Physiotherapy for urolithiasis. Kidney stone disease. Physiotherapy for urolithiasis

For treatment urolithiasis(urolithiasis) is used various methods dissolving and crushing stones in the kidneys and ureters with their subsequent removal. When removing stones, complications such as blockage of the lumen of the ureter or injury to its wall may occur, so medical supervision is necessary during treatment.

Crushing and removing stones

Removing kidney stones is the mainstay of treatment for urolithiasis. For stones larger than 5 mm, lithotripsy or surgical removal is used. Removal of stones whose size does not exceed 5 mm is carried out mainly by drug treatment. But it should be remembered that removing stones does not eliminate the cause of the disease, which means that the stone can form again.

Lithotripsy

Lithotripsy is a remote impact on the stone using the shock wave method. It is performed using a device called a lithotripter. A powerful electromagnetic or ultrasonic wave, depending on the modification of the lithotripter, painlessly and unhindered overcomes soft fabrics organism and affects dense media, in particular stone. The stone is crushed into smaller fractions, which can subsequently be excreted from the body through urination.

The method of shock wave extracorporeal lithotripsy is highly effective, relatively safe and quickly produces positive result. The removal of stones begins when urinating immediately after the session. After the lithotripsy procedure is completed, the patient can continue treatment at home. Lithotripsy is used quite widely today and is the leading method in the treatment of urolithiasis.

Ureterorenoscopy

This method is used to remove small stones from the urethra, Bladder, ureter and kidney. The patient does not need to be hospitalized for the procedure. A special instrument is inserted into the ureter - a ureteroscope, with which the stone can be crushed and/or removed. This depends on the size of the stone and the condition of the urinary tract (the presence of narrowings, bends, inflammatory changes, etc.). Ureterorenoscopy is a traumatic method of removing stones and requires highly qualified medical personnel.

Surgical stone removal

Removal surgically previously used for all stones whose size exceeded 5 mm. But this method is traumatic and has a lot of side effects. Therefore, surgical removal of stones today is used strictly according to indications. Large stones that completely fill the renal pelvis (coral stones), blockage of the urinary ducts, ineffectiveness of lithotripsy, chronic pyelonephritis against the background of urolithiasis, as well as the appearance of blood in the urine of a patient with urolithiasis, are an indication for stone removal through surgery.

Removing stones using medications

Medicines are used in cases where the size of the stone does not exceed 5 mm. With the help of drug treatment, the stone becomes softer and more fragile, breaks up into more fine particles and is excreted through urination. The type of drug depends on chemical composition stone Along with medications, therapeutic nutrition is prescribed, which promotes the destruction and removal of stones, and also prevents the formation of new ones.

For phosphate stones (consisting of salts of phosphoric acid), diuretics and acidic mineral waters of Truskavets, Kislovodsk, Zheleznovodsk are used. The diet is limited to fruits, eggs, vegetables and dairy products. Sometimes medications used to treat gout are used.

For oxalate stones (consisting of oxalic acid salts), diuretics, drugs that suppress the growth of oxalate stones, and acidic mineral waters are prescribed. Foods rich in vitamin C are excluded from the diet: bell peppers, figs, cabbage, citrus fruits, black currants, etc. It is necessary to limit the intake of meat broths, potatoes, beans, eggs, cottage cheese, cheese and tomatoes.

For urate stones (consisting of uric acid salts), agents that normalize uric acid metabolism, diuretics, and alkaline mineral waters of Borjomi, Essentuki, Truskavets, and Zheleznovodsk are used. Meat broths, fatty and fried meats, offal, chocolate, cocoa and alcohol are excluded from the diet. It is recommended to take more vegetables, grapes, cherries, currants and apples.

For cystine (protein) stones, medications are prescribed that maintain the alkaline reaction of urine and dietary food as with urate stones. Mixed stones do not lend themselves well drug treatment Therefore, the main method for removing such stones today is lithotripsy.

If you have urolithiasis, you need to take at least 2 liters of fluid daily. The prescription of antibiotics and anti-inflammatory drugs also occurs for urolithiasis. They are prescribed to prevent the development infectious complications from the urinary tract (pyelonephritis, cystitis). Indications for use and active drug determined by the doctor based on the characteristics of the disease.

Preventing stone formation

Herbal medicine for urolithiasis

The use of herbs in the treatment of urolithiasis is currently the only possible way long-term exposure to the body in order to destroy existing stones and prevent the formation of new ones. Herbal treatment can last for years. Both individual herbs and their collections, as well as herbal-based medicines, are used. The composition of the collection or the drug is prescribed by the doctor, since it (the drug) is selected depending on the chemical component of the stone. For treatment, madder root, knotweed, corn silk, mint, strawberry leaf, lingonberry leaf, horsetail, parsley, bearberry and St. John's wort are mainly used. The action of herbs is expressed in the destruction of stones, diuretic, anti-inflammatory effect, normalization of metabolic processes in the body.

