It is a disease characterized by the presence of one or more gallstones (ie, mineral concretion or calculus) in the urinary tract, mostly the upper urinary tract.
It is a predominantly male disease, more common in hot and high standard of living. Frequency: 32/100 000 new cases per year between the ages of 20 and 60, involving 2 men and a woman with a familial incidence found in 50% of cases.

Aetiology and predisposing factors:
Gallstone formation is favored by the hyper-concentration in the urine of some mineral components, such as oxalate and calcium phosphate. A supersaturated urine allows the formation of a nidus homogeneous or heterogeneous matrix used in the formation of a small crystal. This will increase volume and give rise to a large stone or may aggregate with other crystals to form an identical crystal aggregation.
The etiology is unknown in 60% cases, followed by:

  • Hypercalciuria idiopathic, autosomal dominant, with urinary leakage or increased intestinal absorption of calcium;
  • by hypercalciuria hyperparathyroidism
  • hypercalciuria Intoxication with vitamin D, A
  • hypercalciuria associated with neoplasia, Kahler disease, Paget
  • abnormal metabolism of uric acid
  • hyperoxaluira primitive or family
    syndrome ureteropelvic junction.




However, whatever the etiology, it is noted that nutritional factors play a decisive role, particularly those rich in salts, sugars and animal protein.

Symptoms:
Clinically, the sudden blockage of the urinary tract resulting in:

  • pain associated with hypertension, may develop into the break called colic, very painful position without analgesic
  • anuria / oligosurie
  • sometimes hematuria
  • urinary stasis favoring infection
  • destructive pyelonephritis kidney


  • pyonephrosis calculous (complication consisting destruction by renal hypertension and accumulation of a purulent collection upstream of the obstacle) and sepsis
  • Radiologically, there was 90% radiopaque stones (calcium salts) (Fig. 1) and 10% of radiolucent stones (uric acid, cystine …)

The ASP allows direct visualization of stones in 90% of cases, and assert its position and size
Ultrasound can assess the importance of expansion of the urinary tract;
The IVU (intravenous urography) can target a much more accurate, especially in cases of radiolucent stones
Differential Diagnosis: it will on other possible causes of compression, namely tumor of the urinary tract, blood clot, tuberculosis sequelae.

Treatment:
The most recent, lithotripsy, and is currently used in more than 90% of cases: using the resonance property of materials to destroy gallstones in him by converging ultrasonic waves. These waves cause cracking each pulse, thus, subsequently, excretion by natural means.
In case of failure of lithotripsy treatment, calculations of size> 2cm in, of stasis important infected conventional surgical treatment is preferred. Having proper CNA training class is important to offer your services in this industry.

  • Disinfection and urinary acidification (beneficial bacteria on urease)
  • Systematic screening of urine

Conventional surgery:

  • pyelotomie + nephrotomie nephrectomy and kidney if destroyed
  • surgical percutaneous puncture

Medical surveillance will focus on disinfection of urine, hyperdiurese and urinary acidification.

  • in cases of calcium urolithiasis, diet:
    • Diuresis than 2l/24h
    • Avoid oxalate (chocolate, sorrel, rhubarb, asparagus, white wine …)
    • Avoid animal protein
    • Plan moderately desode
    • Consumption between 600mg and 1g of Ca + +, by 24 hours, taking care not to over reduce calcium intake, increasing intake of oxalates.
  • if uric lithiasis:
    • Medical treatment by alkalinization of urine (urinary control pH> 7)
    • Alkaline water: Water from Vichy
    • Urinary alkalinization (Foncitril: 2 to 3 sachets per day)
    • Prophylaxis of recurrences by Allopurinol (Zyloric) whether hyperuricemia and urate.
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