The incidence of IBC in the world is from 0,5 to 5,3% in Russia
this figure is an average 38,2% of all urological patients. Disease
can be diagnosed and have a seven-month baby and a man of senile
age, but 68% of the IBC is developing in the working age
(20-60 years). Bilateral urolithiasis diagnosed in 15 - 30% of patients with ICD. There are regions where the disease occurs most often and
is endemic. Such regions in Russia are: North
Caucasus, the Urals, the Volga, the Don basin and the Kama. According to many
researchers and the Russian Statistics Committee, today an increase in morbidity
urolithiasis among all population groups.
concretions often form in males, women are more
widespread severe disease, such as staghorn
nephrolithiasis, when the stone occupies almost the entire abdominal system of the kidney.
It is fair to note that thanks to modern technology
diagnosis and treatment of IBC incidence of coral-like nephrolithiasis for
recent years significantly decreased, while the increased proportion
other,moremild forms of the disease, which is due to the increasing
influenced by a number of adverse external environmental factors of the environment
on the human organism. Increase in the incidence of urolithiasis provoke in
Among other factors, and conditions of modern life: physical inactivity, leading to
violation of phosphoass-calcium metabolism, the nature of supply (abundance of protein in food
a monotonous diet). All of the above allowed to call it
disease associated with metabolic disorders in the body, illness
civilization. To the development of ICD predisposes also a number of other factors:
climatic, geographic and housing conditions, occupation, and inherited
genetic factors.
Among the reasons for the formation of kidney stones can be dominant or more
less pronounced changes in the local character: a urinary tract infection,
anatomical and pathological changes in the upper urinary tract
nephroptosis and others, leading to disturbance of the normal outflow of urine from the kidneys,
as well as metabolic and vascular disorders in the kidney.
single concept pathogenesis of urolithiasis is not currently
exists. IBC poly etiology is considered to be disease-related
complex physical and chemical processes occurring in the body
Overall, and at the level of urinary system, and wearing a congenital or
and acquired in nature. At the same time in each case at
careful and thorough examination of the patient and medical history can be
identify the factors that underlie the development of IBC. Since attempts
explain the development of the IBC of any single cause have been unsuccessful in
each case before prescribe treatment, it is necessary to
comprehensive survey to determine the cause of the disease in
this patient.
most perfect is the etiopathogenetic process scheme
stone formation, which is widely recognized and includes the causes of endogenous and
exogenous origin. The mechanism of stone formation depends on a number
physical and chemical processes and passes a series of stages, from saturation and
supersaturation of urine salts to the phases of enucleation, the crystallization and growth
crystals prior to the acquisition of clinically relevant dimensions when it
processes do not interfere with (or do they lack) the mechanisms
inhibiting the growth of crystals.
Accession urinary infection significantly exacerbated during the
disease. It can be seen as an important additional local
factors that fuel the emergence and maintenance of chronic
(Relapsing) course of the ICD as a result of adverse effects on urine
metabolic products of some microorganisms that contribute to its dramatic
alkalinization and the rapid formation of crystals, amorphous phosphates, and when
the presence of core crystallization - and rapid growth of the stone.
most studied endogenous cause of metabolic disorders of calcium
(Basis of most urinary stones) is a dysfunction
parathyroid glands. Thus, when coral-like or frequently relapsing
nephrolithiasis hyperparathyroidism is etiopathogenetic factor of at least
than 30 - 40% of cases.
climatic, environmental and dietary exogenous factors (nitrate,
sulfates and other compounds contained in mineral fertilizers, as well as
pesticides and penetrating the body with water and food) may
have a direct or indirect toxic effects on the body
person, causing metabolic disorders in biological fluids. As a result, they
may lead to dysfunction of the nephron and, in particular, its tubular
apparatus (tubulopatiyam), which is accompanied by increased levels
kamneobrazuyuschih substances in the blood seasm and urine. Similar changes
occur in patients with diseases of the gastrointestinal tract or at
fractures of long bones, prolonged immobilization, etc.
