{"id":17686,"date":"2020-04-15T16:24:38","date_gmt":"2020-04-15T16:24:38","guid":{"rendered":"https:\/\/urosassociats.com\/tratamientos\/lithiasis\/"},"modified":"2026-04-10T06:37:19","modified_gmt":"2026-04-10T06:37:19","slug":"lithiasis","status":"publish","type":"project","link":"https:\/\/urosassociats.com\/en\/treatments\/lithiasis\/","title":{"rendered":"Lithiasis"},"content":{"rendered":"<div id=\"cmsmasters_row_gh98s8h44\" class=\"cmsmasters_row cmsmasters_color_scheme_default cmsmasters_row_top_default cmsmasters_row_bot_default cmsmasters_row_boxed\">\n<div class=\"cmsmasters_row_outer_parent\">\n<div class=\"cmsmasters_row_outer\">\n<div class=\"cmsmasters_row_inner\">\n<div class=\"cmsmasters_row_margin\">\n<div id=\"cmsmasters_column_xlabzu7bx\" class=\"cmsmasters_column one_first\">\n<div class=\"cmsmasters_column_inner\"><div class=\"cmsmasters_tabs tabs_mode_tour tabs_pos_left\">\n<ul class=\"cmsmasters_tabs_list\">\n<li id=\"cmsmasters_tabs_list_item_pd2d09s48c\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-27\">\n<span>PATHOLOGY \/ SYMPTOMS:<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_9pfxd6wtkk\" class=\"cmsmasters_tabs_list_item current_tab\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-arrow-right\">\n<span>UROLITHIASIS\/OBSTRUCTIVE UROPATHY, NEPHRITIC COLIC.<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_0qa8076l2\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-arrow-right\">\n<span>Lithotripsy Unit at Uros Associats<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_hybjbq0def\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-arrow-right\">\n<span>Metabolic study of the lithiasic patient<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_dg5zs9ota\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-8\">\n<span>TREATMENTS:<\/span>\n<\/a>\n<\/li><\/ul>\n<div class=\"cmsmasters_tabs_wrap\">\n<div id=\"cmsmasters_tab_pd2d09s48c\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<ul style=\"user-select: auto;\">\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">UROLITHIASIS\/OBSTRUCTIVE UROPATHY, NEPHRITIC COLIC.<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">UNIT OF LITHOTRIPSY IN UROS ASSOCIATS.<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">METABOLIC STUDY OF THE LITHIASIC PATIENT.<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_9pfxd6wtkk\" class=\"cmsmasters_tab active_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<h2 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Obstructive uropathy and nephritic colic<\/b><\/span><\/h2>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"> <b style=\"user-select: auto;\">Nephritic colic<\/b><span style=\"font-weight: 400; user-select: auto;\"> is severe <\/span><b style=\"user-select: auto;\">pain<\/b><span style=\"font-weight: 400; user-select: auto;\"> that originates at the height of the kidney or urinary tract due to an acute obstruction in these areas caused by <\/span><b style=\"user-select: auto;\">lithiasis<\/b><span style=\"font-weight: 400; user-select: auto;\"> (stone or kidney stone).<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">This obstruction causes urine not to advance along the urinary tract; is held back. This produces an increase in pressure within the urinary tract that is the cause of the pain that accompanies nephritic colic.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Nephritic colic is a fairly frequent problem: in Spain four out of every hundred people manifest this disease, which means about one hundred thousand new cases a year.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Aetiology<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In addition to stones, any other element that occupies the ureter and obstructs the kidney can cause colic. This is the case of some <\/span><b style=\"user-select: auto;\">tumors<\/b><span style=\"font-weight: 400; user-select: auto;\"> that grow inside the ureter or encompass it from neighboring organs such as the intestine, ovary, or <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/cuidateplus.marca.com\/sexualidad\/diccionario\/utero.html\"><br style=\"user-select: auto;\" \/><span style=\"font-weight: 400; user-select: auto;\">uterus<\/span><br style=\"user-select: auto;\" \/><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">It can also be caused by benign diseases <\/span> such as <b style=\"user-select: auto;\">retroperitoneal fibrosis <\/b><span style=\"font-weight: 400; user-select: auto;\">or vascular dilations such as <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/cuidateplus.marca.com\/enfermedades\/enfermedades-vasculares-y-del-corazon\/aneurisma.html\"><span style=\"font-weight: 400; user-select: auto;\">aortic aneurysm<\/span><\/a><\/span><\/p>\n<p style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It is important not to confuse it with other conditions that have low back pain as a symptom. