All about the causes, symptoms and treatment of kidney stones in men
Urolithiasis, or oralities – the formation of solid substances, which are often called urinary stones. The stones are formed in the areas organs directly in contact with the urinary mucous membranes of the kidneys, ureters and bladder. The formation of stones in the urethra is quite rare due to the high rate of movement of urine. However, there may be a delay of large stones, infiltrated from the parent bodies.
Kidney stones in men is characterized by severe pain, even the development of agonal state in the period of the early migration of stones.
The etiology of the disease and risk factors
The reasons for the formation of urinary stones are in the cases of supersaturation of urine with salt and minerals such as calcium oxalate, struvite (ammonium-magnesium phosphate), uric acid and cystine. About 60-80% of the stones of the total contain calcium. These formations vary considerably in size from small "match heads" to large stones Staghorn type. Upon reaching a certain size, stones may remain in the place in which they are formed, or migrate down to the bladder, thereby causing the corresponding symptoms.
Studies show that the kidney stones in the early stages of development due to the presence of nanobacteria in the focus of the education of the future stone. The activity of microorganisms leads to the formation of the hard shell from calcium phosphate, which subsequently "wound" subsequent layers of minerals. A so-called snowball effect.
The following causes provoking urolitiaz, is the formation of Randall's plaques. Calcium oxalate precipitates in the basement membrane of thin loops of Henle in the kidneys. This process eventually leads to accumulation in the subepithelial space of the renal papillae primary plaque Randall.
The accumulation of excessive amount of salts in the urinary channels contribute to some of the conditions, reflecting the vital functions of the patient and his medical history. There are several risk factors recognized to increase the potential susceptibility of the patient to the development of kidney stones. These include:
- Anatomical abnormalities in the kidneys or urinary tract (e.g., horseshoe kidney, ureteral stricture).
- Urolithiasis in the history of the ancestors of the first and second row.
- Relative dehydration.
- Of metabolic disorders, which result in enhanced removal of dissolvedinorganic substances from blood plasma (e.g., chronic metabolic acidosis, hypercalciuria, hyperuricosuria). It should be noted that the treatment of a number of diseases not always helps to stop stone formation.
- Deficiency of citrate in the urine.
- Cystinuria is a genetic disease caused by autosomal-recessive type of heredity, which is based on the symptoms of aminoaciduria.
- Active treatment of diuretics such as triamterene. For this type of development urolithiasis characteristic symptoms of accumulation of stones in the cavity of the bladder.
- Regular and long-term treatment with preparations containing calcium and vitamin D.
It should be noted that prevention of urolithiasis is to prevent the above-mentioned criteria.
Symptoms of the presence of urinary stones
Urolithiasis in its early stages occurs, usually without clinical signs. There is a significant role to play in prevention of urolithiasis. The symptoms of the disease appear most often when the diagnosis of a third-party or competing diseases or their treatment.
The classic symptoms of renal or ureteral colic manifest in the form of sudden severe pain. This effect is typical for the early promotion of the stones down to the bladder, which is caused by the dilation, stretching and spasm of the urinary narrow channels of these bodies.
In most cases, the nature and localization of pain can initially determine the place of localization of the stones:
- The pain starts in the lower back, at the level of the costal-vertebral angle, sometimes below, and moves to the groin – the symptoms of stone formation in the kidneys and the promotion of the ureters. Often these symptoms are accompanied by appearance of blood in urine men.
- If the stone is high and stretches the renal capsule, the main focus of pain is observed at the side of the lower back and also goes into the groin area.
- The moving of the stone are always more painful than statically located.
- The pain usually radiates to the scrotum and anterior thigh.
Unlike intestinal colic, symptoms of pain with kidney stones are more irregular. However, there are periods of relief, alternating with exacerbations. This is especially true for the concentration of stones in the cavity of the bladder.
Other symptoms that causes kidney stones may include the following:
- Deterioration of the General condition and increases the body temperature.
