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Indications for non-operative treatment of ureteral stones

Since ancient times, medical researchers have been trying to find methods of treatment of urolithiasis.
In origin ureteral stones - it's kidney stones that have migrated into the ureter and stayed there. As the stones of kidneys by chemical composition, 59% are oxalate, 34% - phosphate and only 7% -urate (Yu, Single, 1972), it equally applies to the ureteral stones. In most cases, the stones stopped in physiological narrowing, but more often in extasiscasino Department of the ureter.
Lingering in the ureter, stone causes changes in its wall, and in the kidney. First stone causes loosening of the mucous membrane, then desquamation of the epithelium, granulation development and bleeding. At long stay in the ureter stone becomes infected. This leads to the spreading of inflammatory process on all layers with the transition to the surrounding tissue, causing the phenomenon of uretrita, periparturient, ulceration and sometimes gangrene wall of the ureter and perforation.
Infringement of a stone leads to the accumulation of urine above the place of its location. Further, in connection with the accession of inflammation, damage the nervous and muscular systems of the ureter and develops its atony with hydronephrosis or pyonephrosis. The above changes do not depend on the size of the stone. Sometimes you can see, that a small stone causes more significant changes in the upper urinary tract in comparison with the stone of big size. Apparently, it depends on the degree of inflammation and duration of stones in ureter.
The treatment of patients with ureteral stones was repeatedly discussed on surgical and urological congresses, conferences, symposia, widely reported in the literature. Most experts believe that the removal of the stone should be considered as preventive measures aimed at preventing the death of kidney due to violations of the outflow and the possibility of infection.
Regarding the choice of method of treatment of patients with ureteral stones, memorial plaques Javad-Zade (1961) wrote that "once a patient is diagnosed stone of the ureter, it is necessary to decide what kind of treatment method should be applied", - operational or non-operational whether to apply first non-operative method, and in case of failure - operative, or immediately make ureterolithotomy.
Because indications for one or another type of treatment is impossible to invest in certain limits because of the many different circumstances, the choice of method of treatment often puts the doctor in a very difficult position.
There are divergent views on the question of the choice of treatment, however, most experts came to the conclusion that in cases where you can not hurry with the operation should always begin with conservative therapy (I. M. Epstein, 1958; M. A. Margolin, 1966; I. F. Novikov, 1968; B. N. Pashkovsky, 1971; Yu, Single, 1972, and others).
To select a method of treatment must be closely urological examination taking into account a number of points.
The size and localization of the stone, its shape and the surface, gender and age of the patient, the disease duration and length of stay of stones in one place, the degree of violation of the outflow of urine from the kidneys and its anatomical and functional status, the presence of a urinary infection, fever, a condition of the second kidneys, and the General condition of the patient, must all be taken into consideration.
In the extensive literature on the question of non-operative treatment of ureteral stones, great importance is attached to the size of the stone.
N. N. Elansky (1933) believed that non-operative method can be used in patients with small stones (less than 1 cm in diameter) with a smooth surface, and in the absence of infection in the upper urinary tract.