Physiotherapy for urolithiasis

Physiotherapeutic treatment is carried out in a complex general treatment urolithiasis. They use ultrasound, laser therapy, and exposure to various currents. With the help of physiotherapy, an anti-inflammatory effect is achieved, the smooth muscles of the urinary system relax, and metabolic processes are normalized.

Sanatorium-resort treatment of urolithiasis

For urolithiasis, annual spa treatment can not only reduce the formation of stones, but also achieve complete recovery. You can go to a specialized resort only after removing or if there are stones with a diameter of no more than 5 mm. Patients with urate, cystine and oxalate stones are sent to resorts with alkaline mineral waters: Essentuki, Kislovodsk, Pyatigorsk, Zheleznovodsk. Patients with phosphate stones are sent to Truskavets, where there are springs with acidic mineral waters.

Treatment of an attack of renal colic

Stones larger than 5 mm, when released with a stream of urine, can clog the lumen of the ureter. Such a serious complication of urolithiasis as renal colic develops. Intense pain that occurs with colic is relieved with the help of agents that relax smooth muscles, including the wall of the ureter. You can also place the patient in a warm bath or apply a warm heating pad to the lumbar region on the side of pain. It is imperative to call ambulance, since the administration of conventional painkillers is usually not effective. At renal colic hospitalization is required.

Dr. Lerner offers personalized. In St. Petersburg, it is possible to call a doctor at home. We send herbal medicines to other cities by mail.

Ask your question to the doctor.

GMO VPO SSMU named after V.I. Razumovsky Ministry of Health and Social Development

Institute of Nursing Education

Department physical therapy, sports medicine and physiotherapy.

Head Department of Mathematics and Mathematics, Associate Professor V.V. Khramov.

Teacher: assistant G.A. Safronov.

Test on rehabilitation science

Physiotherapy for MVD diseases

Completed by a student

ISO (w/o) 4 courses 2 gr

Savina Lyudmila Vladimirovna

Saratov 2013

MBC diseases are diseases associated with pathological changes in the organs of the genitourinary system.

The most common inflammatory diseases of the kidneys (pyelonephritis, pyonephrosis, kidney tuberculosis), bladder (cystitis), urethra (urethritis), prostate gland (prostatitis), testicle (orchitis) and its epididymis (epididymitis), balanitis, as well as kidney stones , tumors genitourinary organs, kidney prolapse, hydronephrosis.

The most common and serious complications in the clinic are urosepsis, acute and chronic renal failure.

According to statistics, 350 out of every 10 thousand Russians suffer from kidney diseases of varying severity. Only up to 70% of kidney disease cases are diagnosed in women.

Kidney diseases lead to various violations excretory functions, which are expressed primarily in changes in the amount and composition of urine.

When kidney function is impaired, necessary substances are removed from the body, but harmful substances remain. Hence urinary tract infections, urolithiasis, oxaluria, cystinuria, chronic pyelonephritis, chronic glomerulonephritis, chronic renal failure.

Glomerulonephritis is a kidney disease characterized by inflammation of the glomeruli. This condition may present with isolated hematuria and/or proteinuria; or as nephrotic syndrome, acute renal failure, or chronic renal failure. They are collected in several various groups-- non-proliferative or proliferative types. Diagnosing a pattern of glomerulonephritis is important because management and treatment differ depending on the type.

Glomerulonephritis can be divided into acute, chronic and rapidly progressive.

From physical methods For treatment, diathermy on the kidney area is advisable, helping to restore blood circulation in them. Under the influence of diathermy, diuresis increases, glomerular filtration increases and, as a result, the duration of the disease decreases. With diathermy, the current strength is 1-1.5 A, the duration of the procedure is from 30 minutes to 1 hour; only 15-20 procedures. In the hematuric form of nephritis, diathermy can significantly increase hematuria; in other forms, the increase in hematuria is usually small and is considered by some experts as a beneficial indicator. However, performing diathermy with acute nephritis requires constant monitoring for urine. Instead of diathermy, inductothermy can be applied to the kidney area with a disk electrode or a cable electrode in the form of a flat spiral at an anode current of up to 150 mA.

In acute nephritis, primarily in anuria, often combined with a preeclamptic state, X-ray irradiation of the kidney area is indicated (source-skin distance 30 cm, field size 10X15 cm, voltage 160 kV, filter 0.5 mm copper + 1 mm aluminum , dose 50 r).

Pyelonephritis is an inflammatory disease that affects the pyelocaliceal system and renal parenchyma. Pyelonephritis can affect a person of any age and gender. However, it most often affects children under 7 years of age (which is due to anatomical features structure of the urinary system in children), girls and women aged 18-30 years (the development of the disease is facilitated by the onset of sexual activity, pregnancy, childbirth), elderly men (suffering from prostate adenoma).

