The ureter is a muscular passage that connects the kidneys and the bladder, through which urine passes to the bladder, which gets rid of it outside the body. Ureteral ureteral lithotripsy, symptoms, diagnosis, and treatment.

Symptoms of ureteral stones:

The nature, size and location of the stone are among the main factors that affect the symptoms that the patient feels, but in all cases, the patient often suffers from renal colic, along with some other symptoms such as:

blood with urine;
Burning sensation in urine.
Sudden interruption of urination.
the heat.
Desire to vomit.

The relationship between the location of ureteral stones and the symptoms

If the stone is in the upper area of ​​the ureter, it causes pain in the middle of the abdomen that extends to the lower back.
If the stone is in the middle area of ​​the ureter, the pain is in the middle of the abdomen only.
But if the stone is below the ureter, the patient feels pain in the middle of the abdomen that extends to the upper thigh.

Diagnostic methods

The traditional examination: in which the doctor relies on the patient and describes the symptoms he feels.
Radiological examination: where the x-rays show a large percentage of stones.

Methods of treating ureteral stones:

Drug treatment: It is used with small stones that do not exceed several millimeters in diameter and that do not obstruct the passage of urine from the ureter, as some medicines help in their disappearance and descent with urine.
Aspiration: This method is used with some stones located at the bottom of the ureter or in the urethra.
External or superficial lithotripsy: It is the disintegration of stones using shock waves, sound waves, or lasers.
Internal fragmentation: It is fragmentation using a laser through surgical endoscopes.
Surgery: It is the doctor’s resort to performing a surgical operation with anesthesia to extract stones, which are often large in size and in areas where the doctor cannot insert the endoscope, and they did not respond to other methods of fragmentation.

Laparoscopic ureteral lithotripsy:

Laparoscopic fragmentation of ureteral stones is a procedure that begins with inserting the endoscope from the urethra, until it reaches the ureter stone. The endoscope camera gives an accurate picture of the ureter and the stone, its location and size, and then the doctor targets it with x-rays, fragments it and turns it into small particles, then sucks it and pulls it out, and a fragmentation process is performed Laparoscopic ureter stones under the influence of anesthesia and this process takes from one to three hours.

If the ureteral stone is small, it is removed completely by endoscopy only, and if it is large, with a narrowing of the ureter, it is first broken up using a laser into small parts, removed by the endoscope.

The type of endoscope used for endoscopic dissolving ureteral stones

The rigid endoscope is used to break up ureteral stones if the stone is in the lower region of the ureter, while the flexible endoscope is used in most endoscopic ureteral stone fragmentation operations.

Conditions for lithotripsy with ultrasound and shock waves

The length of the stone should be less than one and a half centimeters.
The patient does not suffer from any infections in the urethra.
The patient does not suffer from kidney obstruction.

If the patient’s condition does not improve and the stones are not broken down during one or two sessions at most of the shockwave and sound wave therapy, these sessions should not be repeated and attempts to treat in this way should be stopped, and the doctor resorts to endoscopic fragmentation of ureter stones as an alternative and final solution.

Bladder stones

It is a mineral mass that forms in the bladder due to the patient’s inability to get rid of urine completely when the concentrated minerals and foreign substances crystallize in the urine, to become a stone, the stones may be small and descend with the urine without treatment, but in some cases the patient must undergo drug treatment Or surgery, and if bladder stones are neglected without treatment, the patient may be exposed to infection or complications, and the largest percentage of bladder stones are men over the age of fifty.

Symptoms

Usually, even large bladder stones do not result in any symptoms or problems, but if the stones lead to irritation in the bladder wall or impede the descent of urine and the patient is exposed to episodes of urinary retention, it may result in the following symptoms:

Pain in the lower abdomen
Painful urine with frequent urination
Difficulty and interruption in urination
Presence of blood in urine
Urine cloudy and discolored

Causes of bladder stones:

Enlarged prostate gland: It may cause the formation of bladder stones in men because the enlargement of the gland obstructs the flow of urine, and prevents the bladder from getting rid of urine, allowing sediment and salt to accumulate and the formation of stones.
Nerve damage: In case of damage to the nerves that give signals to the bladder and direct it to contract or relax; The bladder may lose the ability to completely expel urine.
Bladder infections: Urinary tract infections or exposure of the abdomen to radiation therapy are among the things that may lead to the formation of bladder stones.
Medical devices: the use of a bladder catheter in cases of urine retention in the bladder and its inability to expel it; It may cause the formation of bladder stones, and some crystals formed on the equipment used in gynecology or the urinary stent can move to the bladder, which may later turn into stones.
Kidney stones: Some of the small kidney stones that reach the bladder, do not go out with the urine and with time, the impurities suspended in the urine are deposited on them that turn into bladder stones.
Any problem that obstructs the flow of urine and its descent from the bladder may lead to the formation of bladder stones, and the most common cause is an enlarged prostate.

