Urolithiasis

Urolithiasis (UCD) is the formation of stones in the upper urinary tract.

Classification:
1. By localization in the organs of the urinary system
a. in the kidneys (nephrolithiasis)
b. in the ureters ( ureterolitiasis )
c. in the bladder ( cystolithiasis )
2. By type of stones
a . urates
b . phosphates
c. oxalates
d. cystine stones, etc.
3. According to the course of the disease
a. primary stone formation
b. recurrent (repeated) formation of stones
4. Special forms of urolithiasis
a. coral kidney stones
b. solitary kidney stones
c. urolithiasis in pregnant women
5. By size
a. Large stones – more than 2 cm in maximum diameter
b. Medium stones – from 1 to 2 cm in maximum diameter
c. Small stones – less than 1 cm in maximum diameter
6. According to the radiopacity of stones:
a. Radiopaque ;
b. Poorly radiopaque ;
c. X-ray non-contrast

Types of stones:
1) Cystine stones
X-ray positive
They contain sulfur and are yellow in color.

2) Triple phosphate stones

X-ray positive
More often in women and patients with catheters - sources of bacteria that produce urease .
The stones are large in size and act as pelvises and cups.

3) Calcium stones
They grow on the renal papillae.
Ultrasound or radiographic studies reveal multiple calcifications - nephrocalcinosis .
Typically occur with severe hypercalciuria .

4) Putty
Cystine and uric acid in high concentrations precipitate as “putty.”
May cause ureteral obstruction
1 g of uric acid and 400-800 mg of cysteine can fall out per day.
Oxalates do not form putty
5) Phosphates - white, formed in alkaline urine, x-ray positive .
6) Oxalates – dense with spikes, x-ray positive . These are the hardest, most difficult to crush
stones.
7) Urats – yellow-brown, hard, X-ray negative . Formed by overeating and excess uric acid.
8) Carbonate stones - formed from calcium salts of carbonic acid, X-ray negative .
9) Protein stones are formed mainly from fibrin mixed with salts and bacteria. They are white,
X-ray negative , and soft.
Radiation diagnostic:

Ultrasonography

Survey radiography

a - left kidney stone

b - coral stone

multiple stones in
the right kidney and a coral stone in the left kidney
Excretory urography:
ability of the kidneys to secrete
a contrast agent administered
intravenously

Left renal pelvis

stone. Hydrocalycosis

Retrograde (ascending)
ureteropyelography: x-ray
image after retrograde filling
with a contrast agent
Antegrade pyelography: direct
introduction of a contrast agent
into the renal pelvis either by
percutaneous puncture or
through pyelostomy drainage

CT scan

Magnetic resonance urography

Anomalies of development of the reproductive system in women
Anomalies:
- incomplete organogenesis;
- deviations in size, shape, proportions, symmetry, topography;
- the presence of formations that are non-specific for female individual in the postnatal period.

Etiology:
● Teratogenic factors:
1.genetic, determining male and female sexual differentiation
2. external (environment, trauma, teratogenic effects).
3. internal (enzymes, hormones).
● Gene and chromosomal mutations (pure gonadal dysgenesis - Swyer syndrome, karyotype 46 xx,
46 xy, or mosaicism)
● Heredity, which determines the biological inferiority of the cells that form the genital organs;
● Exposure to harmful physical (radiation), chemical (cytostatic agents, ethyl alcohol), medicinal
(thalidomide, methyltestosterone) and biological agents, viruses (rubella measles, cytomegaly),
toxoplasmosis, listeria, etc.;
● Occupational hazards;
● Addictions (nicotine, alcohol, drugs).

Pathogenesis:
The formation of internal genital organs has in 3 stages:
- growth of ducts in the caudal direction and formation of Müllerian tubercle;
- their fusion with the urogenital sinus, fusion of the ducts with each other in the area of ​the future
uterus and vagina; - - resorption of the median septum at the confluence of the ducts with the
formation of a single uterus and vagina.

Violation of any stage leads to the formation of developmental defects. Thus, the lack of resorption of
the common wall of the ducts leads to the formation of duplication of the uterus and vagina.
Examination of pelvic organs:

Ultrasound * The uterus is located behind the bladder and anterior to the rectum.
* It is pear-shaped, with clear and even contours.
* The muscle layer has an isoechoic fine-grained echostructure.
* The endometrium has a homogeneous hypoechoic structure.
* The vagina has hypoechoic walls of uniform thickness.
* The ovaries are located behind the bladder, lateral to the uterus, visualized as
ovoid hypoechoic formations (3 x 2 cm)

CT * to assess the condition of regional lymph nodes and surrounding tissues in

case of malignant tumors of the genital organs

MRI

HSG Hysterosalpingography (HSG) to investigate the shape of the uterine cavity and
the shape and patency of the fallopian tubes. In this procedure, a radio-opaque
material is injected into the cervical canal, and radiographs are taken.

A normal result shows the filling of the uterine cavity and the bilateral filling
of the fallopian tube with the injection material. To demonstrate tubal patency,
spillage of the material into the peritoneal cavity needs to be observed.

in treatment of infertility, especially in the case of fallopian tube blockage or

anomalies of development.