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Kidney stones can have four origins:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Most stones, between 70 and 80%, contain <\/span><b style=\"user-select: auto;\">calcium<\/b><span style=\"font-weight: 400; user-select: auto;\">. They are just as common in men as in women. <\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Between 20 and 30% of stones are caused by <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/cuidateplus.marca.com\/enfermedades\/ginecologicas\/infeccion-urinaria.html\"><br style=\"user-select: auto;\" \/><span style=\"font-weight: 400; user-select: auto;\">urinary tract infections<\/span><br style=\"user-select: auto;\" \/><\/a><span style=\"font-weight: 400; user-select: auto;\"> (by germs called urea splitters). This type is much more common in women than in men. They are larger stones that usually remain in the kidney. <\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Between 5 and 10% of kidney stones are produced by uric acid. They are the only ones that can be disposed of with treatment, alkalizing urine. The people who have <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/cuidateplus.marca.com\/enfermedades\/musculos-y-huesos\/gota.html\"><br style=\"user-select: auto;\" \/><span style=\"font-weight: 400; user-select: auto;\">Gout<\/span><br style=\"user-select: auto;\" \/><\/a><span style=\"font-weight: 400; user-select: auto;\"> has usually suffered some nephritic colic.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">1% of the stones are due to <\/span><b style=\"user-select: auto;\">cystinuria<\/b><span style=\"font-weight: 400; user-select: auto;\">, a disease of genetic origin.<\/span><\/span><\/li>\n<\/ol>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Symptoms<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The most important symptom is <\/span><b style=\"user-select: auto;\">pain in the lower back<\/b><span style=\"font-weight: 400; user-select: auto;\">, which appears abruptly and intensely.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Usually, this pain radiates to the bladder and genitals, following a downward trajectory although the irradiation depends on the level of the obstruction.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The pain is usually accompanied by <\/span><b style=\"user-select: auto;\">nausea, vomiting, and sweating. <\/b> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Other common symptoms that may occur are:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Fever<\/b><span style=\"font-weight: 400; user-select: auto;\"> and\/or signs of sepsis. Nephritic colic with fever is a VITAL EMERGENCY that should be assessed immediately in the emergency room. Uros Associats has specialists located to attend the Urological Emergencies of Cl\u00ednica Sagrada Familia and Teknon Medical Center <\/span><\/span><\/li>\n<\/ul>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Hematuria:<\/b><span style=\"font-weight: 400; user-select: auto;\"> It is the presence of blood in the urine. It may appear in small amounts so it should be detected through urine tests or it may be visible.<\/span><\/span><\/li>\n<\/ul>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Dysuria:<\/b><span style=\"font-weight: 400; user-select: auto;\"> difficulty or pain of the patient in the evacuation of urine.<\/span><\/span><\/li>\n<\/ul>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Pollakiuria:<\/b><span style=\"font-weight: 400; user-select: auto;\"> increase in the number of urinations during the day, which are usually of small amount.<\/span><\/span><\/li>\n<\/ul>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Anuria:<\/b><span style=\"font-weight: 400; user-select: auto;\"> Definitive suspension of urine secretion. This is the sign of greater severity.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\"><br style=\"user-select: auto;\" \/><\/span><span style=\"font-weight: 400; user-select: auto;\">The pain may vary in location as the lithiasis progresses in the urinary tract:<\/span><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In renal cramps<\/span>, the <span style=\"font-weight: 400; user-select: auto;\"> pain is located more intensely in the renal fossa, radiating to the hypochondrium (area of the abdomen located under the diaphragm and floating ribs).<\/span><b style=\"user-select: auto;\"><\/b><span style=\"font-weight: 400; user-select: auto;\"><br style=\"user-select: auto;\" \/><\/span> <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\">In <b style=\"user-select: auto;\">ureteral<\/b> <span style=\"font-weight: 400; user-select: auto;\">cramps <\/span> the <span style=\"font-weight: 400; user-select: auto;\"> pain radiates to the genitals. <\/span> <\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Kidney or ureteral stones (the most common cause of colic) produce varying degrees of suffering in the urinary tract, which can be classified depending on the <\/span><b style=\"user-select: auto;\">degree of obstruction<\/b><span style=\"font-weight: 400; user-select: auto;\"> and <\/span> the <b style=\"user-select: auto;\">dilation <\/b><span style=\"font-weight: 400; user-select: auto;\">it produces in the system.<\/span> <span style=\"font-weight: 400; user-select: auto;\"> There are different degrees of dilation, depending on the obstruction:<\/span><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Grade I:<\/b><span style=\"font-weight: 400; user-select: auto;\"> slightly dilated renal pelvis without calyx dilation.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Grade II:<\/b><span style=\"font-weight: 400; user-select: auto;\"> moderately dilated renal pelvis with mild calyx dilation.