- Delay the excretion of urine, often caused by a blockage of the bladder neck.
- Nausea and vomiting.
The causes of colic whenurolitiaze characterize the discomfort of the patient due to severe pain. This distinguishes this pathology from severe pain associated with irritation of the peritoneum, which cause the patient to take a fixed reclining position.
Increased body temperature characteristic of complicated stone disease of infectious pathogens. Often this phenomenon is observed in pyelonephritis bacterial etiology, prevention which was held by antibiotic therapy.
Diagnosis and distinction from other diseases
As already noted, the characteristic symptoms of kidney stones in men due to the presence of severe pain at the beginning of the movement of the stones. This phenomenon is called renal colic, which need appropriate treatment. To build a correct therapeutic schemes should be distinguished stone disease from other pathologies with similar clinical picture:
- Biliary colic.
- Autopsy an aneurysm of the aorta.
- Pyelonephritis, which is characterized by very high temperatures and the absence of pain in the groin.
- Acute pancreatitis.
- Acute appendicitis.
- Perforated gastric ulcer.
- Epididymoorchitis or a twisting of the testis.
- Inflammation of the mucous membrane of the bladder.
- Radiculitis and other diseases of the lumbar spine.
- Addiction. False information about the presence of renal colic, designed to obtain an injection of pethidine.
- Munchausen Syndrome.
Initial examination of the patient is complex, with the obligatory account of the history and initial clinical examination. Further, a series of special studies, clarifying the diagnosis of urolithiasis, and localization of stones.
Urolithiasis requires to use the following range of laboratory and visual studies:
- General and detailed analysis of the urine for the presence of erythrocytes, leukocytes, nitrite, pH determination. a pH above 7 indicates the presence of urea-splitting microorganisms, such as Proteus SPP and the like. Figure 5 below, may affect stone formation with the base of uric acid.
- Obtaining a urine specimen for microscopy. The availability of microorganisms and pus involves the parallel development of infection. When delays mochevyvodjashie the introduction of a catheter through the urethra into the cavity of the bladder.
- Laboratory biochemical blood tests ‒ performed to clarify renal function, electrolytes, calcium, phosphate and urate, and creatinine concentrations.
- Prothrombin time ‒ gives information about possible problems of blood coagulation in a patient.
- CT is increasingly replacingclassic visual methods of research. This method with high accuracy and at a sufficiently high resolution to determine the presence of extraneous structures in the urinary tract and the bladder.
- Ultrasound may be indicated to detect the physical structure of the stone and evidence of obstruction in the foci of pathology.
- Radiograph of the kidneys, ureters and bladder is useful in the search for radiopaque stones. It is worth noting that x-rays are able to burn only about 75% of urinary stones calcium based.
- Chemical investigation of the constituents of urinary stone substances, for which the trapping is produced in the time of urination with the help of strainers, napkins and so on. Usually this procedure is carried out by patient independently at home.
Primary treatment of kidney stones usually carried out in outpatient conditions. Hospitalization is indicated only in extremely rare cases possible complications. The first step in the therapeutic algorithm of the schemes will be removing to be painful:
- Nonsteroidal anti-inflammatory drugs are first-line drugs to relieve severe pain of renal colic. In severe cases, use of narcotic pain relievers.
- If needed, use antiemetics and rehydration therapy.
- In some cases it is possible to use stomata bladder.
- Most stones come out on their own, which takes from one to three weeks. Upon detection of large stones shows the weekly monitoring of their condition.
- Conservative treatment can be continued up to three weeks if the patient is not able to cope with the pain or begin to develop signs of infection or obstruction.
- Drug treatment is aimed at expelling the stones. Often for these purposes, use calcium channel blockers or alpha blockers.
Surgical techniques such as extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy and ureteroscopy, are used to crushing large stones into smaller with a view to their subsequent removal. It should be noted that invasive treatment is rarely used when other methods do not produce the desired result.