Factors contributing to the development of pyelonephritis include obstruction of the urinary tract due to urolithiasis, frequent renal colic, prostate adenoma, etc. Pyelonephritis is divided into acute and chronic.

Chronic pyelonephritis is a consequence of ineffective treatment of acute pyelonephritis or the presence of any chronic diseases.

Patients with pyelonephritis are prescribed:

* drinking mineral waters;

* sodium chloride and carbon dioxide baths;

* amplipulse therapy;

* Microwave therapy;

* UHF therapy;

* direct current treatment.

Most often, the treatment complex includes drinking mineral water, a mineral bath and one of the following physical factors. After surgery for urinary tract stones and acute pyelonephritis, physiotherapy is prescribed in different terms(from 10 days or more), depending on the nature of the course postoperative period and inflammatory activity.

Physiotherapy is contraindicated for:

* primary and secondary pyelonephritis in the phase of active inflammation;

* terminal stage of chronic pyelonephritis;

* polycystic kidney disease;

* decompensated hydronephrosis.

Microwave therapy is also contraindicated for coral kidney stones, stones of the renal pelvis and calyces.

Cystitis is inflammation of the mucous membrane of the bladder. This is one of the most common inflammatory diseases genitourinary organs. About 20-25 percent of women experience cystitis in one form or another, and 10 percent suffer from chronic cystitis, and these numbers are steadily growing every year. Men suffer from this disease much less frequently - cystitis occurs in only 0.5% of men.

Patients with acute cystitis prescribe:

* UHF therapy;

* irradiation of the bladder area with an infrared radiation lamp;

* sodium chloride baths or sitz baths of fresh water at a temperature of 37 ° C;

* paraffin (ozokerite) applications locally or on the lumbar region.

For moderate inflammation, ultrasound is used, acting directly on the area of the neck and anatomical triangle of the bladder vaginally or rectally. For hyperreflexia and detrusor hypertonicity, amplipulse therapy is prescribed, both in isolation and for ganglerone electrophoresis. In the remission stage of cystitis, mud rectal or vaginal tampons, mud “panties”, iodine-bromine, sodium chloride, carbon dioxide baths are used.

Contraindications to physiotherapy in patients with cystitis are:

* prostate adenoma stage II-III;

* urethral stricture and sclerosis of the bladder neck, requiring surgical intervention;

* presence of stones and foreign bodies in the bladder;

* leukoplakia of the bladder;

* ulcerative cystitis.

If patients with cystitis have prostate adenoma of any stage, balneotherapy (including mud therapy) is contraindicated.

Urolithiasis (urolithiasis) in traditional official medicine-- a disease associated with the formation of stones in the kidneys and/or other organs of the urinary system. Urolithiasis can affect all age groups - from newborns to the elderly. The type of urinary stone usually depends on the age of the patient. In older people, uric acid stones predominate. Protein kidney stones form much less frequently. It should be noted that more than 60% of the stones are mixed in composition. Urine stones almost always form in the kidneys, in the ureter and, as a rule, in the bladder; they are secondary in nature, that is, descended from the kidney. Kidney stones can be small (up to 3 mm - sand in the kidneys) and large (up to 15 cm); observations of stones that weighed several kilograms have been described.

Stones can be localized in any part of the urinary tract. Most often, stones are localized in the kidneys, ureters and bladder.

The choice of physiotherapy method for treating patients with urolithiasis depends on the location of the stone. When a stone is located in the pelvicalyceal system, the treatment complex includes factors that have an anti-inflammatory effect, normalize kidney function and ultimately prevent the growth of the stone: sodium chloride baths, ultrasound, drinking mineral water. Since urates and oxalates are deposited when urine is acidic, drinking alkaline sodium bicarbonate or calcium waters is recommended.

For phosphate stones formed in alkaline urine, drinking carbonic-bicarbonate calcium-magnesium waters, which reduce the pH of urine, is recommended. Drinking mineral water is not recommended in cases of urinary passage disorder, prostate adenoma, renal failure and of cardio-vascular system. When a stone is located in the ureter at any level, the following are sequentially applied:

* drinking mineral water;

* HF therapy (inductothermy);

* amplipulse therapy.

30-40 minutes after drinking mineral water, inductothermy is performed in the projection of the location of the stone in the ureter on the back or abdominal wall. Immediately after this, amplipulse therapy is prescribed, placing one electrode in the area of the projection of the kidney on the lower back, and the second in the suprapubic area at the site of the projection of the lower third of the ureter. Inductothermy can be replaced by microwave therapy and sodium chloride baths. If the calculus is located in the lower third of the ureter, the treatment complex includes drinking mineral water, sodium chloride baths and ultrasound (vaginally or rectally at the site of the calculus projection).