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Grade III:<\/b><span style=\"font-weight: 400; user-select: auto;\"> enlarged renal pelvis, dilated calyxes and normal parenchyma.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Grade IV:<\/b><span style=\"font-weight: 400; user-select: auto;\"> enlarged renal pelvis, dilated calyxes and thinning of the renal parenchyma.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Diagnosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">To confirm the disease, the specialist must study if the patient suffers from fever, since this symptom can lead to other clinical pictures that require different approaches.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">For clinical diagnosis, the specialist studies the presence, first of all, of the following symptoms :<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Acute onset abdominal pain.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Irradiation to the groin or genitals.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The patient does not feel an improvement with rest or changes in posture.<\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><strong style=\"user-select: auto;\">Nausea and vomiting <\/strong><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">After this evaluation, the specialist will perform a physical examination that will consist of:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">An abdominal and lumbar scan <\/span><span style=\"font-weight: 400; user-select: auto;\"><br style=\"user-select: auto;\" \/><\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">A vital signs test.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In addition, other tests may be performed, such as <\/span><b style=\"user-select: auto;\">blood and urine tests<\/b><span style=\"font-weight: 400; user-select: auto;\">, <b style=\"user-select: auto;\">x-rays of the abdomen, ultrasound and abdominal tomography<\/b><span style=\"font-weight: 400; user-select: auto;\"> to detect the location of the stones.<\/span><\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Imaging tests are very useful in diagnosis and guide the specialist on how to manage the pathology. The images also reveal the degree of obstruction caused by lithiasis in the urinary tract.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatment<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Treatment should be done as quickly as possible to avoid complications and control pain.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The specialist usually <\/span><b style=\"user-select: auto;\">prescribes non-steroidal anti-inflammatory analgesics<\/b><span style=\"font-weight: 400; user-select: auto;\"> which are effective against pain and inflammation. In very acute episodes of pain, this can be treated through the application of drugs intramuscularly or intravenously.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It is also usually necessary, in a large number of cases, to administer medications to reduce or eradicate vomiting, in addition to gastric protectors.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">If pain management does not respond to analgesics, the specialist will place a <\/span><b style=\"user-select: auto;\">ureteral catheter (JJ catheter)<\/b> <span style=\"font-weight: 400; user-select: auto;\">to resolve the urinary obstruction and thus control the pain.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In the event that the calculations need to be fragmented to facilitate their elimination, lithotripsy shall be carried out, <\/span><b style=\"user-select: auto;\"><\/b><span style=\"font-weight: 400; user-select: auto;\"> Medical procedure in which shock waves are used for the decomposition of the stone. Other possible approaches are surgical, almost all endoscopically: <\/span><b style=\"user-select: auto;\">ureterorenoscopy, intrarenal retrograde surgery and percutaneous nephrolithotomy<\/b>, <span style=\"font-weight: 400; user-select: auto;\">procedures that are indicated depending on the size, location and anatomy of the urinary tract.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">At Uros Associats we have an expert team in the management of urinary lithiasis. Our management is multidisciplinary, we have urologists, nephrologist and a specialist in Nutrition for a better control of your disease. . We also focus on prevention, setting regular check-ups in consultation to determine alterations that can be resolved in time, and thus minimize the chances of recurrence or complications. In case the treatment of your stone is necessary we can offer you all the Minimally Invasive techniques available today: EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL or LEOC), RIGID OR FLEXIBLE URETEROSCOPY, RETROGRADE INTRARENAL SURGERY (RIRS) AND PERCUTANEOUS SURGERY (PERCUTANEOUS NEPHROLITHOTOMY OR NLP).<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Chronic pelvic pain<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Chronic pelvic pain is pain that occurs in the area below the navel and between the hips and lasts six months or longer. It can have several causes, and be a symptom of another disease or be a condition in itself.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">If chronic pelvic pain seems to be caused by another medical problem, treating that problem may be enough to relieve the pain.