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Stones

WHAT ARE TYPES OF THE URINARY SYSTEM STONES?

According to their chemical structures;

Ca oxalate – Ca phosphate – Struvite ( Mg- Ammonium – Phosphate) – Uric acid – Cystine – Xantin

Stones according to their radioopacity: (visibility on direct radiograph)

Ca-Pfosphate – Ca-oxalate – Struvite (radiopaque)

Cystine (semiopaque)

Uric acid – xantin (non-opaque)

WHAT ARE FINDINGS AND SYMPTOMS OF URINARY TRACT STONES

A- PAIN

The stone pain of kidney and urinary tracts are called renal colic. Colic pains are characterized with severe pain which decreases after a while and repeats again. (Pain of the patients with renal calculus depends on the urinary obstruction).

B- HEMATURIA (bloody urination)

In general, patients refer if there is an intermittent gross hematuria accompanied to the pain or tea colored urine (old hematuria) are present. Most patients develop microscopic hematuria at least.

C- INFECTION

MgNH4PO4 stones mean infection stones. It is together with proteus, pseudomonas, providencia, kelbsiella and staphylococcus infections.All stones may be together with an infection secondary to the obstruction and stasis. Specific antibiotics against the germ in the urine culture should be given before elective procedures.

DOES THE PAIN PROVIDE INFORMATION ABOUT LOCATION OF THE URINARY SYSTEM STONES?

Renal Pelvis:

As renal pelvis tones larger than 1 cm will cause obstruction on passage to the ureter, they create severe pain. The pain diffuses into the flank area (CVA – Costa Vertebral Angle) and upper abdomen on the same side (abdomen).

Upper and Mid Ureter:

Upper ureter stones cause pain on lumbar region and flank while mid ureter stones cause pain on middle and lower section of the abdomen.

Distal Ureter:

Lower ureter stones cause a referred pain on the testicles and the groin in men and labia majora in women.

Ureter stones may cause some cystism symptoms such as cystitis, prostatitis, pain on the penis tip, frequency, urgency, dysuria, strangury or gross hematuria and imitate diseases of these organs.

WHAT ARE RISK FACTORS FOR DEVELOPMENT OF THE URINARY SYSTEM STONE?

1. Socioeconomic Factors:

Renal stone disease is more common in industrialized countries.

2. Diet:

Saturated, insaturated fat acids, animal originated proteins increased fiber, vegetable protein and unrefined carbonhydrate may decrease stone incidance.

3. Occupation:

Incidence increases for those who work under high temperatures which may cause dehydration and in jobs with less physical activity.

4. Climate:

Hot climate may cause dehydration which increases uric acid stone incidence in particular. Hot climate also causes to be exposed to ultraviolet light more and Vitamin D3 increase. This increases Ca absorption from the intestines.

5. Family Background:

Those who have stone history in their family have a high incidence of urinary stone. Incidence is 2 times more in the patients with family history than those without family history.

6. Drug:

Stone formation possibility increases for those who use antihypertensive (triamterene), antacids (including silica), carbonic anhydrase inhibitors.

HOW IS URINARY SYSTEM STONE DIAGNOSED?

Physical Examination:

Pain is severe in renal colic and the patient tries to reduce the pain by changing her/his posture. Systemic findings are tachycardia, sweating and nausea. Severe pin occurs in the examination performed in the form of impact onto the lumbar region.

In complete urine analysis;

Macroscopic (visual) or microscopic hematuria (bleeding), leukocyte increase which is a finding for infection and crystals that is called sand in the public may be detected.

Radiology:

For every patient referred for stone or similar complaints, direct urinary system radiography (DUS) should be taken after the urine test and a complete abdominal ultrasonography (US) should be applied by considering the differential diagnosis. If a final diagnosis can not be established by these two tests; Uropgraphy (IVP) taken by administrating colored agents intravenously or Computed Tomography (CT) with or without intravenous colored agent may be utilized.

WHAT ARE ENDOSCOPIC SURGERY TREATMENT ALTERNATIVES FOR URINARY SYSTEM STONE DISEASE?

– percutaneous nephrolithotomy- lithotripsy (breaking and removing the kidney stone with a closed system)

– Ureteroscopic lithotripsy (breaking and removing the ureter stone with a closed system)

– Cystolapaxy (breaking and removing the ureter stone with a closed system)

The purpose of all endoscopic systems is to approach the patient within a minimally invasive form and to handle the problem as simplest as possible. Whatever the insertion path is (by a small skin incision from the ilium for the kidney or outer foramen of the urinary tract for the bladder and ureter), breaking energies used are the same (ultrasonic- electrohydraulic- pneumatic- laser) and tools are also similar endoscopes with different sizes (cystoscope- ureteroscope- nephroscope).

WHAT IS ESWL? HOW IS IT APPLIED?

The purpose of the treatment is that focused shock waves pass through the body and breaks the stone into fragments when such waves come onto the stone. 1000 to 4000 shock wave shoots are done per session which lasts thirty minutes in average and most of the patients do not FEEL PAIN. Some patients may have pain due to the sensitivity or size or location during the stone breaking procedure; even for such cases, it is not necessary to anesthetize or narcotize. Intramuscular analgesic application will be sufficient and breaking procedure may be applied.

The patient is awake during the stone breaking procedure and she/he may talk to the people around. Because stone breaking procedure may be applied in the office or polyclinic environment, it does not cause any labor power loss. The patient will be able to get up and get dressed at the end of the breaking procedure and continue on her/his work. The physician recommends her/his patient to drink water much and to move a lot after the first breaking session. Then, the patient is asked to come to the control visit after 3 days to 1 week. The patient is told to observe while she/he is urinating and that she/he may pass some particles like sand. Having pain during this period is quite natural.When severe pain occurs, local hot water application (thermophore) or sitting in a bath tub filled with hot water will relax the patients. If pain is not resolved, analgesic injection or suppository is done under the control of the physician.

DOES ESWL APPLICATION HAVE SIDE EFFECTS?

ESWL does not have complication much if applied regularly. It may cause bleeding in the kidney, flushing, hypertension crisis rarely. Kidney function changes that appear within the short period are completely temporary. It does not cause any permanent kidney damage. It is a safe technique. It should not be applied for pregnant women.

WHAT ARE OPEN SURGERY APPLICATIONS FOR URINARY SYSTEM STONE DISEASE ?

Main open surgery methods are;

Pyelolithotomy (removal of kidney stones from pelvis renalis),

Nephrolithotomy (removal of kidney stones by opening the kidney parenchyma),

Ureterolithotomy (stone removal from the ureter)

Cystolithotomy (stone removal from the bladder).

WHAT ARE PROTECTION METHODS FROM URINARY SYSTEM STONE DISEASE?

TRUTHS ON PROPHYLACTIC TREATMENT !!!

THE PATIENT SHOULD DRINK 2 LT. FLUID PER DAY.

THE PATIENT SHOULD NOT EAT ANY FOOD EXCESSIVELY.

THE PATIENT SHOULD MOVE A LOT.

FOODS THAT SHOULD NOT BE EATEN EXCESSIVELY:

MILK AND MILK PRODUCTS

SNACKS SUCH AS NUTS

CHOCOLATE

STRAWBERRY

COLA DRINKS

TEA – COFFEE

Those who do not care about prophylaxis methods have relapse (stone formation again) with 50% within 5 years.