Ureteral calculi

　　Ureteral calculi are a relatively麻烦 issue and have a significant impact on our lives. Naturally, we should try our best to avoid such a麻烦. So first, let's understand its etiology and then make countermeasures. The etiology of ureteral calculi is the same as that of renal calculi, including heterogeneous nucleation, orientation attachment, and the theory of stone matrix and crystal inhibitor as the basic theory of stone formation.

　　Ureteral calculi are mostly derived from primary renal calculi, which descend into the ureter due to gravity and the peristaltic action of the urinary tract. Therefore, the composition of ureteral calculi is also the same as that of renal calculi, mainly composed of oxalate calculi, followed by uric acid calculi. Primary ureteral calculi are rare and are often secondary to some ureteral diseases, such as ureteral polyps, tumors, cysts, strictures, diverticula, and megacystis. Due to the retention of urine in the ureter, calculi form in the areas where urine accumulates and expands.

　　Ureteral calculi refer to the presence of stones in the ureter, which can lead to various complications. The following is a summary:

　　1, Hematuria

　　After the stone removal surgery for ureteral calculi, there is hematuria to varying degrees, which does not require special treatment and can heal spontaneously. When hematuria is severe, drinking more water or intravenous fluid therapy can increase urine volume to prevent the formation of blood clots.

　　2, Air embolism

　　During the process of ureteroscopic碎石, sometimes due to the reverse connection of the vacuum pump, air is inadvertently compressed into the tissue at high pressure, and air bubbles entering the blood circulation may cause embolism in the small blood vessels of certain organs, causing dysfunction of the organ. In severe cases, it may be life-threatening.

　　3, Lumbar costal pain

　　Some patients may experience pain and discomfort in the ipsilateral lumbar costal area after ureteroscopy for stone removal, and sometimes the pain may extend to the ipsilateral abdomen. The pain in the lumbar costal area after ureteroscopy for stone removal may be caused by the high-pressure perfusion of normal saline during the operation.

　　4, Infection

　　Most patients after ureteroscopy for stone removal may have symptoms of slight fever, which is a normal postoperative reaction and usually returns to normal after 3 to 4 days. Some patients may have a high fever above 38℃, which suggests the possibility of infection, and antibiotics should be administered to prevent and control infection.

　　5, Ureteral stenosis

　　Ureteroscopy for stone removal can cause some degree of ureteral injury, which can generally be self-repaired in the short term without sequelae. Some patients may form ureteral scar stenosis during the ureteral repair process, which can lead to complete ureteral obstruction and renal function damage in severe cases.

　　The complications of ureteral calculi are very harmful to the human body, so once a patient finds ureteral calculi, they must be treated in a timely manner.

　　When ureteral calculi occur, various symptoms may appear, such as pain, hematuria, and these can be easily observed. Then, what are the other symptoms? The following will give a specific introduction to the typical symptoms of ureteral calculi.

　　1, Pain

　　(1) Colic: It is mostly intermittent and its characteristic is that the pain radiates to the lower abdomen, perineum, external genitalia, or the inner side of the thigh along the same side of the ureter.

　　(2) Dull pain: It is caused by the obstruction of the ureter, leading to hydronephrosis and the stretching of the renal capsule, which in turn causes pain.

　　2, Hematuria

　　Mild cases show microscopic hematuria, severe cases show gross hematuria.

　　3, Other

　　(1) Nausea and vomiting, with no pain relief after vomiting.

　　(2) The stones are located in the lower segment of the ureter, causing bladder irritation symptoms.

　　(3) Chills and fever occur when associated with urinary tract infection.

　　Ureteral calculi are one of the common urinary system stones, and ureteral calculi can cause many complications, resulting in adverse effects, therefore, it is necessary to pay attention to prevention. The occurrence of ureteral calculi is related to many bad habits in daily life, therefore, the prevention of ureteral calculi should pay attention to forming good living habits, and the following points should be noted in the prevention of ureteral calculi:

　　1. Supplement fiber

　　Adding bran to the diet can prevent the occurrence of stones.

　　2. Exercise more

　　People who do not exercise easily accumulate calcium in the blood. Exercise helps calcium flow to its bones. The prevention of ureteral calculi should avoid sitting all day waiting for stones to form, and should go out for a walk or exercise.

　　3. Drink more water

　　Regardless of the type of stones you have, the prevention of ureteral calculi should focus on increasing water intake. Water can dilute urine and prevent the accumulation of high concentrations of salts and minerals into stones. The appropriate amount of water is to produce 2 liters of urine per day. Even if you are drinking enough, if you work under the hot sun all day, you need to drink 2 gallons of water.