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">However, many times it is not possible to identify a single cause of this pain. If this is the case, the goal of treatment is to reduce pain and other symptoms and improve quality of life.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Symptoms<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Chronic pelvic pain is usually described as follows:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Intense, constant pain<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Pain that comes and goes (intermittent)<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Stabbing pains or cramps<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Pressure or heaviness in a deep area of the pelvis<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Pain during sex<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Pain with bowel movement or urination<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Pain when sitting for prolonged periods of time<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The discomfort may intensify after standing for long periods and ease when you lie down. The pain can be mild and annoying or it can be so severe that you miss work, can&#8217;t sleep, or can&#8217;t exercise.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Aetiology<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Chronic pelvic pain is a complex condition that can have multiple causes, constituting a symptom of several medical conditions. For example, it is possible for a woman to have endometriosis and interstitial cystitis, both pathologies can cause chronic pelvic pain.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Some of the causes of chronic pelvic pain can be:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Endometriosis.<\/b><span style=\"font-weight: 400; user-select: auto;\"> This is a condition in which tissue from the lining of the uterus grows outside the uterus. These tissue deposits respond to the menstrual cycle, as does the uterine lining, i.e., thickening, rupturing, and bleeding, as hormone levels rise and fall. Because this takes place outside the uterus, blood and tissue cannot leave the body through the vagina. Instead, they remain in the abdomen, where they can lead to painful cysts and fibrous bands of scar tissue.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Musculoskeletal problems.<\/b><span style=\"font-weight: 400; user-select: auto;\"> Disorders that affect bones, joints, and connective tissues (musculoskeletal system), such as fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint (pubic symphysis), or hernias, and can lead to recurrent pelvic pain.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Chronic pelvic inflammatory disease.<\/b><span style=\"font-weight: 400; user-select: auto;\"> This can happen if a long-term infection, usually sexually transmitted, causes scarring that affects the pelvic organs.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Ovarian remains.<\/b><span style=\"font-weight: 400; user-select: auto;\"> After surgical removal of the uterus, ovaries, and fallopian tubes, small vestiges of the ovary may accidentally remain, which could then lead to painful cysts.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Fibroids.<\/b><span style=\"font-weight: 400; user-select: auto;\"> These noncancerous uterine growths can cause pressure or a feeling of heaviness in the lower abdomen. In rare cases, they cause sharp pain.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Irritable bowel syndrome.<\/b><span style=\"font-weight: 400; user-select: auto;\"> Symptoms associated with irritable bowel syndrome, such as inflammation, constipation, or diarrhea, may be the source of pelvic pain and pressure.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Painful bladder syndrome (interstitial cystitis).<\/b><span style=\"font-weight: 400; user-select: auto;\"> This condition is associated with recurrent bladder pain and a frequent need to urinate. You may experience pelvic pain as your bladder fills, which may temporarily give way when you urinate.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Some doctors believe that dilated varicose veins (varicose veins) around the uterus and ovaries can cause pelvic pain. However, other doctors doubt that pelvic congestion syndrome is the cause of pelvic pain because most women with dilated veins in the pelvis do not have associated pain.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Psychological factors.<\/b><span style=\"font-weight: 400; user-select: auto;\"> Depression, chronic stress, or a history of sexual or physical abuse can increase the risk of chronic pelvic pain. Emotional distress makes pain worse, and living with chronic pain contributes to emotional suffering. These two factors often create a vicious circle.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Diagnosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Figuring out what&#8217;s causing chronic pelvic pain often involves a process of elimination because there are so many disorders that can cause pelvic pain.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In addition to a detailed interview about your pain, your personal medical history and family history, your doctor may ask you to keep a diary of pain and other symptoms.