Complex physiotherapy is not indicated for:

* stones more than 10 mm in diameter;

* acute pyelonephritis;

* significant anatomical and functional changes in the kidneys and ureter on the affected side;

* cicatricial narrowing of the ureter below the location of the stone.

Prostatitis is one of the most common urological diseases in men. It is generally accepted that after 30 years, 30% of men suffer from prostatitis, after 40 - 40%, after 50 - 50%, etc. At the same time, the real incidence is much higher than the registered one, this is explained by the peculiarities of diagnosis and the possibility of the disease occurring in a latent form.

The prostate gland is a small glandular-muscular organ that is located in the pelvis under bladder, covering the initial section of the urethra (urethra). The prostate gland produces a secretion that, when mixed with seminal fluid, maintains sperm activity and their resistance to various adverse conditions.

With prostatitis, numerous problems with urination occur, libido decreases and erectile function is impaired.

The saddest thing is that in the absence of proper treatment, approximately 40% of patients face some form of infertility, since the prostate gland can no longer produce a sufficient amount of high-quality secretion to ensure sperm motility. It is important to remember that similar symptoms can occur not only with prostatitis, but also with prostate adenoma and cancer.

There are 4 main forms of prostatitis: acute bacterial prostatitis, chronic bacterial prostatitis, non-bacterial prostatitis and prostatodynia.

In people under 35 years of age, the disease usually occurs in the form of acute bacterial prostatitis. Bacterial prostatitis is called when there is laboratory confirmation of the presence of infection. Most often it turns out to be chlamydia, trichomoniasis, gardnerellosis or gonorrhea. The infection enters the prostate gland from the urethra, bladder, rectum, blood vessels and lymphatic vessels small pelvis. However, recent studies prove that in most cases the infection is layered on existing disturbances in the structure of the prostate tissue and blood circulation in it. With non-bacterial prostatitis, bacteria cannot be isolated, although this does not exclude their presence.

Older patients are more often diagnosed chronic forms diseases.

Various areas of physiotherapy and laser therapy have anti-inflammatory, analgesic, antimicrobial and other effects on the prostate gland positive action. A special place in the action of most physiotherapeutic procedures is occupied by the improvement of hemodynamics in the prostate gland in the pelvis.

The use of physiotherapeutic procedures in the complex treatment of prostatitis is aimed at both direct impact of physical agents on the prostate gland in order to normalize functional and pathological changes, and electrophoretic administration medicines into prostate tissue.

When treating patients chronic prostatitis use:

* mud therapy in the form of “panties” and “tampons”;

* hydrogen sulfide baths and microenemas;

* turpentine baths;

* ultrasound;

* amplipulse therapy;

* laser radiation;

* low frequency magnetic field;

* electric UHF fields and microwave.

Contraindications to the use of physiotherapy:

* acute inflammatory diseases of the rectum and prostate gland;

* rectal polyposis;

* anal fissures;

* acute hemorrhoids;

* prostate adenoma.

When prescribing ultrasound, prostate adenoma is not considered a contraindication.

kidney bladder prostate

Literature

1. Fundamentals of rehabilitation: Textbook. - M.: GEOTAR - Media, 2007 160 p.

2. Physiotherapy: tutorial Gafiyatullina G. Sh. [and others]. - M.: GEOTAR-Media, 2010. - 272 p.

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Physiotherapeutic methods of treating urolithiasis

These methods are mainly used in a hospital or sanatorium, only some of them can be used at home (baths, ozokerite and paraffin applications, magnetic therapy). With this type of treatment, physical factors act on the body. These methods include electrotherapy (galvanization, impulse currents), magnetic therapy, laser therapy, hydrotherapy, thermal treatment (paraffin, ozokerite, mud therapy), mechanical treatment (massage, manual therapy, ultrasound). Physiotherapy is often used as a component complex treatment. This treatment causes complex transformations in the body, the formation various connections, biologically active substances and interstitial heat. Most frequent reaction is an increase in blood flow, a change in metabolic processes in various organs. Physiotherapeutic treatment relieves pain, improves blood circulation, tissue nutrition, and improves immunity. In old age, due to increased sensitivity to the effects of physical factors, the duration and intensity of procedures are reduced. During attacks of renal colic, in order to eliminate spasms of the ureters, relieve pain and to pass stones, heat is used in the form of warm baths, irradiation of the lumbar region with a Sollux lamp for 20–30 minutes, paraffin or ozokerite applications at a temperature of 48–50 °C on the lumbar region , heating pads, inductothermy (there should be a feeling of pleasant moderate heat). The adoption of procedures can be combined with water load.

