Urolithiasis, according to the World Health Organization, affects every 10th person on Earth. At the same time, the share of emergency care for patients with this pathology is about 40%. High-quality treatment of the disease is the key to preventing more serious complications. In Germany, patients with urolithiasis are treated with an individualized and interdisciplinary approach.
Main manifestations
Urolithiasis is characterized by the appearance of stones of various types in any part of the urinary system. Thus, the symptoms will depend on the characteristics of the stones:
— kinds
— localization
— form
— quantity
— mobility
All variants of pathology are characterized by three symptoms.
- Pain. Any characteristics of pain will depend on the location of the stone and its mobility. If it is in the kidney, the pain will be mainly in the lumbar region. It can be confused with pain due to osteochondrosis of the lumbar spine. If the stone goes lower and is located in the ureter, the pain is localized in the lower back, as well as the abdomen. This localization is common and can lead to complete occlusion of the ureter. In this case, urine does not flow out, but remains in the kidney. The pain is severe and quite long-lasting. Such sensations are also called “renal colic”. In this case, emergency intervention is required to remove the stone and free the urinary tract.
- Blood in urine. The appearance of blood in the urine or hematuria always accompanies urolithiasis. Stones, passing through the urinary tract, scratch the delicate wall of the organ, which leads to bleeding. If the stone is large and mobile, it can cause bleeding that is severe enough to require intensive treatment. In some cases, blood may not be visible, but a microscopic examination of the urine will reveal red blood cells.
- The appearance of stone fragments in the urine. Depending on the size of the stone, you may see some sand in the urine, but urination will be painful. In some cases, fragments are not visually visible in the urine, however, the analysis reveals a large number of different salts, which provides information to the specialist about the presence of pathology, as well as its type.
Particular attention is paid to situations where stones are located outside the kidneys, that is, in the ureters.
In this case, there are three variants of pathology, depending on the location:
— upper third — pain is localized above the navel;
— middle third – pain on the side of the navel;
— lower third – pain below the navel.
If pain occurred in the suprapubic region, then a stone could form or descend into the bladder. In this case, the pain will be severe and will intensify during attempts to urinate. Also, when urinating, droplets of blood may be released in the urine, which clearly indicates the location of the stone.
Diagnostic tests
First of all, the doctor will conduct a detailed survey about the nature, localization of pain, its duration and time of onset. In addition, the specialist will clarify the presence of concomitant diseases, since it is known that in patients with diabetes mellitus, hypertension and obesity, urolithiasis in the kidneys is much more common.
After the interview, the doctor will examine the patient’s lumbar region if the pain is characteristic of “renal colic” and will assess the presence of Pasternatsky’s symptom or the effleurage symptom. A positive symptom is characteristic of kidney disease.
Next, you need to conduct a urine test. The analysis will determine the nature of the formations, which shows the pH of the urine. In addition, red blood cells and, if there are inflammatory processes, leukocytes can be detected in the urine. In addition to diagnosing the disease, it is necessary to determine the cause of the development of the pathology. In this case, it is necessary to perform a blood test for hormones (thyroid and parathyroid hormones, vitamin D, catecholamines) and various microelements (calcium, sodium, uric acid levels).
After laboratory tests, the specialist will prescribe sonography of the kidneys and urinary tract. Clinics in Germany are equipped with high-tech equipment, with which a specialist can see formations less than a millimeter in any part of the human urinary system.
Another fairly reliable diagnostic method is magnetic resonance imaging. It allows you to identify stones at any level, without requiring any preparation of the patient for the study.
Therapy methods
Treatment depends on the type of urolithiasis and when the patient developed symptoms.
There are several directions in the treatment of pathology.
- Expectation
In German clinics, if, according to instrumental research methods, the size of the formation is small enough to pass through the urinary tract, in such cases experts recommend simply waiting for the stone to pass. Of course, this is done under the supervision of urologists, since, for example, the ureter has various narrowings, which can lead to its obstruction during the passage of a stone, in addition, inflammatory changes can occur and pain can become unbearable. Waiting times can vary from 4 to 6 weeks.
- Pills
German urologists use certain medications that relax the ureter, which facilitates the passage of the stone. In addition, medications for nausea and pain are often used.
- Surgical treatment
Surgery may be required to remove a mass from the ureter or kidney if:
— The stone does not pass.
— The pain is unbearable to wait for the stone to come out.
— Urolithiasis affects kidney function.
Kidney stones should be removed surgically if they cause recurring infections in the urine or block the flow of urine. Today, operations are usually performed using small incisions and are accompanied by minor pain in the postoperative period.
There are several types of operations:
- Extracorporeal shock wave lithotripsy. Shock waves are focused on the stone using X-rays or ultrasound. The shock waves cause the stone to break into small pieces. These small pieces pass through the ureter and come out within a few weeks. Due to the possible discomfort caused by the shock waves and the need to control breathing during the procedure, anesthesia is often required.
2. Urethroscopic removal
In ureteroscopy, a very small telescope called a ureteroscope is inserted through the urethra, into the bladder, up the ureter and into the kidney. There are two options for ureteroscopes:
— Hard for stones in the lower part of the ureter
— Flexible — used for the treatment of urolithiasis localized in the upper ureter and kidneys.
The ureteroscope allows the urologist to see the structure without making any incisions. Once the urologist sees the pathology using the ureteroscope, a small, basket-like device grabs small stones and removes them. If the stone is too large to remove at one time, it can be broken into smaller pieces using a laser or other tools. The procedure is performed under anesthesia.
Once the entire mass is removed, the doctor may place a temporary stent in the ureter. A stent is a tiny, rigid plastic tube that helps hold the ureter open so urine can drain from the kidneys into the bladder. Unlike a catheter or drainage tube, a stent is completely inside the body and does not require an external bag to collect urine. The stent is removed after a few days.
- Percutaneous nephrolithotripsy. This is the best method for removing tumors from the kidneys. For this type of operation, general anesthesia is performed. A small incision is made on the side or back. A nephroscope is inserted through it, which passes into the central part of the kidney, where the stone is located. Using a nephroscope, the entire stone is removed, or if it is large, it is broken into several parts and then they are removed. Usually a tube or drain is left in the kidney for some time to drain blood and urine. The next day the drainage is removed.
- Laparoscopic removal. This technique is used if all previous ones have failed. In this case, the operation is performed using robotic technology, in particular, the DaVinci surgical robot.
After any treatment methods in German clinics, specialists will refer the patient to a nutritionist, who will tell you in detail about those foods that need to be excluded so that urolithiasis does not progress in the future.
Cost of treatment
The cost of treating urolithiasis depends on the nature of the disease, as well as the method of treatment.
Diagnostics — from 1000 Euro, outpatient, 2 days
Diagnostics with conservative treatment — from 4000 Euro, inpatient, 5 days
Which clinic to choose?
There are urologists in Germany who can help in the treatment of pathology. However, in order to choose a highly qualified specialist and the clinic where he operates, knowledge of many aspects of German medicine is required. Our expert doctors will help you solve this problem. They have knowledge of every doctor in Munich, their clinical and scientific achievements.
The experts work under the leadership of Maxim Sergeevich Rykov, who is the head of the German Clinic center, has a higher medical education and has been working in Germany for more than 10 years. The experience of our employees will help you determine the necessary specialist and clinic for quality treatment.
Urolithiasis requires special attention and, in the absence of proper treatment, can lead to serious complications.