Ureteral stones (non-surgical methods of treatment)

The etiology and pathogenesis. There are many theories of the origin and development of kidney stones, but none of them fully explains the origin of it.
Known value in the Genesis of lithogenic have geographical and climatic conditions. There are areas, where kidney stones are very common - the Volga and don basin, the Caucasus, Central Asia, Dalmatia, Bavaria.
In the process of lithogenic a special role is alimentary factor and beriberi. In humans, eating meat, often formed stones - urates and oxalates and when lacto-vegetarian food phosphates. Artificially depriving animals of vitamin a, can cause the formation.
Famous role in the etiology of urolithiasis plays a violation of uric acid, phosphoric acid and oxalic exchange, but it should not be overestimated. So, for example, excessive intake of uric acid in the blood and urine observed in patients with gout. However, among the latter, the percentage of patients with uric acid stones insignificant. Equally, it applies to the overactive parathyroid glands, which is observed hypercalcemia and hypercalciuria. However, diseases of the parathyroid glands rarely combined with urolithiasis.
Fractures are often accompanied by formation in kidneys, which is explained by an increased inflow of blood calcium and phosphorus. A significant factor in the mechanism of stone formation in such patients is also prolonged immobilization.
Violations of phosphoric acid and oxalic exchange are set with simultaneous violation of calcium, since only the calcium salt of phosphoric and oxalic acids are not soluble in urine.
An important role in the mechanism of stone formation is given to the violation of the colloidal state of urine. Urine is a supersaturated solution. This property urine is explained by the presence of urea and electrolytes, the hippuric, salicylic acid, but mainly so-called protective colloids. The last represent protein compounds, consisting mainly of mucin, and albumin, and nucleic chondroitinase acids. Normal protective colloids dissolved in urine (urine, therefore, should be considered as a colloidal solution).
Beli for some reason part of colloids precipitates, dissolving ability urine is reduced and part of crystalloids also drops of the solution. Dropped out in a Deposit colloids and crystalloids alternating layers form a stone and determine its growth. To similar consequences can lead not only the precipitation of colloids, but also reduced the allocation of their kidneys or qualitative change them - discoloured.
The reason of violation of colloid and crystalloid balance is associated with a change urine pH; in alkaline urine easily fall phosphates, and the residue of the uratov and oxalates usually falls in acidic urine. The reason may be a change in the dispersion of colloids, the smallest particles which are moving from the dispersed phase in dense, thus forming the stone.
More important in the formation has the infection. Infectious inflammatory process in the urinary system changes the pH of the urine that causes a change in the epithelium of the urinary organs. The amount of secreted by the kidneys colloids (in the norm of the kidneys to excrete 1 g colloids per day) is reduced. Of their properties under the influence of infections change. Comes discoloured with precipitation of colloids and crystalloids. Products inflammation, mucus, pus, rejected the epithelium is involved in the formation of the stone.
More difficult is the question of the role of infection in primary education stones in the absence of inflammation in the urinary tract.
Experimental studies have shown that, plombira teeth of dogs culture aureus obtained from the urine of patients with nephrolithiasis, you can cause the formation of kidney stones. The mechanism of action when it comes to damage kidney epithelium and violation of colloidal balance not by microorganisms and their toxins. Most of the action of toxin affects the epithelium of the renal papillae, as there urine is the most concentrated and talk it slowed down. Most of the stones is born exactly on the renal papillae.
Recently theory, originating from the idea of the urine as saturated salt solution, provide protective colloids, questioned and denied many. More and more inclined to think, based on many experiments that the Foundation stone formation are increased capillary permeability of glomeruli and changes in the epithelium of the renal tubules, resulting in urine penetrate her unusual protein fractions and formed a pathological form of mucoproteins - polysaccharides. In the lumen of the collective tube near renal papilla in place of the pathologically changed epithelium of these pathological mucoproteins formed the so-called maternal plaque or a bed (matrix) stone, which as a foreign body becomes the focus of precipitation for colloids and crystalloids urine and, thus, here is the formation of stone. For some time the stone remains fixed, but in the end rejected and becomes mobile. This explains the fact that stones are not excreted in the urine in the very beginning of their education.
Famous role in the pathogenesis of stone formation is attributed to the slowdown of renal blood flow. The latter violates the secretory and reabsorbtion functions renal epithelium, followed by separation of the pathological protein that forms an organic matrix - bed stone of the future.
A significant factor in the mechanism of lithogenic are changes that lead to the stagnation of urine, such as an incorrect structure Cup and pelvis, valves and narrowing of the urethra, incomplete emptying of bladder, are observed with adenoma prostate cancer, stricture of the urethra, organic diseases of the spinal cord. In stagnant urine fall salt and infection develops.
Nephrolithiasis no permanent disposition to kamneobrazovaniu. The formation of stones in most cases is sporadic. There is no data in favor of hereditary predisposition to the stone. Therefore, correct to assume that the etiology of urolithiasis explained by the temporary combination of several factors.