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Tests or exams your doctor may order include:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Pelvic exam.<\/b><span style=\"font-weight: 400; user-select: auto;\"> It may reveal signs of infection, abnormal growths, or tight pelvic floor muscles. The doctor checks for areas of tenderness. Let your doctor know if you feel any discomfort during this test, especially if the pain is similar to what you&#8217;ve been feeling.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Laboratory analysis.<\/b><span style=\"font-weight: 400; user-select: auto;\"> During the pelvic exam, your doctor may order lab tests to check for infections. <\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Echography.<\/b><span style=\"font-weight: 400; user-select: auto;\"> This procedure is especially useful for detecting masses or cysts in the ovaries, uterus, or fallopian tubes.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Other imaging tests.<\/b><span style=\"font-weight: 400; user-select: auto;\"> Your doctor may recommend abdominal X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans to help detect abnormal structures or growths.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Laparoscopy.<\/b><span style=\"font-weight: 400; user-select: auto;\"> During this surgical procedure, the doctor makes a small incision in your abdomen and inserts a thin tube connected to a small camera (laparoscope). The laparoscope allows the doctor to look at the pelvic organs and check for abnormal tissues or signs of infection. This procedure is especially useful for detecting endometriosis and chronic pelvic inflammatory disease.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Finding the underlying cause of chronic pelvic pain can be a lengthy process and, in some cases, a clear explanation may never be found.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">However, with patience and open communication, you and your doctor can develop a treatment plan that will help you live a full life with minimal discomfort.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatment<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The goal of treatment is to reduce symptoms and improve quality of life.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">If your doctor can determine a specific cause, treatment will focus on that cause. However, if it is not possible to identify a cause, treatment will focus on controlling pain and other symptoms. In many cases, the optimal approach involves a combination of treatments.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Drugs<\/b><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Analgesics.<\/b><span style=\"font-weight: 400; user-select: auto;\"> It is a symptomatic treatment that helps improve the clinic although they do not treat the cause of chronic pain.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Hormonal treatments.<\/b><span style=\"font-weight: 400; user-select: auto;\"> Some women find that days when they have pelvic pain may coincide with a particular phase of their menstrual cycle and the hormonal changes that control ovulation and menstruation. When this is the case, birth control pills or other hormonal medications can help relieve pelvic pain.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Antibiotics.<\/b><span style=\"font-weight: 400; user-select: auto;\"> If the source of the pain is an infection, your doctor may prescribe antibiotics.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Antidepressants.<\/b><span style=\"font-weight: 400; user-select: auto;\"> Some types of antidepressants may be helpful in relieving chronic pain. Tricyclic antidepressants, such as amitriptyline and others, appear to have analgesic and antidepressant effects. They can help improve chronic pelvic pain even in patients who do not have depression.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Other therapies<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Your doctor may recommend specific therapies or procedures as part of treatment for chronic pelvic pain. These may include the following:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Physiotherapy.<\/b><span style=\"font-weight: 400; user-select: auto;\"> Stretching exercises, massage, and other relaxation techniques can improve chronic pelvic pain. A physical therapist can help you with these therapies and develop strategies for coping with pain. Sometimes specific pain points are treated with a medical instrument called transcutaneous electrical nerve stimulation. Transcutaneous electrical nerve stimulation sends electrical impulses to nearby nerve pathways. It may also be helpful to use a psychological technique called biofeedback, which helps you identify areas of tight muscles so you can learn to relax those areas.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Neurostimulation (stimulation of the spinal cord).<\/b><span style=\"font-weight: 400; user-select: auto;\"> This treatment involves implanting a device that blocks nerve pathways so that the pain signal cannot reach the brain. It may be helpful, depending on the cause of the pelvic pain.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Trigger point injections.