How can we make a comprehensive diagnosis of urinary stones? How to diagnose urinary calculus
The diagnosis of urinary calculi should not only judge whether the stones exist, but also know whether the complications are serious, including obstruction and infection, and how the renal function is. We should also know the possible reasons.
1。 Diagnosis of urolithiasis: most patients can be diagnosed according to typical renal colic, hematuria and x-ray examination. A few cases have been diagnosed due to painless hematuria, hydronephrosis, urinary tract infection or unilateral or total renal function damage, which requires vigilance and further morphological examination of the urinary system.
2。 Diagnosis of urolithiasis complications: not only should we judge whether there is obstruction according to the size of the stone, but also we should carry out morphological examination. IVP, BUS, static or dynamic nuclear scanning or camera can be used to determine the degree of obstruction and renal function. The presence or absence of infection can be judged according to clinical manifestations, urine routine and urine culture, and special culture methods can be used if necessary. For long-term stones, attention should be paid to the combination of squamous cell carcinoma.
3。 Diagnosis of urolithiasis cause: life history (living, diet, working environment), family history (hereditary disease, urolithiasis family), past history (parathyroidism, gout, ulcer disease, intestinal surgery, chronic diarrhea, fracture and bedridden, urinary infection and diabetes, hypertension, huck, collapse, etc.) Drug history (sulfonamide, milk plus soda, aspirin, vitamin c, d, hormone, acetazolamide, calcium, appropriate factors, diarrhea drugs, diuretics, etc.). At the same time, in combination with laboratory tests and other tests, such as serum and urine tests (blood calcium, phosphorus, uric acid, 24-hour urine calcium, phosphorus, uric acid, oxalic acid, cystine, and wolfberry acid), urine culture, such as urease bacteria (mainly Proteus, Pneumonia, Pseudomonas aeruginosa, Salmonella, Aerobacter enterogenes, Staphylococcus, Providence, and Ureaplasma) infection, We should consider whether it is a special metabolic test for infectious stones (chloride load test for renal tubular poisoning, renal tubular phosphorus reabsorption for primary hyperthyroidism, calcium load test, etc.). In addition, we can roughly estimate the composition of stones by reading the density, contour, texture of stones on the X-ray plain film and the thin film and CT value of CT examination. Local factors can usually be found through the morphological examination of the urinary system.
Urinary stone is one of the common diseases in urology, with a high recurrence rate. Patients with urinary stone cannot simply carry out drug lithotripsy and extracorporeal lithotripsy, and should make a personal treatment plan after detailed examination.