  • A brief outline of the anatomy and physiology of urinary tract
  • Indications for non-operative treatment of ureteral stones
  • Medication in the treatment of ureteral stones
  • Physical methods of treatment in the treatment of ureteral stones
  • Indonesienne therapies in the treatment of ureteral stones
  • Diet and health resort treatment
  • Complications endovascular methods of treatment of ureteral stones
  • Remote results of non-operative treatment of patients with ureteral stones

  • In the work experience of the Imperial family Novikova to remove the stones from the ureters without operative intervention. Using indonesiennes procaine blockade, and catheterization of the ureter, various kinds of non-metallic extractors and electrocoagulation mouth stones were revealed more than 600 patients.
    Application of the complex conservative therapy, consisting of drugs, physiotherapy, therapeutic physical training, intravesical manipulation and sanatorium-and-Spa treatment, which contributed to the discharge of stones in 88% of patients.
    Significant attention is paid to indications and contraindications to the use of instrumental methods of descend of ureteral stones.
    In section describes the various kinds of complications that may occur during the extraction of stones in the urinary tract, their prevention and treatment.
    In the last Chapter includes the remote results of non-operative treatment of patients with ureteral stones.
    The monograph is intended for practitioners (urologists and surgeons).
    Among patients with urological stone disease is the most common disease.
    Of all the patients with urolithiasis, ureteral stones account for about 50%. Although the stay of stones in ureter is temporary, however, it is more dangerous than finding it in the renal pelvis. The ureter has the ability to answer irritation interoreceptors pronounced spasm. Due to the passage of the ureter, even a small stone can easily meet the conditions for the difficulty of urine outflow from the pelvis. Spasm of neuromuscular apparatus of the ureter and Eurostat cause renal colic.
    For edema renal colic used a variety of medicines, physiotherapy and procaine blockade - spermatic cord or round ligament of the uterus, perirenal etc. the Bulk of renal colic stopped after the combined use of these funds.
    As is known, in the adventitia and muscular layers of the intramural Department of the ureter is a large number of major nerve ganglia. Because of this intravesical part is considered to be the main reflexogenic zone of the ureter. Since 1962 when nekupeerootesa renal colic has been applied as suggested by the author of the monograph endovascular novocaine blockade. The introduction of the solution novokaina the submucosa of the mouth of the ureter interrupted reflex arc, filmed spasm smooth muscles of the ureter and restored the passage of urine, causing mild renal colic. Endovascular novocaine blockade produced using injection needles own design.
    Non-operative treatment of patients with ureteral stones used for a long time. There is a rich literature on this issue, which describes many different ways aimed at non-surgical removal of stones from the ureters.
    Having 15 years of experience relegated stones ureter in 642 patients, the author became convinced in the expediency of application is not one of any method, and the complex of therapeutic measures, which included: medicines, physiotherapy, therapeutic physical training, endoscopic manipulation, diet and health resort treatment. The leading place in the complex therapy occupied indonesienne treatment methods (procaine blockade of the mouth of the ureter, catheterization of the ureter, removing concrements non-metallic extractors and dissection of the mouth of the ureter by electrocautery). Among intravesical manipulation of great importance was attached procaine blockade of the mouth of the ureter. Carried out the introduction of novocaine with antibiotics or novocaine in combination with corticosteroids (hydrocortisone, adreson). Non-metal extractors used a loop of Zeis, Cliques, Elika, Heine and Davis in modifications of the author.
    Due to the wide spread cystoscopies methods of treatment of patients with ureteral stones and error messages related complications ureterolithotripsy examined the causes and prevention of possible complications.
    At the beginning of the research work was carried out at the Department of urology medical Military order of Lenin Academy. S. M. Kirov. Work was completed at the Department of urology of the Leningrad order of Lenin Institute of improvement of doctors of them. S. M. Kirov.

  • Conclusion