» Bladder lithiasis
 » Ureterolithiasis
The renal calculi (stones) are formed by small glasses that join some with others until ending up forming a visible stone.

Their size can vary, from millimeters up to centimeters. They remain in the kidney (renal lithiasis) or they move toward the ureters (ureterolithiasis). They cause pain when the flow of the urine is blocked from the kidneys until the bladder.

The factors that contribute to the stone formation are the following ones:
Insufficient consumption of liquid
Chronic illnesses or recurrent infections in the urinary tract
Certain medications
Urinary tract obstruction
To remain at bed for long time
  Ureterolithiasis family history
  Ciertas enfermedades genéticas y metabólicas

  Litiasis renal

Some stones won't cause symptoms. Symptoms take place when the flow of the urine is obstructed from the kidneys.
Some common symptoms are:
Strong pain in the back or inferior part of the abdomen that can run to the groin or the genitals.
This pain can last several minutes at several hours, continued by periods of relief.
Nauseas and vomits
Fever, chills and weakness
Blood in the urine

The x-ray, UroTAC and echographies are used to determine the size, the location and the number of stones that you have. Other studies include urine tests (urine analysis, urine culture) and blood tests.

The stones often reappear after the treatment. It is difficult to prevent them, however it is recommended to consume great quantity of liquids and certain medications depending on the cause of the stones.

Most of the small stones can be treated with consumption of liquids and medications. In about three to six weeks, these stones will come out. Certain types of stones that are not the most common, (uric acid) are sometimes dissolved with the administration of medication, however, the most common, those of calcium cannot be dissolved with medication.

The stones that are not spontaneously eliminated, that cause tremendous pain, urinary tract infections, that don't urinate or that affect the kidneys, should be eliminated as soon as possible.

Surgical procedures
The minimal invasive techniques are in vogue for the treatment of the stones and the open surgery is almost in disuse.

Minimal invasive procedures

Extracorporeal shock wave lithotripsy (ESWL):
The Extracorporeal shock wave lithotripsy is a technique for the treatment of stones in the kidney and of the ureter that doesn't require an incision. X rays or ultrasound are used to determine the location of the stones, and a device that emits shock waves through the body. These shock waves break the stones into tiny pieces that are enough small to pass together with the urine. One or two sessions are required for this treatment, each session has duration of about 60 minutes, and the patient is sedated.

Depending on the size, sometimes and previous to the ESWL, an internal tube called ureteral catheter, is placed so that the broken into fragments stones don't obstruct the flow of the urine. Same that will be removed some weeks later

Ureteroscopy: :
Another treatment is the ureteroscopy. It is carried out inserting an ureteroscope that is a hollow optic fiber, toward the urethra and kidney. The stone can be broken into fragments in small sand using a laser. The fragments are then retired, leaving a catheter after the procedure. This procedure is generally carried out in ambulatory way and it is reserved for stones in urethra and kidney.

Percutaneous Nefrolithotomy:
When the stones are big, numerous, or in a location that doesn't allow the use of other techniques, or these failed in the extraction it can be applied the percutaneous method. This procedure is known as percutaneous nefrolithotomy which consists on the next procedure: the urologist makes a small incision, of approximately 1 cm, in the back and creates a tunnel conducting to the kidney. Then, the surgeon can examine the kidney using a nefroscope and extract the stones. When finishing the procedure nefrostomy tube is left (tube to drain the kidney) and / or a temporary urethral catheter. It is necessary to remain hospitalized 1 or 2 days after the procedure.

  Litiasis renal

What should you expect after the surgery
In case of heart problems, it is necessary to be evaluated by your cardiologist.
Don't eat neither drink anything at least eight hours before the surgery
The aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, E Vitamin, Ticlid, Coumadin, Lovenox, Plavix and some medications for the arthritis can cause hemorrhage and should be avoided one week before the date of the surgery.
It is necessary to inform your urologist about all medication you take.

Usually, the duration of the operation is of 45 minutes to three hours, depending on the procedure type applied in your case

Possible risks and complications
All procedures are safe, however, all bear a risk although it is minimum

Bled: the urine with blood after the surgery is frequent in all these procedures. In the percutaneous nefrolithotomy the transfusion risk is approximately of 1%  
Infection: All the patients are treated with antibiotics intravenous before the surgery to diminish the probability of infection after the surgery 
Lesions of organs or tissues: Although it is uncommon, the lesions to the surrounding tissues and the organs, including the intestine, the blood vessels, the liver, the spleen, the lungs, are possible
Redox: When the stones are many, sometimes it is necessary to repeat the procedure

After the surgery
After the surgery you will have to drink many liquids to help to eliminate the clots. You can experience some pain due to the fragments that leave, this pain can last up to four to eight weeks. These symptoms can attenuate with simple analgesics.

The blood in the urine usually lasts some days, as much as you drink liquids, it will disappear
Pain control: You can expect to have pain and require medication during some days after the discharge. Starting from then, Tylenol should be enough to control the pain 
To take a shower: You can take a shower at home 
Activity: To take walks is very important. To remain sat down or at bed should be avoided. To go up stairways is much recommended. You should not drive a car at least one week after the surgery. You should not lift heavy objects (more than 10 kg) during one week after the surgery. You should not exercise (to run, to swim, walking machine, bicycle) until the doctor determines that it is safe to make it. You can expect to return to the work in two to four weeks, depending on the kind of procedure. 
Post operatory tests and x-rays: they will be determined in the following sessions with the doctor, as well as the retirement of probes and catheters

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