Urolithiasis

　　Urethral stones can also be divided into primary and secondary types, and the causes are as follows:
　　Primary urethral stones refer to stones that form within the urethra from the beginning. Urethral stricture, infection, retention cysts, mucosal injury, diverticula, and foreign bodies are among the causes.
　　Secondary urethral stones refer to stones that first form in the urinary system above the urethra and then enter the urethra and remain in it. They are more often found in the physiological dilated parts and the proximal parts of the narrow parts of the urethra, so urethral stones are more common in the prostate part, bulbous part, penile part, navicular fossa, and external orifice of the urethra.

　　The main harm of urinary system stones to health is manifested in three aspects: local injury caused by stones to the urinary tract, urinary tract obstruction caused by stones, and concurrent urinary tract infection;

　　1,Local injury:

　　Small stones can move freely within the urinary tract and easily injure the urinary tract mucosa, causing bleeding and renal colic, but this local injury is relatively mild. Larger, more fixed stones or staghorn-shaped urinary system stones, although the pain is not severe, can compress the urinary tract mucosa for a long time, causing epithelial shedding, tissue ulceration, and eventually adhesion between the stone and the wall of the ureter, and in severe cases, it may even lead to cancer.

　　2,Ureteral obstruction:

　　Kidney and ureteral stones are most likely to stay at the renal pelvis ureteral junction (the first stricture), the ureteral crossing of the iliac vessels (the second stricture), and the ureteral bladder entrance (the third stricture), causing urinary tract obstruction. After urinary tract obstruction, the upper ureter and renal pelvis above the obstruction will dilate and accumulate water. Renal hydrops can be divided into mild, moderate, and severe renal hydrops. When there is renal hydrops, the renal parenchyma is compressed, affecting renal function. If renal hydrops is not relieved for a long time, severe cases can cause the whole kidney to lose function. If both urinary tracts are severely obstructed, it may also lead to uremia.

　　3,Urethral infection:

　　Urethral obstruction complicated with bacterial infection can lead to renal pyonephrosis after secondary infection of hydronephrosis. Severe urinary tract infection may also cause sepsis, threatening human life. In addition, urinary tract infection can promote the formation of stones, causing the original stones to increase in size rapidly.

　　Therefore, once urinary system stones are found, enough attention should be paid and active treatment should be carried out.

　　The main symptoms are difficulty in urination, strenuous effort in urination, which can be in a dripping state, and sometimes there is an interruption of urine flow and urinary retention. Urination may have obvious pain, which can radiate to the head of the penis. Posterior urethral stones have pain in the perineum and scrotum. Urethral stones in the penis can be felt as a mass in the area of pain, and the stone can be expelled with forceful urination. Complete obstruction can lead to acute urinary retention. Infection can cause purulent discharge in the urethra. Female urethral diverticulum stones are mainly symptoms of lower urinary tract infection, including frequent urination, dysuria, nocturia, purulent urine, and hematuria, with sexual pain as the prominent symptom, and sometimes urethral discharge. In male urethral diverticula, in addition to urethral discharge and pain, a gradually enlarging and hard mass can appear below the penis, with significant tenderness but no symptoms of urinary obstruction.

　　(1)Ensure adequate water intake, aiming for 1500ml of urine per day, especially paying attention to drinking water appropriately at night. Drinking water can prevent urolithiasis and also help in the excretion of smaller urolithiasis.

　　(2)If the urolithiasis is not large, with a diameter less than 1 centimeter, without urinary tract infection or obstruction, and with good renal function, treatment without surgery can be attempted, including drinking plenty of water, being active, and taking traditional Chinese medicine that is beneficial for stone excretion.

　　(3)For larger stones that are estimated to be difficult to expel on their own, extracorporeal shock wave lithotripsy can be used. This is a method that uses underwater high-voltage discharge to cause explosive vaporization of water, releasing a large amount of energy, thus generating supersonic shock waves in the water. These powerful shock waves, after focusing, concentrate the scattered energy, aiming at the urolithiasis within the human body, crushing the stones, and then the fragmented stones are excreted with urine. China has cured tens of thousands of patients with urolithiasis using this method, and it is advisable for patients to consider this option.

　　(4)The last resort is surgical treatment, where the urolithiasis is removed by surgery. For those with long-standing blockage of stones, or larger urolithiasis, or renal function already affected, who need to be cured as soon as possible, doctors may consider this method.

　　In shortUrolithiasis cannot be ignored within the body; it is necessary to closely cooperate with doctors, find appropriate and effective methods, and remove the urolithiasis as soon as possible.

　　1,Urine routine: It refers to the presence of a large number of oxalate or phosphate crystals in urine, whether there are red blood cells; if there is a urinary tract infection associated with calculi, pus cells may also be found in the urine.

　　2,Abdominal X-ray: This is the most valuable examination for the diagnosis and treatment of nephrolithiasis. About 95% of patients with urinary calculi can be visualized on X-rays. If necessary, further intravenous pyelography should be performed to understand the renal function and hydronephrosis.

