Urinary Tract Stone disease

Urinary Tract Stone disease

Tas


Urinary tract is a common disease of the urinary system after stone disease, prostate diseases and infection and is monitored by 1-20% in industrial societies. It occurs more often in hot areas and in the seasons, although it is seen everywhere in the world and in any climates. This increases the loss of water by sweating, thereby decreasing the amount of urine and increasing the concentration of urine is blamed for easier precipitation of substances in the urine. Diet, genetic susceptibility, experienced geography, dietary habits, frequent urinary tract infections, some metabolic disorders, physical activity are among the factors related to the formation of stones. It is accepted that abundant fluid consumption and regular physical activity reduce stone formation.

Urinary tract stone disease is most commonly seen in the age of 30-60 years. It is three times more than women in men. In adult males, the risk of life-long stone creation is considered to be 20%, and in women, this rate is between 5-10%. A person with a stone disease has been reported to have more than 50% of the risk of reconstructing stones within 5 years. Calcium stones constitute 80% of kidney stones, while the rest constitute uric acid, citruvit, cysteine and xanthin stones.

The stones are presented with varying symptoms according to their locations. The stones found in the kidney do not cause a pronounced complaint as long as they do not obstructs the urinary flow. The stones were thought to the channel called the Ureter (the canal connecting the kidney to the bladder) anywhere between the kidney and the bladder; They can cause severe pain to prevent urinary flow (colic pain). It may accompany symptoms such as bleeding in the urine, nausea, vomiting. Many women who drop stones mean that this pain is more violent than the labor. When the urinary tract stones cause infection, they lead to symptoms such as fever, chills, tremors, sweating, weakness, pain in the throbbing style of the kidney, burning when urinating, blurry and sometimes smelly urine. In such cases, it is necessary to apply for a doctor immediately.

HOW IS IT DIAGNOSED?

Depending on the widespread use of ultrasound every day, some of the stones can be detected without any complaints. On the other hand, complaints such as low back pain, recurrent urinary tract inflammation or bleeding in the urine are the elements that bring the patient to the physician. One or more of the following examinations are diagnosed in patients presenting with these complaints.

Direct Urinary tract radiography (DÜSG): The majority of kidney stones which are transparent (opaque) can be seen with this film taken using X-ray. Non-opaque stones or small ureter stones are not seen with this technique.

Ultrasonography: Although it appears to be a safe method because X-ray is not used, it is insufficient to show small stones especially in the ureter (Kidney Canal). Nowadays it is widely used.

Intravenous pyelography (IVP): In this method, both the anatomy and functions of the kidneys can be examined at the same time through a contrast substance given in the vein. With this method, detailed information can be obtained about the settlements of the stones in the kidney and the damage they create in the kidney. This technique should not be applied in those with allergic to contrast substance, pregnant women and renal failure.

Spiral computed tomography (CT): Gold standard in urinary tract stones. This review can be done in minutes and even 1-2 millimeter stones can be seen. Also, the density of the stone can be measured and the degree of breakability of stone can be determined.

Treatment

Follow-up and drug treatment
The follow-up treatment is applied to give a chance to spontaneously fall into small-size stones. However, the treatment for lowering the stone should be decided by your doctor which Stone can fall, which should be used for other treatment methods. Drug therapy is especially applied to help reduce the small stones entered into the production or to prevent the growth of existing small stones or to protect them from the formation of stone again after cleaning the stones in any way.

Stone Crushing (ESWL)
The high-frequency sound waves (shock waves) obtained from a source outside the body are based on the stone breaking by focusing on the stone. Today, thanks to advanced devices, all the stones formed anywhere in the urinary system can be broken. However, this method is not preferred because of the prolongation of the treatment process in large stones and the increase of undesirable side effects.