, in turn, increase the concentration of substances in kamneobrazuyuschih
seasm and as a consequence, the inevitable increase in their allocation of kidneys
leads to a glut of urine that may show the formation of
salt crystals and microlites undoubtedly create favorable conditions for
formation of urinary stones. For many people, the urine is often replete with
kamneobrazuyuschimi substances, and the stones they have not formed, ie
the very fact of supersaturation of urine (crystalluria and microlites in the urine)
still insufficient for the diagnosis of urolithiasis, for which development
necessary and some other factors. It is established that a number of substances affect
on the colloidal stability of urine, contribute to the maintenance of salts in
dissolved state and prevent their crystallization. To substances
supporting salt dissolved in the urine and prevents them from
deposition include: gipurovaya acid, xanthine, sodium chloride, citrate,
magnesium, inorganic pyrophosphate, inorganic ions of zinc, manganese,
cobalt, etc. Even at low concentrations of these substances inhibit
crystallization, with the vast majority of ICD patients, they
missing or are in insufficient quantities. So, if
normal conditions, magnesium ions bind in the urine up to 40% oxalic acid
their lack of education shows calcium oxalate crystals.
In other words, the metastable state of the salt in the saturated solution is easy
can be violated, and if there is also local factors, there is growth
crystals and microliths from settling on them as the nucleus, all new and
new salts which in turn leads to the formation of stone and immediately
IBC.
One of the main factors supporting metabolic state
Most salt in equilibrium, which can successfully influence is
hydrogen ion concentration, expressed in pH values of urine and is normally
components of 5,6 - 6, 0.
currently worldwide accepted mineralogical classification
urinary stones. 70-80% of urinary stones are inorganic compounds
calcium: oxalate (Wedel, vevelit), phosphate (Whitlock, basshite, apatite,
karbonatapatit, hydroxyapatite), calcium carbonate. Magnesium-containing stones
occur in 5 - 10% of cases (Newbury, Stasvite, magnesium ammonium phosphate
monohydrate) and often associated with infection in the urine. Uric acid stones are
10 - 15% of all urinary stones (lithate ammonium lithate sodium dihydrate uric
acid), and the older the patient, themorehe found uric acid
stones. Less commonly, other proteins are found stones - 0,4-0,6% of cases (cystine,
ksantinovye, etc.) testifying to the violation of the relevant exchange
amino acids in the patient's body. However, in pure form stones revealed no
more than 40% of cases. In other cases, the urine produced mixed
(Polymineral) in composition (in different versions) stones, and education
rocks characterized by parallel proceeding metabolic, and often
infectious processes.
nefrouretrolitiaza Diagnosis is based on the patient's complaints and history
disease. Most pronounced (paroxysmal, nekupiasyuschayasya renal colic)
disease manifests itself in small (up to 1.0 cm) of kidney and ureter stones,
whereas coralloid and large stones for a long time (sometimes up to full
death of the kidney) may exist without symptoms. Ultrasound and
X-ray examination in almost 100% of cases allows
diagnose stones in the urinary tract. Based on the analysis obtained during the
survey data produced by treatment tactics that should be
strictly individual, that is selected on the basis of clinical course
disease.
Current ICD varies extremely varied. In some patients it
disease is an unpleasant character single episode, but often the ICD
asns hard, with frequent relapses or a protracted, chronic
flow. In the absence of dispensary observation and treatment of disease can
lead to loss of kidney pionefrozu, chronic renal failure,
disability and even death of the patient. High prevalence of the disease and
the possibility of serious, life-threatening complications of patients
indicate the importance of this issue in terms of its timely diagnosis and
treatment.
effectiveness of treatment based on biochemical studies of blood and
urine of patients, none of the clinicians is not in doubt. For example, a 10-year
research has shown that relapse (after removal of the stone) have
patients were not receiving adequate treatment and left without supervision,
ascertained in 78.5% of cases, whereas in patients treated with antirelapse
treatment, the frequency of relapses was 3 times lower (21.5%).
Careful clinical observation and examination of patients within a remote
period of time after an independent stone-free rate, or delete them
ways possible to establish that the main factor of relapse
diseases are expressed in metabolic disorders in the body of patients and
urinary tract infection.
Knowledge of the chemical stascture of stone removal is essential not only to
generation of anti-conservative positions of treatment, but also in terms of
choice of various modern methods of disposal.