　　4. Control the intake of calcium

　　Stones are formed by calcium or calcium-containing products. If your last stone was mainly composed of calcium, you should pay attention to the intake of calcium. If you are taking nutritional supplements, you should first consult a doctor to determine whether it is necessary. Next, check the daily intake of high-calcium foods, including milk, cheese, butter, and other dairy products. Milk and antacids may cause kidney stones.

　　Laboratory tests are extremely important for the etiological diagnosis of ureteral calculi, and the following several examination items are usually adopted:

　　1. X-ray examination

　　95% of stones can be displayed on abdominal X-ray films. For suspected negative stones, retrograde urography and double-contrast urography can be used to detect them.

　　2. CT

　　Dense shadows are displayed in the ureter, and small stones may be missed due to the CT section. Thin-section scanning can help with diagnosis. Generally, this examination is not necessary, but it can be used for middle segment stones or suspected solid lesions.

　　3. Ultrasound

　　Ureteral calculi in the upper part and near the bladder can show bright light spots with acoustic shadows, and the affected kidney and the proximal ureter may have mild hydronephrosis. Obstruction for a long time can cause severe hydronephrosis. X-ray negative calculi can also show bright light spots with acoustic shadows. Due to intestinal gas interference, B-ultrasound often cannot clearly display middle segment stones.

　　4. Cystoscopy and ureteroscopy examination

　　Not only can it be detected, but it can also help remove some ureteral calculi.

　　The cause of ureteral calculi is not yet fully understood, but it is related to daily habits, so patients should pay attention to the following points in their diet to help the disease recover quickly.

　　1. Magnetized water can be consumed, which is easy to dissolve kidney stones.

　　2. The daily water intake should be between 2000 to 3000 milliliters, and it should increase to 4000 to 5000 milliliters during hot summer months. After heavy sweating, the intake should be further increased, with a minimum of 2000 milliliters of urine output per day.

　　3. Consume foods rich in vitamin A, such as pork liver, eggs, and fresh vegetables and fruits: walnuts, corn silk, daqing, kiwi, yellow croaker brain, red beans, chicken stew, fragrant vinegar green vegetables, yellow sprouts, winter melon, kowloon melon seeds, watermelon, loofah, pear, cucumber, seaweed, lotus root, carrots, eggplants, bamboo shoots, sweet potatoes, pumpkins, mung beans, snails,螺视, frog meat, and more.

　　3. Eat less food rich in calcium, such as kelp, black fungus, beans, amaranth, milk, celery, nori, sea eel, pickled radish, pumpkin seeds, dried red dates, etc.

　　4. Eat less food rich in oxalic acid, such as spinach, celery, cocoa, coffee, beetroot, strawberry, orange, sweet potato, black tea, etc.

　　5. Eat less food that can easily cause an increase in uric acid, cystine, and xanthine, such as animal organs, seafood, green beans, peanuts, etc.

　　For ureteral stones causing urinary obstruction that has affected renal function, or for those who have failed non-surgical treatment, and do not have extracorporeal shock wave lithotripsy conditions, surgical treatment should be considered. In principle, the simpler and safer side should be chosen first for bilateral kidney stones; for one-sided kidney stones and the other side with ureteral stones, the ureteral stone should be removed first; for bilateral ureteral stones, the side with severe hydronephrosis should be removed first. For those with severe obstruction and systemic weakness, who are not suitable for more complex stone removal surgery, renal fistulization can be performed first. According to the size, shape, and location of the stones, the following common surgical methods are usually used:

　　1. Renal Pelvis or Renal Sinus Stone Removal

　　Incise the renal pelvis, remove the stone, cornual stones or renal calyx stones, and sometimes incise the renal sinus renal pelvis calyx for stone removal.

　　2. Parenchymal Stone Removal

　　For large kidney stones that cannot be removed through renal sinus incision, stone removal is required by incising the renal parenchyma.

　　3. Partial Nephrectomy

　　Applicable to multiple kidney stones in one pole of the kidney (usually in the lower pole), or located in an expanded renal calyx with poor drainage, the pole of the kidney or the renal calyx with the stone can be resected together.

　　4. Nephrectomy

　　For one-sided kidney stones with severe hydronephrosis or pyonephrosis, which causes severe damage or loss of renal function, while the contralateral renal function is good, nephrectomy can be performed.

　　5. Ureterolithotomy

　　For ureteral stones with a diameter greater than 1 centimeter or stones impacted, causing urinary obstruction or infection, and for those who have failed non-surgical treatment, ureterolithotomy can be performed.

　　6. Stone Extraction

　　For ureteral stones in the middle and lower segments with a diameter less than 0.6 centimeters, it is possible to attempt to retrieve them using a specially designed basket or catheter through cystoscopy.