SHOWER MASSAGE

The most effective is underwater shower massage. The patient is in a bath or pool, he is massaged with a stream of water from the shower. The patient is in the bath for adaptation for 5 minutes, then he is massaged with a stream of water (water pressure 0.5–3 atmospheres) for 10–20 minutes. The procedure is carried out daily or every other day. The course of treatment is 15–20 procedures. Shower massage is especially useful for concomitant obesity and gout. In addition to its benefits, it gives pleasure, tones very well and calms at the same time. nervous system.

REFLEXOLOGY

Reflexology is an effect on the body through skin receptors, through active points on the human body, rich in nerve elements. Only a good specialist can use these methods, this especially applies to acupuncture. You can use acupressure and linear massage very carefully. Acupressure is performed palmar surface nail phalanges of the 1st, 2nd or 3rd fingers; In this case, basic massage techniques are used: stroking, kneading, rubbing, vibration. By massaging certain areas on the feet daily, you can influence the associated internal organs. Massage of the reflexogenic zone of the kidneys improves their blood supply and excretory function, the violation of which leads to the formation of stones and promotes the passage of stones. If the stone is lodged in the ureter, the area of the ureter and bladder should be massaged. The reflexogenic zone of the kidneys is located in the center of the foot on the plantar surface, the ureter zone is 2–3 cm lower and closer to the inner edge of the leg; the bladder area is another 2–3 cm lower, at the inner edge of the foot.

MAGNETOTHERAPY

Magnetotherapy is the effect of a magnetic field on the body. Magnetic fields have an analgesic, anti-inflammatory effect, reduce tissue swelling. Contraindications to the use of magnets are acute purulent diseases, severe cardiovascular diseases, high numbers blood pressure, tendency to bleeding. For older people, the number of procedures and exposure time are reduced.

MASSAGE

Massage is a useful and pleasant procedure. This is a mechanical effect on the body. It can be part of physical therapy. Massage is widely used in medicine. It affects the functions of various organs through the nervous system. Under the influence of massage, biologically formed active substances, tissue nutrition improves, after a course of massage it improves general state, many lost functions are normalized, training vascular system. ethnoscience offers grinding of kidney stones with an ebonite circle. You need to lie on your stomach and massage your lower back with small circular movements for 10–15 minutes. The second hand at this time is below the navel. The number of procedures is 10–15.

MUD TREATMENT

When exposed to dirt, a skin vascular reaction (redness) first appears. According to studies of capillaries (the smallest vessels), at a mud temperature of 38–40 °C, a narrowing of the skin capillaries is first observed for a few seconds, and then their expansion. This leads to improved nutrition and metabolism in deep-lying organs. The higher the temperature of the mud, the more it penetrates into the body chemical substances. Exposure to chemicals when using sludge mud is caused by the entry into the body of hydrogen sulfide and substances similar to antibiotics.

Indications for mud therapy: inflammatory diseases of the pelvic organs without exacerbation in men and women, inflammation of the bladder, rectum, etc.

Contraindications: kidney diseases with impairment of their functions; severe diseases of the cardiovascular system; chronic ischemic heart disease with cardiac arrhythmia ( atrial fibrillation), conduction (complete block of the left bundle branch), with angina pectoris; heavy hypertonic disease and etc.

This text is an introductory fragment. author Pavel Nikolaevich Mishinkin

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From the book Kidney Stones author Alevtina Korzunova

In a comprehensive conservative treatment patients with urolithiasis include the appointment of various physiotherapeutic methods: sinusoidal modulated currents; dynamic ampli pulse therapy; ultrasound; laser therapy; inductothermy.

When using physiotherapy in patients with urolithiasis complicated by urinary tract infection, it is necessary to take into account the phases inflammatory process(indicated during latent course and in remission).

Rehabilitation therapy for patients with urolithiasis

The goal of treating patients with urolithiasis (KD) is to restore impaired metabolism and prevent the precipitation of salts in the urine.

Comprehensive prevention of patients with urolithiasis and urolithiasis consists of a combination of the following therapeutic factors: internal and external use of mineral waters; purpose of therapeutic mud, therapeutic nutrition, therapeutic physical culture, therapeutic regimen, hardware physiotherapy. Several groups of patients can be distinguished rehabilitation treatment: patients who have undergone surgical removal stones from the kidneys and ureters or their extraction or extracorporeal shock wave lithotripsy, patients with small stones in the kidneys and ureters, which, judging by their size and the anatomical and functional state of the kidneys and urinary tract, can pass away on their own. The maximum size of the stone should not exceed 8 mm in the absence of the active phase of chronic pyelonephritis in these patients, patients with unilateral or bilateral coral stones, in which surgical treatment at the moment, it is either not indicated or impossible, for patients with stones in a single kidney, if they are not obstructive or migrating, preoperative preparation of patients with urolithiasis. Thus, the main objectives of restorative therapy for patients with urolithiasis and urolithiasis are the following: elimination of small stones; removal of salts, mucus, tissue breakdown products, bacteria from the urinary tract; anti-inflammatory therapy; normalization of the disturbed mineral metabolism substances and urodynamics of the upper urinary tract. Consequently, the strategic goal of spa therapy is primary and secondary prevention of urolithiasis.

