Stone lithiasis is treated both in the emergency phase and in the second year. Jumolysis of stones is performed depending on the composition of the stones and extracorporeal conservative lithotripsy and laser lithotripsy throughout the urinary system (bladder, ureter, kidneys). Cystolithotripsy, ureteroscopy, flexible ureteronephrolithotripsy and percutaneous nephrolithotripsy are performed.

 

Bladder lithiasis

Bladder lithiasis mainly hides obstructive urination and occurs due to accumulation of urine in the bladder and formation of salts and subsequent stones. Stones from the kidney and ureter are not included in bladder lithiasis. Primarily, cyst lithiasis is due to obstructive prostatic hyperplasia and is an indication for removal of the prostate either transurethrally (TURIS-P or LASER) or with open surgery (open transurethral). In the first case, the stone is removed after lithotripsy followed by transurethral prostatectomy, while in the second case, the entire stone is removed after opening the cyst.

           

Ureteral lithiasis

Ureteral stones are stones that form in the kidneys and "fall" into the ureter. Passage of stones may be painless, but is primarily painful and causes renal colic, an emergency. In the case of colic, the first measure of treatment is the administration of anti-inflammatory drugs and the deprivation of fluids until the symptoms subside. A urine dipstick is then recommended, where microscopic hematuria is usually present, and a kidney-ureter-bladder (kidney-ureter-bladder) x-ray, where a radiopaque element is sought in the course of the ureter to indicate lithiasis. It is also common to have a NOK ultrasound to find stones, or dilatation of the renal pelvis. If there are no findings, a CT scan is indicated due to its greater diagnostic value. Criteria for further treatment are renal function, the presence of fever and the size of the stone. On deterioration of renal function with or without fever there is an absolute indication for drainage of the kidney either percutaneously (nephrostomy placement) or transurethral (Pigtail placement). Regarding the size of the stone, in stones without deterioration of kidney function and fever and size up to about 1cm and without marked dilatation of the kidney, the stone is given the opportunity to "fall" with conservative treatment. If after about 20 days the stone remains in the same position, surgical removal with endoscopic laser lithotripsy is indicated. In ureteral lithiasis, extracorporeal lithotripsy does not have such good results. Open stone removal is not common in modern Urology, except when endoscopic removal is impossible.

           

Kidney stones

The kidney is the preeminent place where stones form. As for how to deal with nephrolithiasis, the main criterion is the size of the stone. Extracorporeal lithotripsy can be applied to kidney lithiasis and stones up to 2 cm. Alternatively, flexible laser reverse nephrolithotripsy can be applied. In stones >2cm there is an absolute indication to perform percutaneous nephrolithotripsy through a small hole in the loin. Open stone removal has no place in modern Urology except in cases of failure of the aforementioned methods.

           

          

Stone control

In case of removal of part or the whole stone invasively or in case the patient urinates the stone, chemical analysis of urolith is recommended to find the composition of the stone and to take appropriate therapeutic and preventive measures for lithiasis. In case of recurrent lithiasis, metabolic control is recommended to rule out diseases that need treatment (eg hyperparathyroidism).

 

General preventive measures

It is recommended to drink plenty of water (2-3 liters per day), limit red meat and excessive salt, and consume vegetables and natural juices.

References:

http://uroweb.org/guideline/urolithiasis/

http://www.imop.gr/uroinfo-urolithiasis