Diagnosis, prevention and composition classification of urinary tract stones
> 6.5 // How do I know if I have urinary tract stones?**
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The main symptom of urinary tract stones is pain. Depending on the location of the stone, ureteral stones generally present as severe colicky pain in the lower back, accompanied by hematuria. The pain has a sudden onset and cannot be relieved by ordinary painkillers. It can be diagnosed quickly through abdominal X-ray and B-ultrasound.
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Kidney stones are often asymptomatic in their early stages and are usually discovered incidentally during a physical examination. Sometimes, lower back discomfort and microscopic hematuria may occur. Ultrasound and CT scans can provide a definitive diagnosis.
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The main symptom of urethral stones is the sudden onset of inability to urinate, accompanied by penile pain.
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Severe pain in the urethra, which is most noticeable during urination, can usually be diagnosed by a doctor through a simple physical examination.
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6.6//How to prevent urinary tract stones?
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(1) Dietary prevention
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Drinking plenty of water and controlling diet can prevent the formation of new stones in 64-70% of patients with recurrent kidney stones.
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Drinking plenty of water can increase urine production, which can dilute the concentration of calcium oxalate and other substances in the urine. At the same time, urine can flush out small stones that have already formed. Increasing urine volume by 50% can reduce the incidence of stones by 86%.
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A normal person should maintain a urine output of more than 2000 ml in 24 hours, while patients who have had kidney stones should maintain a urine output of 2000-3000 ml. Water intake should be evenly distributed throughout the day.
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Drinking water itself has a diuretic effect, so you should develop the good habit of drinking plenty of water. It can be said that drinking water is the most economical and reliable way to prevent and treat kidney stones.
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Animal protein is important for nutrition, but excessive intake can increase the risk factors of calcium, oxalic acid, and uric acid. Adults need 75-90% of their daily protein intake, and should supplement with plant protein such as tofu.
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Drinks and foods containing sucrose should be consumed sparingly, as they can increase urinary calcium levels; patients with kidney stones should strictly limit their intake.
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Spinach contains high levels of oxalic acid, so it is not suitable for people with kidney stones. Other types of vegetables and fruits, however, should be consumed in large quantities.
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Alcohol can increase uric acid levels and can also cause urine concentration after drinking. People with gout should especially abstain from alcohol.
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Since the calcium content in the Chinese diet is not high, it is not currently recommended to restrict the intake of calcium and milk or dairy products. Furthermore, reducing the amount of calcium in food will increase the absorption of oxalic acid, so there is no obvious restriction on calcium intake.
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(2) Drug treatment for kidney stones
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Urolithiasis caused by metabolic abnormalities that can be controlled or prevented through diet usually requires oral medication.
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> Category 1 drugs: Drugs that lower urinary calcium and oxalate: Cellulose phosphate, orthophosphate, and indomethacin can reduce calcium absorption, and vitamin B₆ can reduce urinary oxalate, etc., which can be used to prevent urinary stones.
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The second category of drugs includes magnesium preparations, potassium citrate, and seaweed, which can increase the activity of stone-inhibiting components in urine, thus playing a role in preventing stones.
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The third category: Traditional Chinese medicine for the prevention and treatment of stones, based on syndrome differentiation, prescribing a suitable Chinese herbal medicine formula.
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(3) Regular physical examinations
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It is recommended to have a urinary tract ultrasound examination annually.
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If you have a history of kidney stones, it is recommended that you have your stones analyzed to determine their characteristics. This will allow for more precise prevention of kidney stones.
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> 6.7 // Composition and Treatment of Urinary Tract Stones**
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> 6.7.1 **Composition of Stones**
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Based on their composition, kidney stones are further classified into: ① Calcium-containing stones, whose main components are calcium oxalate and calcium phosphate. Most kidney stones are calcium-containing stones, which are also the most common type of stones in urology, accounting for about 80-84% of all stones. ② Uric acid stones, whose main component is uric acid. Because uric acid stones contain little calcium, they are not visible on X-rays and are generally diagnosed by ultrasound and CT scans.
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The urine of patients with uric acid stones is strongly acidic, and the stones are not very hard. It is the only type of stone that can be dissolved by medication. Generally, potassium citrate and sodium bicarbonate are taken orally to raise the urine pH. When the urine pH is maintained at 7.0, it is conducive to the rapid dissolution of uric acid.
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12% of patients with primary gout may develop uric acid stones.
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> ③ Cystine stones, whose main component is cystine, account for 1-3% of kidney stones and are mainly seen in congenital renal tubular defects.
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> ④ Infectious stones, mainly composed of magnesium ammonium phosphate hexahydrate, calcium phosphate, and urate, are primarily caused by poor urinary drainage and secondary urinary tract infections, accounting for approximately 15-20% of kidney stones. Infectious stones grow rapidly and have a high recurrence rate. Their formation is mainly caused by bacterial infection that decomposes urea. The urine of these patients is strongly alkaline. Treatment differs from that for uric acid stones; the urine cannot be alkalized but must be acidified. Ammonium chloride 3-9 grams/day, divided into 3 oral doses, can be used, along with oral antibiotics and plenty of water. However, there are currently no litholytic drugs to treat this type of stone.