Contraindications: the presence of urostasis caused by a stone or anatomical features of the upper urinary tract, chronic pyelonephritis in the phase of active inflammation, patients with large stones of the ureter and kidneys that have been in one place for a long time, patients with coral stones and stones in a single kidney against the background of progressive chronic renal failure(CRF) - intermittent and terminal stage. The remaining contraindications for the treatment of patients with urolithiasis are general and are associated mainly with cardiovascular and cardiopulmonary insufficiency.

Urolithiasis is a disease characterized by the formation of calculi (stones) consisting of urine components in the organs of the urinary system. This is a very common pathology - it accounts for about 40% of all cases of urological diseases. Three to four out of ten patients undergoing treatment in a urological hospital suffer from urolithiasis, and the number of cases is steadily growing year after year.

In approximately 65-70% of patients, this pathology develops at a young or mature age - 20-50 years, and in 20% of cases, unfortunately, leads to disability of the patient. To avoid this, it is important to at least have an idea of what kind of disease this is, why and how it occurs, clinical manifestations, principles of its diagnosis and treatment tactics, in which physiotherapy techniques also play an important role. These are the questions you will find answers to in our article.

Classification

Kidney stones may have different shapes and size.

According to the localization of stones:

in the calyces of the kidneys (most cases);
in the renal pelvis;
in the ureters;
in the bladder;
in the urethra.

In 2/3 of cases, stones are found in one kidney, but often the disease is bilateral.

By number of stones:

single;
multiple.

By type of stones:

urate (the main component of the calculus is uric acid);
oxalate (they are based on oxalic acid salts);
phosphate (contain salts of phosphoric acid);
protein (consist of casts of protein fragments);
mixed (contain more than one of the specified components).

The shape of the stones can be varied, sizes - from 1 mm to 10 cm or more, weight - up to 1 kg.

Depending on the causative factors, there are:

primary stone formation (no diseases that are a risk factor for the development of urolithiasis);
secondary stone formation (there are diseases that contribute to the formation of stones).

Causes and mechanism of development

The issues of etiology and pathogenesis of urolithiasis have not yet been fully elucidated - scientists are still studying this disease.

In a healthy body, urine does not contain free crystals, and they are formed under the influence of a number of exogenous (external) and endogenous (internal) factors on the body.

External factors that increase the risk of developing urolithiasis are:

high temperature and humidity (cause dehydration);
lack of ultraviolet rays, vitamin D deficiency;
tough drinking water with a high content of mineral (especially calcium) salts;
excess meat, sour, spicy foods, canned food and table salt in the diet (increase the acidity of urine);
work in hazardous production;
high physical activity;
sedentary, sedentary lifestyle.

Endogenous risk factors include:

enzymopathies (galactosemia, fructosemia, oxaluria and others);
congenital malformations of the kidney;
narrowing of the ureter;
kidney prolapse;
foreign bodies;
slowing of blood flow to the kidney due to injury, bleeding, shock, or other reasons;
neurogenic dyskinesia of the urinary tract;
in men – prostate adenoma;
chronic pyelonephritis and other inflammatory diseases of the urinary tract;
kidney injuries;
hyperparathyroidism (primary or secondary hyperfunction of the parathyroid glands);
chronic pathology digestive tract (peptic ulcer, gastritis and others);
bone injuries.

The above factors lead to changes in the composition of urine (it is saturated with certain minerals) and the structure of the kidneys and tubules, which contributes to the deposition of salts on them.

Symptoms

Most patients with urolithiasis complain of aching pain in the lower back.

At the initial stages, when the calculus is just forming and increasing in size, the disease is asymptomatic. When it grows so large that it becomes an obstacle to the flow of urine, partially blocking the urinary tract, or injures the epithelium of the kidneys, characteristic symptoms appear. clinical manifestations. These are:

Pain. This is the most common symptom of this pathology. Its intensity depends on the location, shape and size of the stone, as well as on its mobility. If the stone is motionless and does not obstruct the flow of urine, there is no pain. In 80% of cases, the pain is localized in the lower back, is dull, aching in nature, and intensifies when the patient moves. As a rule, it occurs with large stones, which are located in the cups or pelvis and only slightly affect the outflow of urine. In this case, patients “delay” in seeing a doctor and are admitted to a medical facility with complications. In some cases, the patient first learns about his illness when he experiences an acute, sharp, cramping pain in the kidney area - renal colic, which occurs due to an unexpected cessation of the outflow of urine associated with blockage of the urinary tract by a calculus. The pain radiates to the groin area, inner thigh and genitals. Since the solar plexus is irritated during renal colic, the patient also experiences nausea and vomiting, impaired gas discharge (due to intestinal paresis), muscle tension in the anterior abdominal wall and lower back on the affected side. The patient cannot find a place for himself and is restless.
Hematuria. This is what is called blood in the urine. It occurs due to mechanical damage to the mucous membrane of the ureter by a calculus. At the end of a painful attack, as a rule, total post-pain macrohematuria occurs - the release of a large amount of blood in the urine.
Urinary disorders. Pollakiuria (frequent urination), nocturia (nighttime urge to urinate), dysuria (impaired urination up to acute urinary retention) may occur.
Discharge of stones from the urinary tract. This is the most reliable symptom of urolithiasis. As a rule, the stones pass away soon after the attack of renal colic stops - on their own. Every fifth patient experiences painless passage of stones.

