Urolithiasis Treatment

Kidney stones form due to metabolic disorders that result in an excessive amount of salts in the urine and the formation of dense crystals. They can be urate, oxalate, phosphate, xanthine or cystine based. The development of the disease is contributed to by factors such as:

• having the same problem in close relatives;
• congenital abnormalities of the ureters and bladder;
• chronic and recurrent urinary tract infections;
• gastrointestinal diseases, hormonal imbalance and other causes of salt metabolism disorders;
• taking medications that promote stone formation;
• dietary errors.

Even if treatment for urolithiasis is not administered in time, in the early stages it does not cause significant symptoms. During this period, kidney stones are minimal in size and do not significantly disrupt urinary dynamics. The first clinical manifestations occur with complications of urolithiasis and are characterized by severe pain (colic) in the lower back. Symptoms are accompanied by nausea and vomiting, abdominal bloating, constipation, and either frequent or absent urination.

The main and most dangerous complication of the disease is renal colic. An extremely severe pain attack occurs when kidney stones block the urinary passages and disrupt urine flow. This leads to expansion of the proximal parts of the urinary system, increased pressure in the calyceal-pelvic system and overstretching of the renal capsule.

Stimulation of peripheral nerve endings in urolithiasis causes acute pain, preventing the patient from finding a comfortable position and causing restlessness. Without urgent therapy, kidney stones can provoke life-threatening complications such as bacteremic shock, urosepsis, and ureteral strictures. In case of colic, immediate urological assistance and comprehensive treatment measures are required. If a patient does not receive adequate urolithiasis treatment, other symptoms and complications gradually develop:

• acute pyelonephritis;
• chronic pyelonephritis;
• hydronephrosis;
• pionefrosis;
• inflammation of the perirenal tissue (perinephritis);
• infections of the lower urinary tract (bladder, ureter, urethra).

All of the above conditions lead to a gradual decline in kidney function. Blood filtration and urine formation are impaired, resulting in intoxication with nitrogenous waste products. If urolithiasis treatment does not begin even at this stage, the condition progresses to chronic kidney disease and the need for renal replacement therapy (hemodialysis).

Urate kidney stones, which consist of uric acid crystals, can be dissolved with special medications. Citrate mixtures are prescribed to maintain the urine’s acidity in the optimal range of 6.2-6.8. This helps break down dense urates into easily soluble salts that are naturally excreted without causing uncomfortable symptoms. Oral litholysis for urolithiasis treatment is possible with a small number of stones, in the absence of colic and other complications. Litholytic therapy is effective if the kidney stones are no larger than 5-10 mm in diameter. For larger stones, it can only be used as an auxiliary method in addition to lithotripsy.

Emergency therapy for renal colic

Patients experiencing an acute pain attack are admitted to hospital for emergency care. The aim is to relax the ureter and restore urine flow. Once the cause of the MCD exacerbation—stretching of the renal capsule and urinary tract—is addressed, symptoms gradually diminish and then completely disappear.

Treatment of urolithiasis during colic includes several potent medications:

• non-narcotic analgesics combined with antispasmodics, which provide good effects for moderate pain;
• opioid analgesics in combination with antispasmodics for unbearable colic;
• antihistamines, which provide additional sedative and anti-inflammatory effects;
• neuroleptics, which are used to enhance the analgesic effect of narcotic analgesics during severe attacks.

For rapid relief of pain in urolithiasis, medicinal blockades of the spermatic cord or the round ligament of the uterus can be used. As an additional measure, heat treatments are applied, which have a reflex effect. If all the aforementioned methods fail, kidney manipulations are indicated to artificially restore urine flow: catheterization, stenting, emergency removal of stones.

If kidney stones cannot pass on their own or dissolve with luteolytic drugs, remote, contact or percutaneous shock wave lithotripsy is used. The procedure involves the use of physical waves to break the stones into small fragments that can be easily expelled with urine. Ultrasound, electrohydraulic impact, laser beams, and pneumatic waves are used for the destruction of the stones.

Treatment of urolithiasis using extracorporeal lithotripsy is carried out in the following situations:

• kidney stones up to 20 mm in diameter without infectious complications and with good ureteral patency;
• urinary tract stones up to 10 mm in diameter;
• symptoms of renal colic.

When kidney stones reach 20-25 mm in size, contact lithotripsy is more effective and reliable. Urolithiasis treatment is quick and has a 100% success rate. For the removal of complex stones, the N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology uses the percutaneous nephrolithotripsy method. This involves a small incision in the area over the kidney, through which instruments are inserted and a wave is applied to break the stones. This method allows for successful removal of large, multiple, and staghorn stones.

Treatment for urolithiasis is carried out only if the patient is in good health: normal cardiovascular function, good blood clotting indicators, and no purulent-inflammatory processes in any part of the body. Before any surgery, a patient with urolithiasis undergoes a standard set of tests to rule out contraindications and reduce the risk of complications.

How lithotripsy is performed

When kidney stones are broken remotely, the procedure is carried out on an outpatient basis and lasts up to 1-1.5 hours. Comfortable treatment of urolithiasis is possible under local anesthesia to avoid the systemic effects of anesthetic drugs. The skin is treated with a conductive gel and a water cushion is placed on top to protect against excessive wave impact. The doctor then switches on the device, focuses on the stones and breaks them, gradually increasing the intensity.

Contact lithotripsy is performed under epidural or general anesthesia and lasts no more than 60 minutes. Treatment of urolithiasis involves inserting an endoscope through the bladder and ureters into the renal pelvis, after which the stones are broken up using ultrasound or laser. Small fragments are passed with urine, while larger ones are removed using endoscopic equipment. If kidney stones are removed by percutaneous lithotripsy, the procedure takes up to 90 minutes and requires general anesthesia. The urologist makes an incision in the skin and inserts the endoscopic equipment directly into the renal pelvis. A contact lithotripter is then positioned and activated to break up the stones. The resulting fragments are removed endoscopically and by ultrasonic aspiration. After the operation, nephrostomy drainage is required and hospitalization for 2-3 days.

This question does not have a simple answer, as kidney stones vary in composition, size and location, and the most effective therapy programs are chosen accordingly. Before prescribing treatment for kidney stone disease, urologists conduct a comprehensive examination, which includes the following methods:

• clinical urine analysis to detect hematuria and signs of inflammation;
• bacteriological urine analysis to confirm or rule out pyelonephritis;
• clinical blood analysis;
• biochemical blood analysis to assess metabolic status and degree of intoxication;
• ultrasound of the abdominal and retroperitoneal organs, which shows expansion of the renal calyces and pelvis and dilation of the ureters;
• radiological diagnosis such as excretory urography and renoscintigraphy to visualize kidney stones.

Based on the results of analyses and instrumental research methods, the urologist differentiates urolithiasis and renal colic from emergency surgical conditions, intercostal neuralgia, herniated intervertebral discs and other processes accompanied by severe pain. After a definitive diagnosis is made, personalized treatment for kidney stone disease is prescribed, taking into account the presence of complications and the specifics of the disease course in the individual.