Stones of a mochetochnik
Stones of a mochetochnik – the manifestation of an urolitiaz which is characterized by migration of a concrement from a kidney lokhanka to the output canal are more rare – primary formation of concrements in a mochetochnik. Stones in a mochetochnik most often cause development of renal colic – the expressed pain syndrome, dizurichesky frustration, an oliguriya, a gematuriya. Diagnostics of a stone in a mochetochnik includes performance of a survey X-ray analysis of an abdominal cavity, urography, ultrasonography of uric system, an ureteroskopiya and ureteropiyelografiya. At impossibility of an independent otkhozhdeniye of a stone from a mochetochnik resort to an ureterolitoekstraktion, an ureterolitotripsiya, an ureterolitotomiya.
Stones of a mochetochnik
Stones in a mochetochnik () in comparison with concrements of other localizations (stones of a bladder, urethra, kidneys) are dangerous by the heaviest and serious complications. The concrements breaking an urine passage cause a loosening mucous a mochetochnik, hemorrhage in its submucous layer, a hypertrophy of a muscular wall. Over time the progressing changes lead to an atrophy of muscle and nervous fibers of a mochetochnik, sharp decrease in its tone, ureteroektaziya and a gidroureteronefroz. At infectious process in anatomic the changed mochetochnik the ascending pyelonephritis quickly develops, the descending cystitis, an inflammation of surrounding cellulose - periureterit and peripiyelit. On the place it is long the stone which is in a mochetochnik decubituses, striktura, perforation of a wall can be formed.
The reasons of formation of stones in a mochetochnik
The most part of concrements of mochetochnik which the practical urology faces are the stones of kidneys displaced from a lokhanok. They can have the various form and size. More often in a mochetochnik single concrements get stuck, however also multiple stones of a mochetochnik meet. Usually the concrement is late in zones of physiological narrowing of a mochetochnik – a lokhanochno-mochetochnikovy segment, in the field of a recross with podvzdoshny vessels or a puzyrno-mochetochnikovy segment. For a delay in a mochetochnik diameter of a stone has to exceed 2 mm.
The Lokhanochno-mochetochnikovy segment is a place of transition of a kidney lokhanka of bigger diameter in a mochetochnik with a gleam 2-3 mm. After a lokhanochno-mochetochnikovy segment the gleam of a mochetochnik extends to 10 mm therefore the small stone can be displaced distalny – before the second physiological narrowing at the level of podvzdoshny vessels. In this place the mochetochnik crosses the upper bound of an entrance to a basin and again is narrowed to diameter of 4 mm. The third physiological narrowing of a mochetochnik is the puzyrno-mochetochnikovy segment where diameter of a mochetochnik makes 1-5 mm.
In the top third of a mochetochnik about 25% of stones, in average – about 45%, in lower – to 70% get stuck. Primary stones in a mochetochnik meet seldom. Their initial education in a mochetochnik can be promoted an ureterotsela, a tumor, by an ektopiya of a mochetochnik, a striktura, foreign matters (ligatures, etc.). Stones of the left and right mochetochnik come to light equally often.
In genesis of an urolithic disease a certain role belongs to geographical and climatic factors. So, in the basin of Don and Volga, in the Caucasus, in Central Asia, Bavaria and Dalmatia meets especially often. Kamneobrazovany in urinary tract is promoted by alimentary factors – features of food and quality of drinking water.
As formation of stones violation fosfornokisly, shchavelevokisly, mochekisly, etc. is the cornerstone of types of a metabolism, the frequency of an urolithic disease correlates with gout, giperparatireozy, osteoporosis, fractures of bones.
In pathogenesis of a kamneobrazovaniye paramount value plays change urine, violation of its colloidal state and decrease in the dissolving ability. Such changes can develop under the influence of an infection, first of all, of pyelonephritis. The known part is assigned to the factors leading to an urostaz here - to the wrong structure of cups and a lokhanok, to striktura and valves of a mochetochnik, incomplete depletion of a bladder at an urethra striktura, prostate adenoma, diverticulums of urinary tract, vertebral and spinal injuries etc.
Symptoms of stones in a mochetochnik
Clinical manifestations of stones of a mochetochnik develop at a partial or total block of outflow of urine from a kidney. Therefore at 90 — 95% of patients stones in a mochetochnik come to light only at development of renal colic.
At partial overlapping of a gleam of a mochetochnik a stone dull aches, with localization in the corresponding costal and vertebral corner. In case of a full obturation of a mochetochnik sudden violation of outflow of urine from a kidney, restretching of a lokhanka and increase in vnutrilokhanochny pressure develops. Violation of microcirculation in renal fabric and irritation of the nervous terminations causes the strongest attack of pains - renal colic.
The bad painful attack at a stone in a mochetochnik develops suddenly and is more often connected with the physical tension, bystry walking, jolty driving or plentiful reception of liquid. Pains are localized in a waist and a podreberye, irradiate on the course of a mochetochnik in a scrotum or vulvar lips. The acute pain forces the patient to change continuously situation that, however, does not give relief. Renal colic can proceed several hours or days, periodically abating and renewing again.