There are no differences in the clinical picture of the disease in men and women.

Complications

If a patient contacts a doctor late or if medical care is not provided in a timely manner, urolithiasis can cause a number of complications, namely:

pyelonephritis – acute or chronic;
nephrogenic arterial hypertension;
hydronephrosis;
renal failure - acute or chronic.

Diagnostic principles

Ultrasound allows you to identify stones in the urinary system.

The doctor will suspect urolithiasis based on the patient’s complaints, life history and disease. Then he will assess the objective status - he will detect a positive tapping symptom on the affected side. The next stage of diagnosis will be laboratory and instrumental examination, which, depending on the clinical situation, may include the following methods:

general blood test (leukocytosis will be detected ( increased level leukocytes in the blood), shift leukocyte formula to the left (a sign of bacterial inflammation) and high ESR);
biochemical blood test (possibly increased levels of urea, creatinine, uric acid);
level of electrolytes in the blood (increased levels of phosphorus and calcium ions, decreased levels of magnesium);
general urinalysis (it contains red blood cells (not normally contained), casts, salts, bacteria, increased levels of leukocytes, not a large number of protein (no more than 0.3 g/l));
Amburger, Addis-Kakovsky, Nechiporenko samples;
cystoscopy (examination of the bladder from the inside using a cystoscope);
Ultrasound of the kidneys and bladder (the doctor determines the size, shape, structure of the organ, sees whether there are stones in it);
abdominal radiography;
survey urography;
excretory urography (injection of a contrast agent into a vein followed by radiography);
dynamic scintigraphy (injection of a radioactive substance followed by a series of x-rays);
retrograde pneumopyelography;
computed tomography after the introduction of a contrast agent (images are taken layer by layer - at different depths) - the most reliable diagnostic method;
consultation with a nephrologist or urologist.

Differential diagnosis

Urolithiasis manifests itself with symptoms similar to those of some other kidney diseases. Differential diagnosis should be carried out with:

acute appendicitis;
intestinal obstruction;
complicated by perforation;
acute pancreatitis;
ectopic pregnancy.

Treatment tactics

Treatment tactics in each specific case are different, since each of them is unique in terms of the number, location, composition, shape of stones and features of the functioning of the urinary tract. In this regard, only general principles treatments, the essence of which is to eliminate stones from the urinary tract by dissolving them, removing them or removing them surgically, restoring the normal path of urine outflow, stopping the impact on the body of factors that contribute to stone formation, and disinfecting the organs of the urinary system.

In any case, treatment must be comprehensive.

Conservative treatment

First of all, the patient is prescribed dietary nutrition. It is recommended to limit table salt and fatty foods in the diet, and completely abstain from alcohol.

With urate stones, the patient should not eat smoked meat, dried fish, offal, or meat broths - these dishes contribute to the formation of uric acid in the body.

With phosphate stones, on the contrary, the patient is recommended to eat meat, and he should limit peas, beans, and milk.

If you have oxalate stones, you should exclude tomato paste, tomatoes, sorrel, herbs and other foods containing large amounts of oxalic acid from your diet.

It is also important to observe the drinking regime - drink about 2-2.5 liters of clean water during the day.

The patient may be prescribed the following medications:

antispasmodics (spasmobru, no-shpa);
products that dissolve urate stones (blemarene, uralite and others);
antibiotics and uroantiseptics (urolesan, ceftriaxone, canephron and others);
drugs with an antispasmodic effect on the ureter, which also have a diuretic effect (cystenal, olimethine); instead, water loads in a volume of up to two liters of warm liquid, drunk within half an hour, followed by an antispasmodic and diuretic may be recommended;
B vitamins.

Instrumental treatment methods

Currently, doctors use to treat urolithiasis endoscopic techniques, allowing you to remove stones from the urinary tract with minimal possible trauma to the patient’s body.

Endoscopic methods are divided into:

ureteroscopic (the mouth of the ureter is widened and a ureteroscope is inserted through it from the side of the bladder, slowly moving it into the renal pelvis, while simultaneously crushing stones or removing them);
nephroscopic (the kidney is punctured through the skin, the resulting tract is expanded and a nephroscope is inserted into the pelvis, with the help of which the stone is crushed or removed under visual control).

