Severe pain in the flank, such as urolithiasis

▲ Choi Young-hoon, a specialist in urology at Ulsan Jeil Hospital, is treating a patient who has visited the hospital for urolithiasis.

Urolithiasis is a disease in which stones (hard substances formed in organs within the body) form in the urinary tract from the kidneys (kidneys) to the bladder. When urolithiasis occurs, you feel severe side pain and hematuria occurs. The reason why the pain of urolithiasis is particularly severe is that when the stone is blocked while moving along the urinary tract, it stimulates surrounding muscles and organs and causes the ureter (urinary duct) to spasm. During the hot summer months, the body loses water by sweating a lot, and the urine volume decreases and becomes concentrated, resulting in more patients visiting the hospital. For these urinary stones, we will learn more about treatment and prevention methods with Choi Young-hoon, a urologist at Ulsan Jeil Hospital.

◇Increase the incidence of westernized eating habits

Urolithiasis is a relatively common urological disease with a prevalence of 3-5%. With the improvement of living standards and westernization of eating habits, the incidence is increasing. The risk of recurrence within 5 to 10 years after treatment is high, with one in two patients.

There are several causes of urolithiasis. First of all, there are racial and genetic factors. There is also the cause of nutrient metabolism abnormalities. However, it is known that urolithiasis is primarily affected by environmental factors. Mostly, urolithiasis occurs in mountainous areas, deserts, and tropical climates. This is because you sweat a lot and your body loses water, and your urine output decreases and stones are formed. If the stones made in this way are not discharged, they gradually grow and cause pain.

Choi Young-hoon, a urology specialist at Ulsan Jeil Hospital, said, “Westernized eating habits centered on meat also affect the occurrence of urolithiasis. It promotes the formation of urolithiasis by increasing the excretion of uric acid and increasing the acidity of urine according to insulin resistance.”

◇ Pain in the flank, stabbing and aching

The most common symptom of urolithiasis is a stabbing, aching pain in the side. It is most common to have sudden severe flank pain and visit a hospital, and this pain repeats aggravation and improvement. This is not caused by urolithiasis by directly damaging the urinary tract, but by blocking the flow of urine or interfering with the peristalsis of the ureter.

In addition to pain, digestive system symptoms such as nausea, vomiting, and diarrhea may also occur. In the case of stones near the bladder or stones that descend to the urethra, urinary symptoms such as frequent urination, urgency to urinate, and a feeling of residual urination that does not cool even when urinating may occur. In addition, there may be hematuria with blood in the urine, and if it is accompanied by a urinary tract infection, symptoms such as fever and chills may occur together.

◇Diagnosed by abdominal CT

If a urolithiasis is suspected, the most accurate diagnosis of the stone is an abdominal CT that does not use a contrast agent first to determine the location and size. If a CT scan is not possible, an abdominal ultrasound or X-ray of the abdomen is performed. If it is determined that urolithiasis is diagnosed through this diagnostic process, it is treated with atmospheric therapy, extracorporeal shock wave lithotripsy, and surgery.

Standby therapy is a method of waiting until the stones are naturally discharged by drinking a lot of water, using diuretics, and dissolving stones, when the size of the urolith is small (less than 4 mm) and when the pain is relatively well controlled. If the stones move downward by radiographs every 1 to 2 weeks, you can wait up to 4 weeks.

Extracorporeal shock wave lithotripsy is the most popular treatment for stones. The device generates a high-energy shock wave and concentrates the shock wave to the urinary stone in the body to break the stone. It is a non-invasive treatment method that does not require anesthesia and allows you to return to daily life immediately after the procedure if there are no side effects However, pain may occur while the crushed stone is discharged, and if the size of the stone is large or hard, it has the disadvantage of requiring multiple procedures.

Surgical stone removal methods include stone removal surgery using a ureteroscope, percutaneous nephrolithiasis, and open stone removal surgery. Among these, stone removal surgery using a ureteroscope is the most tried and the most technologically developed stone removal surgery. Ureteroscope stone removal surgery removes stones by inserting a ureteroscope into the urinary tract, just like a gastroscopy or colonoscopy, without skin incision.

Percutaneous nephrolithiasis treats kidney stones in areas that are difficult to reach with an endoscope or very large kidney stones. Laparotomy is rarely performed recently, but it can be tried when other urinary tract diseases need to be treated together.

Specialist Choi said, “For ureteroscopic stone removal surgery, flexible ureteroscope and stone-breaking laser equipment have recently been well developed, so not only ureteric stones but also kidney stones can be easily removed. It can be removed with an endoscope by creating a passageway to the kidney stone.”

◇Drink 2 to 2.5 liters of water a day for prevention

Drinking plenty of water is the most important thing to prevent kidney stones. It is recommended to habitually drink 2 to 2.5 liters of water per day. You should also avoid drinking too much caffeine, coffee, green tea, black tea, and alcohol. Salt intake should also be limited because excessive salt intake causes calciumuria and reduces citric acid excretion. Foods high in salt include salt, frozen foods, canned fish or meat processed foods, kimchi, soy sauce, pickles, soybean paste, red pepper paste, ham, sausage, and bacon.

Patients whose stones are calcium oxalate should also avoid overdose of vitamin C. Protein is a well-known risk factor for urolithiasis, so an excessive protein diet also needs to be limited.

Specialist Choi said, “Restriction of calcium intake for urolithiasis patients rather increases the risk of stones, so it is recommended to consume adequately. “It’s good to eat foods like milkshakes, cheese and milk,” he said. By Jeon Sang-heon, staff reporter [email protected]

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