　　3,Ultrasound: It is economical and simple, and can make a diagnosis for positive calculi and occult calculi that cannot be detected on X-rays. However, its disadvantage is that the display of lower ureteral calculi is not very satisfactory.

　　4,CT scan: It can be used for patients with urinary calculi that cannot be visualized on X-rays, but it is expensive and not included in routine examinations;

　　5,Cystoscopy + retrograde urography: This method is mainly used for patients with IVP (Intravenous Pyelogram) that is not ideal or patients allergic to contrast agents.

　　1.Pay attention to the intake of dietary fiber: Studies have shown that the intake of dietary fiber is negatively correlated with the incidence of urinary calculi. Increasing the intake of dietary fiber can reduce the amount of calcium oxalate and uric acid in urine.

　　Grains, tubers, and fresh vegetables are rich in fiber. Achieving a coarse and fine combination and eating more fresh vegetables can have a beneficial effect of increasing dietary fiber.

　　2.Increase the intake of calcium-rich foods: Low calcium can cause bone resorption to be greater than bone formation, resulting in increased blood and urine calcium levels, and also increases the absorption and excretion of oxalate through the urethra. This will lead to the deposition of oxalate and calcium, promoting the formation of urinary calculi. Therefore, it is necessary to increase the intake of calcium-rich foods such as milk, fish and shrimp, kelp, etc. Pay attention not to prevent urinary calculi by taking calcium supplements, as excessive intake of calcium supplements may increase the risk of urinary calculi.

　　3.Eat more foods rich in vitamins: Vitamin B6 can reduce the formation of calcium oxalate crystals in urine, while vitamin K can reduce the content of oxalate in urine. Therefore, it is necessary to increase the intake of these two vitamins in the diet. Green vegetables such as alfalfa, spinach, cabbage, and oranges are rich in both vitamins, and eating them appropriately can help reduce the incidence of urinary calculi.

　　4.Limit the intake of foods high in oxalate:Most of the oxalate in urine comes from the metabolism of the body, while a small part comes from food. However, it is still necessary to reduce the absorption of oxalate by the intestines and avoid eating foods rich in oxalate such as chocolate, coffee, etc.

　　5.Control the intake of animal protein foods:Excessive intake of animal protein can increase the excretion of oxalate and calcium in urine, reduce the excretion of citrate, lower the urine pH, and increase the risk of urinary calculi. Therefore, it is necessary to control the excessive intake of animal protein in the diet.

　　6.Avoid eating high-salt foods:High-salt foods can promote the increase of urinary calcium, while reducing the excretion of citrate, thereby increasing the incidence of urinary calculi. Therefore, when cooking in daily meals, it is necessary to add less salt, eat less salted vegetables, preserved meat, and fried foods to maintain a light diet. At the same time, pay attention to drinking more water to prevent the occurrence and recurrence of urinary calculi.

　　1. Non-surgical Treatment

　　(1) General Treatment: Drink plenty of water, 2000ml/d. Those who cannot drink water or have vomiting should receive intravenous fluid therapy, and at the same time, analgesic antispasmodic drugs or other treatments such as acupuncture and Chinese medicine should be used to help the stones pass.

　　(2) Stone Passage Treatment: The therapy is chosen based on the size and location of the ureteral stones, whether there is urinary tract infection, and the anatomical characteristics of the urinary tract. Only 20% of stones located in the lower segment of the ureter with a diameter of 6mm can be excreted. When treatment lasts for more than 6 months and the stones have not been excreted, attention should be paid to check kidney function, understand whether there is urinary tract infection, obstruction, etc., in order to decide whether to continue observation or take active surgical treatment.

　　(3) ESWL: With the continuous accumulation of clinical experience in ESWL and the improvement of lithotripters, the indications for ESWL in ureteral stones are expanding. The absence of obstruction in the distal ureter and the non-impact on the passage of stones after lithotripsy are indications for ESWL treatment.

　　(4) Ureteroscopic Treatment: Generally, ureteral stones can be removed by ureteroscopic lithotripsy at any location in the ureter. However, it is currently considered better to treat mid-lower segment stones, and ureteroscopic lithotripsy, electrohydraulic lithotripsy, laser lithotripsy, pneumatic lithotripsy, and electrokinetic lithotripsy can be used. The first two methods have been basically abandoned due to significant tissue damage.

　　2. Surgical Treatment For those with long-standing kidney stone diagnosis and who have tried various non-surgical methods without effect, it is advisable to consider surgery early, especially for those with obvious accumulation of fluid above the kidney stones. Ureterolithotomy can be performed. The advantages of ureterolithotomy are that the surgery is small, the kidney stones can be completely removed, and even bilateral ureteral kidney stones can be removed simultaneously in one operation. According to the location of the ureteral kidney stones, different surgical approaches are taken, and the stones are fixed during the operation to prevent them from slipping. The ureter is incised above the stone, and after the stone is removed, the patency of the ureter is explored up and down with a ureteral catheter, and a double-J tube is placed, then the ureter is sutured. Before the operation, another urinary system plain film should be taken to determine the location of the stones and select the best surgical incision.