External shock wave lithotripsy is also used to treat urolithiasis. The essence of the method is to expose the stone to a focused shock wave from the outside. This type of treatment has led to a decrease in the number of surgical interventions, but, unfortunately, it also has serious side effect– significant damage to the kidney parenchyma during the impact.

Surgical treatment

Towards the open surgical intervention There are a number of absolute and relative indications for urolithiasis.

Absolute indications for surgery:

anuria (lack of urine output due to blockage of two ureters at once by stones);
kidney bleeding leading to severe anemia;
obstructive pyelonephritis (acute inflammation of the kidney due to obstructed outflow of urine from the collecting system).

Relative indications are:

frequent renal colic;
progressive enlargement of the kidney cavities;
calculous with frequent exacerbations.

The most commonly performed procedure is called pyelolithotomy. Less commonly, nephrolithotomy, pyelonephrolithotomy, and in especially severe cases, nephrectomy (removal of the entire kidney).

Physiotherapy

Physiotherapy methods are used, as a rule, after preliminary lithotripsy in order to facilitate and speed up the process of removing stone fragments from the urinary tract. If the stone is in the ureter, physiotherapy can be used only if its size is no more than 10 mm and with normal, unimpeded outflow of urine. It can also be prescribed during the period of renal colic to relieve spasm of the urinary tract muscles, reduce inflammation and pain.

Physiotherapy should be carried out exclusively under the supervision of a urologist.

For renal colic the following is prescribed:

inductothermy of the ureter area on the affected side (exerted for 20 minutes, if the pain resumes, repeat the procedure);
ureteral zones;
pulsed high-intensity (“S”-inductor is placed above the area of the lower ureter, and “N”-inductor is moved along the ureter in the direction from top to bottom).

During the interictal period apply:

ureter with sinusoidal modulated or diadynamic currents (after this procedure, pain may occur in the area of the projection of the stone of an aching nature, which lasts about two hours and goes away on its own);
pulsed high-intensity magnetic stimulation.

inductothermy;
thermal massage couch;
thermal chair "Graviton";
vibration massage of the lower back.

The effects are carried out daily until the stone comes off. This usually occurs 3-5 days after the start of treatment.

Spa treatment

Some people suffering from urolithiasis may be referred to. The main indication for it is the presence of stones in the kidney up to half a centimeter in size with unchanged kidney function and in the absence of signs of obstruction, or blockage, of the urinary tract. In each specific case, the question of the necessity and, importantly, the safety of treatment in a sanatorium is decided by the attending physician based on the results of the examination of the patient.

The main focus of treatment in the sanatorium is the patient’s consumption of medicinal mineral waters, which have a diuretic effect and affect the acidity of urine and the level of electrolytes in it.

In case of urate stones and acidic urine reaction, the patient is recommended to take alkaline mineral waters (Smirnovskaya, Slavyanovskaya, Borjomi and others).

For calcium oxalate stones, treatment is carried out using slightly acidic mineral waters of low mineralization (Essentuki No. 20, Sairme and others).

If calcium phosphate urolithiasis occurs in combination with an alkaline urine reaction, the patient is sent to Pyatigorsk, Zheleznovodsk and is recommended to take Narzan mineral water, which acidifies the urine. The same sanatoriums are recommended for treatment of patients with cystine stones.

The patient is sent to the resort only after the stone has been destroyed instrumentally or through surgery.

Forecast

Early referral of a person suffering from urolithiasis to a qualified specialist medical care and timely lithotripsy or other intervention leads to his recovery. Therefore, the prognosis in this case is favorable. It is worth noting that every fifth patient experiences a relapse of stone formation.

For bilateral pathological process or in the case of stones located in a single kidney, the prognosis is significantly worse.

Prevention

In most cases, it is impossible for a person who does not have stones in urinary tract, convince them that their appearance is possible, and force them to follow a diet. This is why we can say that there is no primary prevention for this disease. Secondary prevention measures include:

active lifestyle;
body weight control;
refusal to drink alcohol;
frequent drinking of clean water (up to 2.5-3 liters per day);
prevention of the development of inflammatory diseases of the urinary tract, active, timely treatment;
compliance with dietary recommendations depending on the type of stones identified.

Conclusion

Urolithiasis is a serious pathology, which, in the absence of timely comprehensive treatment, can lead to a number of dangerous complications and ultimately to kidney failure. Its treatment can be conservative or surgical (through minimally invasive or open intervention), and also include physiotherapy techniques that will speed up the process of passing stones from the ureters after lithotripsy, relieve spasm and reduce inflammation.

Video on the topic “Treatment of urolithiasis in men”:

MDC "Energo", nephrologist Yu. B. Perevezentseva talks about urolithiasis: