Urolithiasis: Modern Approaches to Classification, Diagnosis and Treatment

Abstract

Urinary stone disease (USD) is the most common and progressive disease of the urinary system, which is characterized by frequent exacerbations and a severe course. This is a complex disease caused by various causes, in which several biochemical processes are involved, occurring not only in the urinary system, but also in the whole organism. USD depends on geographical, climatic, ethnic, dietary and genetic factors. Over the past 20 years there has been an increase prevalence of this disease. The course of USD is characterized by the acute and chronic pyelonephritis and frequent recurrence, which leads to the development of renal failure, disability and fatal consequences. Calculus can form de novo anywhere in the urinary tract. The pathophysiology of USD differs depending on the place of stone formation and depends on endogenous and exogenous factors. Urinary tract stones are classified depending on etiology, location, size, number, frequency of occurrence, and radiopacity. The main symptoms of USD are pain of various nature; microscopic hematuria; dysuria, which most often indicates the presence of a stone in the urinary bladder or a low location in the ureters; discharge of crystals of urinary salts or concretions; increased body temperature. The diagnosis of USD is based on a carefully history taking and physical examination, which allows to determine the correct direction of diagnostic approach, which include laboratory and instrumental methods of diagnosis. Ultrasound diagnosis is used as the main method for visualization of calculi, but recently non contrast-enhanced computed tomography has become the standard for the diagnosis of acute low back pain, replacing intravenous urography. The choice of treatment is based on many parameters, such as the number, size, morphology, shape, volume, mobility, hardness and location of the stones and is individualized for each patient. There are two main approaches: conservative treatment and surgic al one. Medicinal treatment of USD is used primarily to prevent the repeated formation of new stones or to increase those inclusions that are already present in the organs. Drug therapy is carried out with the aim of normalizing processes in the body, the failure of which leads to the development of pathology. However, conservative treatment has its limitations and is most often used as a symptomatic treatment. Open laparoscopic interventions are rarely used recently, minimally invasive methods are more popular: extracorporeal shock-wave lithotripsy; ureterorenoscopy; percutaneous nephrolithotomy. Taking into account the increase in the prevalence of USD in Ukraine and disability (the third place among the general spectrum of causes of disability in urological practice), the article analyzes and reviews modern approaches to classification, early and accurate diagnosis, and choosing a timely and correct method of treatment.