<\/b><span style=\"font-weight: 400; user-select: auto;\"> If your doctor finds specific points where you feel pain, you may benefit from injections of numbing medication into those painful spots (trigger points). The medication, usually a long-acting local anesthetic, can block pain and relieve discomfort.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Psychotherapy.<\/b><span style=\"font-weight: 400; user-select: auto;\"> If pain may be intertwined with depression, or any type of psychological disorder, you may find it helpful to talk to a psychologist or psychiatrist. There are different types of psychotherapy, such as cognitive behavioral therapy and biofeedback. Regardless of the underlying cause of the pain, psychotherapy can help you develop strategies for dealing with pain.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Surgery<\/b><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Laparoscopic surgery.<\/b><span style=\"font-weight: 400; user-select: auto;\"> If you have endometriosis, your doctor may remove adhesions or endometrial tissue through laparoscopic surgery. <\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Hysterectomy.<\/b><span style=\"font-weight: 400; user-select: auto;\"> In rare and complicated cases, your doctor may recommend removing your uterus (hysterectomy), fallopian tubes (salpingectomy), or ovaries (oophorectomy). Undergoing this intervention has significant health consequences. Your doctor will discuss the risks and benefits in detail before recommending this option.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Transurethral bladder resection.<\/b><span style=\"font-weight: 400; user-select: auto;\"> In some pathologies, such as interstitial cystitis, it is sometimes useful to resect endoscopically the lesions that are in the inner lining of the bladder and that are associated with chronic pain. <\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Intravesical injections.<\/b><span style=\"font-weight: 400; user-select: auto;\"> In some cases, the injection of various substances into the mucosa and bladder muscles, such as Botox and some anti-inflammatories, is very decisive. This procedure is performed endoscopically, under anesthesia. <\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Anesthetic block of the nerves of the pelvis.<\/b><span style=\"font-weight: 400; user-select: auto;\"> In cases where it is identified that the pain comes specifically from the trigger points where sensitive nerves of the pelvis pass, the doctor may indicate the anesthetic block of these points, which would reduce the painful sensations of that area. Sometimes it is necessary to carry out this procedure in the operating room.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Pain Rehabilitation Program<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">You may need to try a combination of treatment approaches before you find the best option for you. If applicable, you may need to consider entering a pain rehabilitation program. In Uros Associats we have the support of the Pelvic Floor Rehabilitation section of the Teknon Clinic. They are medical specialists and nurses highly trained in stretching, biofeedback and relaxation-stimulation therapies. <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Lifestyle<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Chronic pain can significantly affect your daily life. When you feel pain, you have trouble sleeping, exercising, or performing physical tasks.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Chronic pain can also cause anxiety and stress, both of which in turn can make pain worse.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Relaxation techniques can help relieve tension, reduce pain, calm emotions, and induce sleep. You can learn many techniques on your own, such as meditation and deep breathing.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Multidisciplinary approach<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Depending on the suspected cause of pain, your doctor may refer you to a digestive system specialist (gastroenterologist), gynecology specialist, or musculoskeletal pain specialist (physiatrist or physical therapist).<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">How to prepare for your appointment<\/b><\/span><\/h3>\n<ul style=\"user-select: auto;\">\n<li style=\"font-weight: 400; text-align: justify; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Make a list of all the signs and symptoms you&#8217;re experiencing.<\/b><span style=\"font-weight: 400; user-select: auto;\"> He mentions those that seemed unrelated to the reason for the consultation.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; text-align: justify; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Write down key medical information.<\/b><span style=\"font-weight: 400; user-select: auto;\"> Include major stressors or recent changes in your life.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; text-align: justify; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Make a list of all the medications you take and the dosages you take.<\/b><span style=\"font-weight: 400; user-select: auto;\"> Indicate prescription and over-the-counter medications, vitamins or other supplements you&#8217;re taking.