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尿 石 症 Urinary Stone Disease

尿 石 症 Urinary Stone Disease. 瑞金医院泌尿外科. Urinary Calculi. The 3 rd most common affliction of the urinary tract. Exceeded only by urinary tract infections and pathologic conditions of the prostate. Epidemiology. Surrouding enviroment ： natural, social

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尿 石 症 Urinary Stone Disease

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  1. 尿 石 症Urinary Stone Disease 瑞金医院泌尿外科

  2. Urinary Calculi The 3rd most common affliction of the urinary tract. Exceeded only by urinary tract infections and pathologic conditions of the prostate.

  3. Epidemiology Surrouding enviroment：natural, social Internal agents：racial inheritance，nutrition，metabolic abnormalities（cystine，oxalate，calcium&phosphate，uric acid），acquired diseases（hyperpara-thyroidism，hypercorticosteronism，gout），medicines

  4. Stone Formation Mechanism： Only partly identified：metabolic，infectious Most： unknown

  5. Stone Formation Requires---supersaturated urine （1）ionic strength （2）urinary PH （3）solute concentration ---decrease of inhibitor

  6. Stone Formation Anatomical abnormalities Urinary infection Abnormal calcium&phosphate transfer in renal epithelial cells

  7. Stone Formation Nucleation theory: stones originate from crystals or foreign bodies immersed in supersaturated urine. Crystal inhibitor theory: calculi form owing to the absence or low concentration of natural stone inhibitors—magnesium, citrate, pyrophosphate(焦磷酸盐), acid glycoprotein

  8. Stone Component Crystal：oxalate，phosphate，uric acid & urate，cystine，xanthine Matrix：organic principle 42%~84%， （1）致密的纤维状基质构成同心层(concentric lamina)结构；（2）不定形基质构成凝胶状结构

  9. 尿结石晶体成分

  10. 尿结石晶体成分

  11. 尿结石晶体成分

  12. 尿结石晶体成分

  13. 尿结石晶体 密度:高 低 草酸钙 磷酸钙 磷酸镁铵 胱氨酸 尿酸 硬度:高 低 磷酸钙 草酸钙 尿酸 胱氨酸 磷酸镁胺 结石愈硬越易击碎

  14. Ureteral stone protruded from the left ureteral orifice

  15. Single calcium oxalate calculus

  16. Multiple calcium oxalate calculi

  17. Multiple uric acid calculi

  18. Pathophysiology Primary pathological changes：renal tubular lesions，production of stone matrix，formation of Randall plaques (肾钙斑). Secondary pathological changes ：local mechanical damage，urinary obstruction，infections，stones combining with polyps or malignancies.

  19. Clinical Features(Stones at upper urinary tract) Pain: Renal colic– stretching of the collecting system or ureter. Noncolicky renal pain-- distension of the renal capsule.

  20. Clinical Features(Stones at upper urinary tract) Hematuria Infection– pyonephrosis, xanthogranulomatous pyelonephritis Associated fever Nausea & vomiting

  21. Diagnosis History Lab Tests：urinalysis，urine culture，serum calcium,phosphate&uric acid，BUN &creatinine Radiological investigations：KUB+IVU，ultrasound，CT，retrograde urography Endoscopy

  22. IVP

  23. Retrograde Urography

  24. MRU

  25. Renal Calculi

  26. Renal Calculi

  27. Renal Calculi

  28. Renal Calculus

  29. 肾结石二维B型超声影像图

  30. Ureteral Calculus

  31. 输尿管结石二维B型超声影像图

  32. Treatment Conservative observation：most ureteral calculi pass and do not require interventions. Conservative therapy: plenty of water intake, diet, infection control, adjustment of urine PH Cystine calculi——alkalinize urine（PH>7.8），D-pencillamine(青霉胺)，-MPG(mercaptopropyonyl glycine)巯丙基甘氨酸

  33. the traditional Chinese medicine 排石冲剂（颗粒）：含关木通(caulis)成分，内有马兜铃酸(Aristolochic Acid)，具备肾毒性。 复方金钱草(lysimachia)冲剂

  34. Treatment Extracoporeal Shock Wave Lithotripsy, ESWL（体外冲击波碎石） Endoscopic surgery： Ureteroscopic (输尿管镜 ) stone extraction PCNL (Percutaneous nephroscopic lithotripsy) Open surgery: pyelolithotomy, nephrolithotomy, ureterolithotomy

  35. 硬性输尿管镜 软性输尿管镜

  36. 钬 激 光 碎 石

  37. 开放手术

  38. 开放手术

  39. 治疗 双侧上尿路结石手术原则：（相对性） （1）双侧输尿管结石：梗阻严重一侧 （2）一侧输尿管一侧肾结石：输尿管 （3）双侧肾结石：容易一侧 （4）急性梗阻无尿：立即手术或经皮肾造瘘

  40. Intervention of Renal Colic Antispasmodic therapy: atropine, anisodamine, progesterone Analgesia: pethidine, suppository of indomethacin, procaine Combining treatment

  41. Case Report 61yr female，recurrent obvious flank pain with high fever。Urinalysis WBC++++，relief after antibiotics therapy. Ultrasound: fluid occupation at lower pole of Rt kidney, KUB+IVP： occupation at lower pole of Rt kidney, Rt kidney not visible. Dense plaque located alongside of Rt ureter. CT: suspect of multiple renal cysts (Rt).

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