Diagnosis

The traditional examination: the regular and manual examination of the doctor to confirm the enlargement of the bladder.
Urine sample analysis: Conducting a microscopic analysis of a urine sample to detect the presence of blood, bacteria or crystallized minerals that may be the cause of bladder stones.
Radiology: Computerized tomography, ultrasound, and x-rays are used to detect the presence of bladder stones.

treatment

At first, the doctor prescribes some drug treatments in addition to advising the patient to drink at least 3 liters of water and fluids that help the bladder get rid of small stones by passing out with urine, but as a result of bladder stones often formed because the bladder is not completely rid of urine, it may not be considered Water and fluids are a solution to get rid of these stones, so the treatment is to remove the stones and get rid of them is the solution.

Bladder stones removal methods:

1- Laparoscopic removal of bladder stones:

The doctor inserts the endoscope through the urethra under the influence of local anesthesia into the bladder to allow the doctor to see the stone. Then, he directs a laser or ultrasound to the stone until it is broken up and drained outside the bladder. The process of breaking up bladder stones with endoscopy is faster, easier and more accurate, and complications are rare for the patient during it .

2- Surgical removal:

The doctor resorts to surgical intervention in the event of the large size of the stones or because there are difficulties in breaking them up, so the solution is to remove these stones through traditional surgery.

kidney stones :

Kidney stones form as a result of a genetic factor or as a result of a lack of fluid in the blood and high levels of salt and some minerals in the urine for a long time.

Symptoms:

Symptoms do not appear in a large proportion of cases as long as the stone is stationary and does not move in the kidneys, but it may cause sharp and sudden pain when it moves outside the kidneys. Besides the pain, the patient may feel a rise in his body temperature with a desire to vomit, with a change in the color of urine to red

treatment

In the event that the stone is small, the doctor prescribes to the patient some treatments that help the body get rid of it, anti-inflammatory and analgesics. In cases of large stones that are difficult to get out of the body, or when they are stuck inside the kidney tissues, in this case, the solution is to break up the kidney stones with laser.

Laser dissolving kidney stones

During this process, the doctor is guided by ultrasound; To determine the location of the pebble, and after inserting the endoscope through the urethra to the place of the pebble inside the kidney, he directs the laser beams on it for several times, to make sure that it is completely disintegrated and then takes it out through a special basket of the endoscope. Small particles may remain that come out with the urine. the time .

The patient can return to his home during the same day or the next day, according to his health condition and to what extent he does not need follow-up. The patient often feels discomfort and fatigue after the removal of kidney stones by laser, along with a burning sensation during urination for a few hours after the operation and these symptoms do not last long but go away gradually.

Kidney stone removal surgery cost

The cost of laparoscopic lithotripsy depends on the type of endoscope used, flexible, solid or digital.
Gallstones in terms of location, size and composition.
Procedures and care that is provided to the patient before, during and after the operation.
The doctor’s experience and medical status, services and level of equipment of the medical center in which the operation is performed.

What are the necessary tips to avoid urinary stones?

Drinking fluids constantly, especially water, in an amount of not less than 3 liters per day, helps prevent the deposition of salts and the formation of stones.
Refer to the doctor before taking any drugs, especially vitamins and nutritional supplements.
Nutritional balance and healthy eating.

Kidney, ureter and bladder stones are among the most pathological conditions facing the urinary system and result in serious complications if the patient neglects them and does not care quickly to go to the appropriate doctor to treat them. He uses the latest treatment techniques with expertise and high efficiency, and the cure rates among his patients are the biggest evidence.

Dr. Mohamed Metwally

Consultant of Urology, Andrology and Infertility at Ain Shams University Hospitals