Surgical methods:

1-ureterorenoscopy (URS): 
Without any incision in this technique, a special endoscopic instrument is entered into the urethra and the stone is disconnecting or removed directly. Most patients are discharged on the same day and return to their normal lives on the following day. Thanks to flexible (bendable) and rigid ureterorenoscopes, this process can be safely applied to patients of any age. To break the stone, the energy source is used as pnomotık (with air pressure) or laser lithotripsy. The stone is very successful in breaking, and since the stone is almost impossible to escape from the ureter, laser energy is the most superior treatment method in the ureteral stones nowadays. Using flexable tools, any stone in the kidney (calyx or renal pelvis) can also be reached and broken with laser energy. (The RIVER)

Surgery Videos
PROXIMAL URETERAL STONE/LASER URS 
DISTAL URETER STONE TREATMENT
FLEXIBBLE URS (KIDNEY STONE/RıRS)
Cyrolithotripsy (Treatment with Mesene stone laser)

2-percutaneous stone Surgery (PCNL)
Entering the kidney under X-ray control from a small hole in the back, with the help of optical device, the stone is seen on the monitor and the process of removing the removal of special tools. This technique is generally used for stones larger than 2 -3 cm.

3-Open stone surgery
Today, thanks to new techniques, open stone surgery is applied at a much lower rate.

TYPES OF STONE;

a) Calcium stones
80% of all urinary tract stones contain calcium. Calcium stones are most dependent on calcium, uric acid, oxalate elevation and decrease in citrate levels.

b) non-calcium stones

1. Struvite
Magnesium is ammonium phosphate stones. It is most common in women. He can relent rapidly. Struvit stones consist of bacteria that break the urea, such as Proteus, Pseudomonas, Klebsiella and Mycoplasma. Urine pH is alkaline. pH is above 7.
It is impossible to sterilize these stones with antibiotics.
Removal of the stone and treatment of infection give successful results.

2. Uric acid
It forms less than 5% of all urinary tract stones. It is seen more often in men. Uric acid is high in urine. It is common in people with gout and myeloproliterative diseases. The height of uric acid may be due to excessive purine intake. Urine is acid.

3. Cystine
It depends on the absorption of the abnormal bowel mucosa. A hereditary metabolic disorder that causes the absorption of Dibazic aminoacids (ornithine, lingo, arginine) to the tubular is caused by the stones of the fog. It forms 1-2% of the urinary tract stones. The formation of cysteine stones depends entirely on the excreto excessive fog.

4. Xanthine Stones
Congenital xanthine oxidase develops due to enzyme deficiency.

5. Indivavir Stones
Protease inhibitors are effective and popular therapies in patients with acquired immune deficiency syndrome. They are radiopaque stones.

6. Rare
Silicate stones are rarely seen and depend on the long-term intake of antacids containing silica, such as magnesium silicate and magnesium aluminometasilikate.

What are the factors that increase the risk of stone formation?

Insufficient fluid intake: if insufficient fluids are consumed, the concentration of chemicals that cause the formation of stones in the urine increases and the risk of stone formation increases. The risk of stone formation in people living in hot geography is higher.
Hereditary causes: If there is a history of kidney stones in the family; Kidney stones are more likely to occur. Again, the risk of stone formation is high in 5 years in front of people with kidney stones.
Age, gender and race: This disease, which is more common in men and in white races, occurs especially between the ages of 30-60.
Diet: It increases the risk of forming stones to consume high animal proteins and foods that contain low fiber. Excess salt consumption is also dangerous.

To prevent the formation of kidney stones;

Modifying life and nutrition can reduce the risk of stone formation. Patients are asked to obtain more fluids. (Depending on the geography, if the sweat is losing too much fluid, the intake of fluids is further increased). Whether it's a stone story or not, a normal person should drink an average of 2-2.5 liters of water per day.

The patient must consume from all food groups. It is recommended to increase fruit consumption due to its beneficial effects and nutrients containing fiber. The consumption of oxalate-rich foods such as rocket, spinach, cress, walnut and wheat bran should be reduced. It is necessary to pay particular attention to patients with high oxalate in urine.