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; text-align: justify; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">It&#8217;s a good idea to bring a family member or friend.<\/b><span style=\"font-weight: 400; user-select: auto;\"> Sometimes it can be difficult to remember all the information provided during a visit. Someone who accompanies you may remember some fact that you forgot or did not notice.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; text-align: justify; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Prepare questions.<\/b><span style=\"font-weight: 400; user-select: auto;\"> Preparing a list of questions can help you not forget any.<\/span><\/span><\/li>\n<\/ul>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_0qa8076l2\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<h2 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Extracorporeal shock wave lithotripsy (ESWL) unit in Uros Associats<\/b><\/span><\/h2>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">At Uros Associats we have the most modern and effective technology for the non-invasive treatment of kidney stones. Our multifunctional station with digital fluoroscopy <\/span><i style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Dornier Delta III,<\/span><\/i><\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"user-select: auto;\"><i style=\"user-select: auto;\"><\/i> <span style=\"font-weight: 400; user-select: auto;\">latest generation lithotripter, which guarantees its efficiency and safety. <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">What is extracorporeal shockwave lithotripsy (ESWL)?<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It is a non-invasive procedure that treats renal or ureteral lithiasis through the application of shock waves in liquid medium, which contact the patient through an external device that comes from an electromagnetic source. The shock wave travels uniformly through the liquid medium, but is partially reflected as it passes into a more solid medium (calculation). The reflected wave overlaps the next, so the summative effect substantially increases the pressures inside the calculation. The sum of the waves manages to crack\/fragment the lithiasis, in a session of approximately 40 minutes.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">A urinary stone is formed by the crystalline aggregation of its mineral components, cohesive together by organic material, in variable quantity according to each type of lithiasis. If the transferred energy (shock wave) is greater than the cohesion forces of the calculation, it fragments into its primary components (crystals). To these effects is added the additional energy produced by the so-called cavitation effect: During the process, microbubbles of air are formed in the liquid medium which undergo a process of compression and subsequent collapse with the formation of microjets that also collaborate to the rupture of the calculus. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">A calculation will be easier to fragment with shock waves the more water molecules it contains, since each of them represents an energy transfer point.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">For shock waves to be effective in lithotripsy, they must all be concentrated in a single point, which corresponds to the calculation to be treated. To achieve this, a focusing system is required, which generally consists of radiology and ultrasound, which are used independently or combined, according to each type of machine.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Indications for extracorporeal lithotripsy<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The maximum effectiveness of the lithotripsy technique is limited to those kidney stones, especially in the pelvis, whose size does not exceed 2 cm in diameter. The universal indications, by consensus, are:<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Pielic calculus:<\/b><span style=\"font-weight: 400; user-select: auto;\"> More generalized indication of lithotripsy. If the size and consistency are right it can be commonly resolved in a single session. The removal of the fragments is early and generally without incident.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Calicilar lithiasis:<\/b><span style=\"font-weight: 400; user-select: auto;\"> it is an indication of lithotripsy from 5 mm in diameter, regardless of the symptoms that may cause. <\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Ureteral lithiasis:<\/b> the <span style=\"font-weight: 400; user-select: auto;\"> most current lithotripsy equipment allows the fragmentation of the ureteral calculus without the need for previous catheterization.<\/span><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Success rate of lithotripsy in the different ureteral locations<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">After 24 or 48 hours it is common to observe a displacement and even the expulsion of the generated fragments, although this expulsion can be delayed between 2 and 3 weeks after the procedure. The overall effectiveness rate of the procedure will depend on many factors, such as the initial size, edema of the urothelial mucosa, the type of lithiasis and the anatomical morphology of the patient. <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Contraindications of lithotripsy<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">There are some conditions where lithotripsy is discouraged:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"> Severe kidney infections. <\/b><span style=\"font-weight: 400; user-select: auto;\">Acute pyelonephritis and pionephrosis are circumstances where this procedure should not be performed, due to the risk of worsening the infectious picture and further damaging the state of the organ. <\/span><\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"> Anatomical alterations of the urinary tract.