The painful attack at a stone in a mochetochnik is followed by reflex disorders of activity of a GIT – nausea and vomiting, a meteorizm, a chair delay, tension of muscles of a forward belly wall. It is connected with irritation of the nervous terminations adjacent to the blocked kidney of a parietal peritoneum.
Dizurichesky frustration at a stone in a mochetochnik depend on the location of a concrement. At localization of a stone in the lower department of a mochetochnik continuous painful desires on an urination, feelings of strong pressure in nadlobkovy area caused by irritation of receptors of walls of a bladder develop.
Sometimes at an obturation of a mochetochnik the stone observes an oliguriya in view of impossibility of removal of urine from a kidney or the general dehydration at severe vomiting. At stones in a mochetochnik in 80 — 90% of cases the makrogematuriya which often precedes a painful attack is noted. Long finding of a stone in a mochetochnik leads to accession of a leykotsituriya and piuriya.
Renal colic is accompanied by sharp deterioration in the general state – a headache, a fever, weakness, dryness in a mouth, etc. At a small stone in a mochetochnik renal colic can end with a spontaneous otkhozhdeniye of a concrement. Otherwise the bad attack of mochetochnikovy pain will surely repeat.
Serve as the most probable complications of stones in a mochetochnik obstructive pyelonephritis, , development of a renal failure (at a bilateral ureterolitiaz or concrements of the only kidney). At a part of patients with stones of mochetochnik the disease is burdened by accession of an infection - colibacillus, vulgar a protea, staphylococcus that is shown by sharp and chronic pyelonephritis, uretrity, pionefrozy, urosepsisy.
Diagnostics of stones in a mochetochnik
The clinic of renal colic with high degree of probability forces the urologist to assume existence of stones in a mochetochnik. The palpation of a projection of kidneys is extremely painful, reaction to a symptom pokolachivy – sharply positive. After knocking over of renal colic at a palpation of points of the Tour corresponding to places of anatomic narrowing of mochetochnik morbidity remains.
Urine researches at a stone in a mochetochnik (the general analysis, a biochemical research of urine, definition of pH, bacteriological crops) can give valuable information on availability of impurity in urine (erythrocytes, leukocytes, protein, salts, pus), chemical structure of stones, causative agents of an infection etc.
For visualization of a stone in a mochetochnik, definitions of their localization, the sizes and a form the comprehensive radiological, endoscopic and ekhografichesky examination including a survey X-ray analysis of an abdominal cavity, survey urography, excretory urography, KT of kidneys, an ureteroskopiya, radio isotope diagnostics, ultrasonography of kidneys and mochetochnik is carried out. On the basis of a complex of data medical tactics concerning a stone in a mochetochnik is planned.
Treatment of stones in a mochetochnik
Conservative and waiting tactics at a stone in a mochetochnik is proved in case of the small size of a concrement (to 2-3 mm). In this case spazmolitik, water loading (more than 2 l a day), medicines-urolitiki (extract of fruits of an amma tooth, the combined phytomedicines), antibiotics, LFK, physical therapy (a diathermy, diadynamic currents, subakvalny bathtubs) are appointed. At development of renal colic urgent measures for its knocking over by means of narcotic analgetics, blockade, spazmolitik are taken.
Introduction to a gleam of a mochetochnik of the special medicines (glycerin, a papaverine, a prokain) strengthening a vermicular movement and facilitating advance of a concrement or carrying out electric stimulation of uric ways through catheters electrodes is among endovezikalny methods of removal of stones.
In some cases for extraction of stones from a mochetochnik resort to endourological intervention – an ureterolitoekstraktion – removal of concrements by means of special loops traps via the channel of the ureteroskop entered into a gleam of a mochetochnik. At infringement of a stone in the mouth of a mochetochnik resort to his section facilitating extraction or an otkhozhdeniya of a concrement. After extraction of a stone stenting of a mochetochnik is made for the best otkhozhdeniye of urine, sand and microscopic fragments of a concrement.
Concrements with a diameter more than 6 mm before extraction demand fragmentation which is reached by carrying out an ultrasonic, laser or electrohydraulic lithotripsy (crushing). At a stone in a mochetochnik apply a remote ureterolitotripsiya or a chreskozhny contact ureterolitotripsiya.
The open or laparoscopic ureterolitotomiya is shown at a stone in a mochetochnik more than 1 cm; the infections which are not giving in to antimicrobic therapy; to the heavy, not stopped colic; not moving ahead concrement; obstructions of the only kidney; inefficiencies of UVL or endourological methods.
Prevention of formation of stones in a mochetochnik
Prevention and the prevention of a recurrence of formation of stones in mochetochnik demands treatment of violations of exchange, pyelonephritis, an urostaz. After removal of a stone and restoration of a passage of urine elimination of the anatomic reason of obstruction is necessary ( and valves of mochetochnik, a prostate giperplaziya, etc.).
The dietotherapy (restriction of table salt, fats), daily primas not less than 1,5-2 l of liquid, special phytocollecting, resort rehabilitation is recommended to the patient with this or that form of an urolitiaz.