[의학신문·일간보사=정광성 인턴기자] The top three causes of pain in the medical community are childbirth, acute gum disease, and urolithiasis. If left untreated, urolithiasis is called a silent assassin because it can cause pyelonephritis or sepsis, and can even lead to kidney damage and dialysis. Therefore, if you have symptoms of urolithiasis, it is important to be tested in advance and treated promptly.
The path through which urine flows from the kidneys to the ureters, bladder, and urethra is called the urinary tract. When the urinary tract becomes saturated with crystals such as mineral salts in the urine, it blocks the way to urinate or forms a lump that causes inflammation, which is called urolithiasis.
Decreased water intake is the most important cause of urolithiasis. Decreasing water intake increases the rate of stone formation by allowing the crystals that make up stones to stay in the urine longer. The prevalence of stones is regarding 11-13%, and men have a higher risk than women.
Temperature and season are also important factors in the development of urolithiasis. In summer, sweating a lot can make urine more concentrated, which can facilitate the formation of urolithiasis.
Urinary stones are basically very painful because stone crystals of various shapes can come out with urine and scratch the urinary tract. It is also called uric acid pain because it is a pain comparable to colic, and the pain may last for more than 10 hours. When stones come out, the urinary tract is blocked and the kidneys swell. This can cause nausea or nausea.
On the other hand, some people have no symptoms. Even if you have urolithiasis, the urinary tract is not completely blocked, so there is no pain, or if the urinary tract blockage is prolonged, the function of the kidneys may be impaired, and even pain may not be felt. So, having no symptoms is not always a good thing. In particular, if hematuria or uric acid pain occurs when urinating, it is recommended to have a urolithiasis test.
After the occurrence of urolithiasis, on average, regarding 7% of urolithiasis occur following 1 year, and regarding 50% of urolithiasis recur within 5 years. If a small amount of broken stone remains even following surgery such as shock wave, the rate of recurrence of urolithiasis increases, and there is a high probability that it will eventually reoccur in the same location.
Above all, one of the biggest reasons to treat urolithiasis is kidney health. If there is no permanent tissue damage, the kidney can recover to some extent. However, if the inflammation is severe enough to cause tissue degeneration, a part of the kidney may die, and in the long term, the kidney may lose its function, leading to dialysis.
To prevent urolithiasis, drinking plenty of water is very important because it helps the stones to be excreted in the urine. Also, don’t forget to limit your intake of foods that are high in stone-forming ingredients.
If the stone has subsided in the lower part of the kidney, you can induce the discharge of the stone by lying down (down dog) or lowering the head by using a bed, sofa, or exercise equipment. Frequent tapping of the back (kidney) area to help the stone move is also helpful.
When urolithiasis is examined by ultrasound, the diagnosis rate is as high as 7 to 80%. However, stones that are small (less than 4 mm) or deep in the ureter are sometimes difficult to detect by ultrasound.
If the size of the stone is small, there is a possibility of spontaneous excretion, but when the size is 5 mm or more, the rate of spontaneous discharge decreases. If the stones are medium in size, such as 5 to 15 mm, ‘extracorporeal shock wave lithotripsy’ is performed by focusing shock waves on the stones and crushing them.
However, if extracorporeal shock wave lithotripsy is performed and the stones do not break or the stones are large, ‘ureteroscopic lithotripsy’, which inserts a flexible endoscope into the urethra and removes the stones in the ureter with a laser, is performed. This method is performed under general anesthesia without skin incision, and in most cases, normal life is possible within 1 to 2 days following surgery.
On the other hand, ‘percutaneous nephrolithiasis’, which is performed when the size of the stone is very large (15~20mm or more), is performed by making a passage through the flank, inserting an endoscope into the kidney, and removing the stone or crushing it with a laser. This method is also performed under general anesthesia and the recovery period is fast without a large incision, but there is a possibility of a large amount of bleeding.
Even with our best efforts, there is still no treatment method with 100% success rate and safety. However, with the development of technology, urolithiasis can be treated much more safely than in the past.
In particular, flexible endoscopic surgery can treat urolithiasis located in all areas of the kidney and reduces the risk of bleeding.