Therefore examination and subsequent treatment of patients should be made in
according to strictly defined algorithm. The physician should not be limited
only the removal of the stone one way or another (DLT, Electrotherapy, open
operation) are also mandatory prevention activities (metafilaktike)
recurrences. Unfortunately, the majority of patients, and some
doctors to date do not realize that the operational methods of removing
stones are not the methods of treatment of IBC and in themselves is a recipe for
additional complicating factors that may exacerbate the disease.
in recent decades in the treatment of urolithiasis has been made
substantial progress. Doctors have learned to destroy and delete all the concretions
types, regardless of their size and chemical composition, without
surgical incisions. The introduction of the urological practice distance
shock-wave lithotripsy (DLT) has allowed muchmoreefficient
removal of stones in most patients with urolithiasis and reduced to
minimum number of complications - compared with open operative manner. DLT is definitely a less invasive method. Due to the relative
simplicity DLT is widely used in many countries around the world, with its
can help get rid of the concretions of kidney and ureter 80%
patients. Even those patients who were due to concomitant disease (heart attack,
stroke, coronary heart disease, etc.) was denied in an operation today can get rid of
stones in the kidney and ureter. The youngest patient who has been with
successfully applied DLT was 9 months. Through the use of DLT for the first time
an opportunity to remove stones as outpatients. Currently, up to 40%
ICD patients are being treated as outpatients. Periods of hospitalization and
recovery from DLT are shorter than similar
various periods after open surgery, significantly reduced the frequency and
severity of postoperative complications and postoperative mortality. However,
This method has some contraindications: coagulation disorders
blood, acute associated diseases, inflammatory processes in the kidney and
organic changes in the upper urinary tract and marked reduction function
kidney. Therefore, the final decision on the possibility of DLT can
only accept professionals urological clinics treating IBC.
However, it should be noted also that as a result of DLT, in contrast to other
methods, the stone does not come out entirely, and shattered fragments depart
independently, in rare cases, this process is complicated by occlusion
ureter, renal colic and acute pyelonephritis. All this requires
mandatory monitoring of patients in outpatient. Percutaneous and
transurethral endoscopic removal of stones from the kidney and ureter may
considered as methods of "secondary trauma". They are no less effective,
than the DLT, and apart from a one-time removal of the stone can in some cases
eliminate the cause of stone formation (stricture urethra). Open
surgery in this disease is far from lost its clinical significance
and is used to simultaneously perform the reconstasction
urinary tract, and under the most severe form of the IBC, such as staghorn
nephrolithiasis. All three methods often complement each other, and therefore
acquisition of only one lithotripter enough to begin
treatment of patients with IBC, if this does not apply in the clinic two other methods
that specified in the regulations of the Russian Federation Ministry of Health.
IBC should be seen primarily as a surgical disease,
so as to rid patients of the stones is often necessary
to resort to one or another surgical method to remove them. Exception
stones are composed of uric acid salts - urate, which can be
subject to the successful dissolution of citrate mixtures (Ural V, and so blemaren
etc.). Therapy citrate mixture for 2 - 3 months, often leads to
complete dissolution of these stones. With regard to the stones of a different composition saxifragant therapy is not effective and treatment is symptomatic
character until the rapid disposal. Dasg Therapy in ICD
used in symptomatic therapy - to remove the stones - or kamneizgonyayuschey therapy
- With their small sizes (up to 0.5 cm) when they
may well move on their own.
removal of stone or of self-discharge of the urinary tract is not
preclude recurrence of the disease, as the main
processes leading to the formation of stones, while not usually
eliminated. Therefore, the effectiveness of ICD therapy in general is largely dependent on
effectiveness of complex treatment of patients at the outpatient phase, which is to
far is the weakest link.
At this point, if there are indications for treatment must be connected
Doctors nutritionists, endocrinologists, nephrologists, etc.
The range of therapeutic measures aimed at correcting the metabolic disturbances
kamneobrazuyuschih substances in the body include: diet therapy, maintenance
adequate water balance, antibiotic therapy, herbal medicine,
physiotherapy and balneology therapy, physiotherapy,
sanatorium treatment.
Diet therapy depends primarily on the composition of stone removal and
detected violations in metabolism. However, we can recommend some
general principles of a diet and water balance: the maximum limit
total volume of food in its diversity, limiting consumption of food rich in
kamneobrazuyuschimi substances, the use of a liquid in an amount that allows
maintain a daily quantity of urine from 1,5 to 2,5 liters. Part of the liquid can be
take the form of fasit drinks cranberry or cranberry, mineral water.
Prior to the appointment of preventive treatment is necessary to conduct a survey with
to determine the functional state of kidneys, liver, seasm
concentration and renal excretion of daily kamneobrazuyuschih substances and
microbiological condition of the urinary system. Control over
effectiveness of treatment in the firs