stones are formed not of a homogeneous, but of a mixed composition. One of the most difficult options are coral stones, which make up 3-5% of all stones. Coral-like calculi grow in the pelvis and in appearance represent its cast, almost completely repeating the size and shape of the organ.

Symptoms of nephrolithiasis

Depending on their size, number and composition, kidney stones can cause symptoms of varying severity. A typical clinic includes lower back pain, the development of renal colic, hematuria, pyuria, and sometimes independent excretion of a stone from the kidney with urine. Pain in the lower back develops as a result of a violation of the outflow of urine, can be aching, dull, and with an abrupt onset of urostasis, with blockage of the renal pelvis or ureter by a stone, progress to renal colic. Coral-like stones are usually accompanied by a dull dull pain, while small and dense ones give a sharp paroxysmal pain.

A typical attack of renal colic is accompanied by sudden sharp pains in the lumbar region, spreading along the ureter to the perineum and genitals. Reflexively, against the background of renal colic, frequent painful urination, nausea and vomiting, and flatulence occur. The patient is agitated, restless, cannot find a posture that alleviates the condition. The pain attack in renal colic is so pronounced that it is often stopped only by the introduction of narcotic drugs. Sometimes with renal colic develops oliguria and anuria, fever.

At the end of the attack, sand and stones from the kidneys often leave with urine. When passing stones, they can injure the urinary tract mucosa, causing hematuria. More often, mucosal damage is caused by pointed oxalate calculi. The intensity of hematuria can be different - from slight erythrocyturia to severe gross hematuria. The excretion of pus in the urine (pyuria) develops with inflammation in the kidneys and urinary tract. The presence of kidney stones is not symptomatic in 13-15% of patients.

Diagnostics

Recognition of kidney stones is made on the basis of anamnesis, a typical picture of renal colic, laboratory and instrumental imaging studies. At the height of renal colic, a sharp pain is determined on the side of the affected kidney, a positive symptom of Pasternatsky, pain on palpation of the corresponding kidney and ureter.

Urinalysis after an attack reveals the presence of fresh red blood cells, white blood cells, protein, salts, bacteria. Biochemical examination of urine and blood to a certain extent allows us to judge the composition and causes of the formation of stones. Right-sided renal colic must be differentiated from appendicitis, acute cholecystitis, and therefore it may be necessary to perform abdominal ultrasound. With the help of ultrasound of the kidneys, anatomical changes in the organ, the presence, localization and movement of stones are evaluated.

The leading method for detecting kidney stones is x-ray diagnostics. Most of the calculi are already determined during survey urography. However, protein and uric acid (urate) stones do not block rays and do not give shadows on survey urograms. They are subject to detection using excretory urography and pyelography. In addition, excretory urography provides information on morphological and functional changes in the kidneys and urinary tract, localization of stones (pelvis, calyx, ureter), shape and size of stones. If necessary, the urological examination is supplemented by radioisotope nephroscintigraphy, MRI or CT of the kidneys.

Treatment of kidney stones

Treatment of nephrolithiasis can be conservative or operative and in all cases is aimed at removing stones from the kidneys, eliminating infection and preventing re-formation of stones. With small kidney stones (up to 3 mm), which can be removed independently, an abundant water load and a diet that excludes meat and offal is prescribed.

With urate stones, a milk-vegetable diet is recommended, alkalizing urine, alkaline mineral waters (Borjomi, Essentuki); with phosphate stones - taking acidic mineral waters (Kislovodsk, Zheleznovodsk, Truskavets), etc. Additionally, under the supervision of a nephrologist, drugs that dissolve kidney stones, diuretics, antibiotics, nitrofurans, antispasmodics can be used.

With the development of renal colic, therapeutic measures are aimed at relieving obstruction and pain attack. For this purpose, injections of platifillin, metamizole sodium, morphine or combined analgesics in combination with atropine solution are used; a warm sitz bath is carried out, a heating pad is applied to the lumbar region. With non-stopping renal colic, a novocaine blockade of the spermatic cord (in men) or a round ligament of the uterus (in women), catheterization of the ureter or dissection of the mouth of the ureter (if the calculus is infringed) is required.

Operative removal of stones is indicated for frequent renal colic, secondary pyelonephritis, large calculi, ureteral strictures, hydronephrosis, blockade of the kidney, threatening hematuria, single kidney stones, staghorn stones. In practice, for nephrolithiasis, a non-invasive method is often used - remote lithotripsy, which allows you to avoid any intervention in the body and remove fragments of stones through the urinary tract. In some cases, an alternative to open surgery is a high-tech procedure - percutaneous (percutaneous) nephrolithotripsy with lithoextraction.

Open or laparoscopic interventions for the extraction of stones - pyelolithotomy (dissection of the pelvis) and nephrolithotomy (dissection of the parenchyma) are resorted to in case of ineffectiveness of minimally invasive surgery. With a complicated course of nephrolithiasis and loss of kidney function, nephrectomy is indicated. After removal of stones, patients are recommended spa treatment, life-long diet, elimination of associated risk factors.

Forecast and prevention

In most cases, the course of nephrolithiasis is prognostically favorable. After removing the stones, subject to the instructions of the urologist, the disease may not recur. In adverse cases, calculous pyelonephritis, symptomatic hypertension, chronic renal failure, hydropyonephrosis may develop.

For all types of kidney stones, it is recommended to increase the volume of drinking up to 2 liters per day; the use of special herbal preparations; exclusion of spicy, smoked and fatty foods, alcohol; exclusion of hypothermia; improvement of urodynamics through moderate physical activity and exercise. Prevention of complications of nephrolithiasis is reduced to the early removal of stones from the kidneys, the mandatory treatment of concomitant infections.

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