Recently, 40-year-old Ms. Zhang (pseudonym) was sent to the Urology Department of the First Affiliated Hospital of Xi'an Medical College in an emergency due to unbearable pain in her left waist and abdomen, general weakness, chills and other discomforts.
After the doctor on duty, Yang Hui, received the diagnosis, an urgent CT scan showed that Ms. Zhang had multiple stones in the left ureter and both kidneys. "The patient had a urinary tract infection caused by a stone in the left ureter. Blood and urine tests showed that he was severely infected and his condition was very critical," Yang Hui said.
The diagnosis was clear, and anti-infection, rehydration, antipyretic and other treatments were actively given. Five days later, Ms. Zhang’s condition improved significantly, the infection was under control, and Ms. Zhang’s spirit was much better than when she was admitted to the hospital, but the key problem has not yet been solved.
Ms. Zhang’s stones are large and numerous. The left ureteral stone is 1cm, the left kidney ureteral junction stone is 1.5cm, the left kidney upper calyx stone is 2cm, and the left kidney lower pole stone is 2cm. Generally, stones above 1cm are already very large, but Ms. Zhang had 4 stones in her left kidney alone, each of which was larger than 1cm and caused serious infection. There is also a 2cm stone in the right kidney.
"Other stones are relatively common, but the left renal inferior calyx and right kidney stones are not ordinary kidney stones ." Director Zhang Hongyi said after understanding Ms. Zhang's condition that ordinary kidney stones are located in the renal pelvis , and Zhang Hongyi said that ordinary kidney stones are located in the renal pelvis . The woman's stone was embedded in the renal medulla , which is a rare medullary stone caused by medullary sponge kidney.
Renal medullary sponge kidney refers to the so-called cystic lesions that appear in the renal medulla. There are two types of cystic lesions, namely medullary sponge kidney and juvenile renal tuberculosis medullary cystic disease. It mainly affects children and young people, and is more common in males. Its incidence rate is 1/5000 to 1/2000. The pathological feature is the expansion of the papillary collecting ducts to form numerous cystic cavities of varying sizes in the renal medulla. The gross specimen looks like a sponge, and most of the cysts are connected with the renal tubule or the renal pelvis. Because urine is retained in the dilated tubules, secondary infection, bleeding, and the formation of tiny stones can occur. The disease is present at birth but is asymptomatic. The results of urine test, and renal function were normal. Its clinical manifestations are mainly caused by complications , such as kidney stones and kidney infections. Therefore, patients are often admitted to the hospital due to symptoms such as acute colic, hematuria , urinary tract irritation, pyuria and other symptoms, and the disease is discovered during further examination. Patients with extensive cystic lesions may have decreased urine concentration and acidification functions, increased urinary calcium excretion of and , and have a good prognosis, and renal failure is rare.
Faced with this rare and complex kidney stone, Director Zhang Hongyi led deputy chief physician Song Yiting, attending physician Zhao Gang and others to determine the treatment plan in a timely manner after discussion. Ms. Zhang has a large number of stones, so she should undergo surgical treatment at different times, and minimally invasive treatment should be considered first. The key at this time is to first solve the urinary tract obstruction caused by the patient's stones. First, perform transurethral ureteroscopy lithotripsy for left ureteral stones, and then perform transurethral flexible holmium laser lithotripsy after the condition recovers.
The left ureteral stone lithotripsy was successfully completed. One month after the operation, Ms. Zhang's condition was stable, and experts planned to perform flexible transurethral holmium laser lithotripsy on her. Although the stones were clearly visible on the preoperative CT, no exposed stones were found during the operation. Once the location of the stone is misjudged and incision is made, severe kidney damage will be caused to the patient. Director Zhang Hongyi relied on years of clinical experience to adjust the lens. When he saw that the mucosa of the lower renal calyx was glowing with light yellow, he said with certainty: "This is the location of the stone!" Sure enough, Director Zhang used a flexible ureteroscope holmium laser to incise the mucosa, and a large number of The stones immediately poured out.
After nearly an hour of holmium laser lithotripsy, the team finally completely crushed the stone and removed it. Using the same method, the expert team also solved Ms. Zhang’s huge renal medullary stone on the right side. After the operation, Ms. Zhang recovered well and was discharged from the hospital smoothly.
In the hot summer, stones are more likely to occur. How to effectively prevent stones?
Stones, simply put, are due to imbalance of the human body's environment, which leads to the accumulation of metabolites in the body, resulting in stones over time.The incidence of stones is getting higher and higher now, mainly because people now live a fast pace and eat irregularly. Therefore, to prevent stones, we must start from these aspects.
1. The first thing is lifestyle. Don’t stay up late. Staying up late is the body’s enemy and will cause many symptoms. Staying up late will affect the body’s normal metabolism, which may lead to stones over time.
2. Drink more water and urinate more to speed up the body's metabolism so that metabolites in the body have no chance to stay. You must drink more water. Just eating fruits or drinking drinks will not be effective.
3. Eat less foods containing oxalic acid, such as spinach, tofu, pineapple, etc. Excessive absorption of oxalic acid by the body may lead to kidney stones. Eat less high-fat foods. Absorbing too much fat will cause the body to absorb too much oxalic acid, which can also lead to stones.
4. Avoid prolonged exposure to the sun in summer. Prolonged exposure to the sun will lead to a decrease in urination. At the same time, the synthesis of vitamin A and and vitamin D in the body will increase, which will increase calcium in the urine, which may lead to stones.