<\/b><span style=\"font-weight: 400; user-select: auto;\">Although the lithiasis to be treated with lithotripsy is lodged in the renal area, the expulsive process of the fragments generated after it requires an adequate state of the urinary tract. The presence of congenital or acquired stenoses compromises the good outcome of lithotripsy.<\/span><\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">-Stenosis of the pyeloureteral ostium.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">-Horseshoe kidney.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">-Ectopic or transplanted kidney. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">-Ureteral anomalies.<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\" start=\"3\">\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"> Calculations greater than 2cm.<\/b><span style=\"font-weight: 400; user-select: auto;\"> In general, these calculations cause obstruction, so it is not advisable to repeat sessions for their resolution. <\/span><\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"> Calculations very impacted.<\/b><span style=\"font-weight: 400; user-select: auto;\"> In ureteral lithiasis, the association of a large calculation, clear signs of impaction and hydronephrosis secondary to it, formally discourages the performance of lithotripsy as a first therapy. The impaction of the stone in the ureteral tract generates local inflammatory phenomena, forming in the first instance an edema of the ureteral wall, followed later by the ulceration of the urothelium that will lead to parietal fibrosis and occasionally the mucosal proliferation that when encompassing the stone will immobilize it definitively. In these cases, the attempt to push the stone up through a catheter is doomed to failure and the practice of lithotripsy will only increase local irritative phenomena and although the calculation could be fragmented and some fragments eliminated, most of it will not progress, maintaining and even increasing, the degree of obstruction. In these cases, the alternative is to perform a laser ureterorenoscopy.<\/span><\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"> Coraliform lithiasis. <\/b><span style=\"font-weight: 400; user-select: auto;\">The treatment of this type of stones with lithotripsy results in high rates of urinary infection, recurrence of stones and need for second maneuvers. There are other alternatives, percutaneous or endoscopic, to treat this type of lithiasis more safely.<\/span><\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"> <b style=\"user-select: auto;\"> Previous diseases of the kidney that significantly deform its structure:<\/b><span style=\"font-weight: 400; user-select: auto;\"> such as renal tuberculosis, organ atrophy, severe hypoplasia, severe chronic interstitial nephropathy.<\/span><\/span><\/li>\n<\/ol>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Adverse effects of lithotripsy<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Despite their effectiveness for the fragmentation of lithiasis, shock waves can be harmful to various tissues of the body. The resulting cumulative energy can lead to bruises and bruises on the renal parenchyma and even affect adjacent organs, such as the pancreas and colon. The same process of removal of the fragments constitutes a phase in which various side adverse effects, such as obstructive uropathy (renal colic) and haematuria, may occur. Fortunately with modern equipment these side effects are very rare, and if they occur they are usually transient and mild.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Pain:<\/b><span style=\"font-weight: 400; user-select: auto;\"> During lithotripsy, pain may appear in the area where the shock wave transits. That is why our structure has the assistance of anesthesiologists in all treatments, who apply general sedation so that these sensations go unnoticed. <\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Hematuria: <\/b><span style=\"font-weight: 400; user-select: auto;\">it is a very frequent post-lithotripsy sign, which reflects a renal microtrauma or the passage of fragments when they descend through the urinary tract.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Renal contusion and hematoma:<\/b><span style=\"font-weight: 400; user-select: auto;\"> It is a rare complication (0.8%), but it is totally related to the act of lithotripsy. Any patient is subject to the possibility of suffering a renal hematoma after lithotripsy, but this circumstance is especially propitious in hypertensive patients and patients treated with anticoagulants. There are circumstances of the technique that can increase the risk of hematoma: too high applied energy, excessive number of shock waves per session and not respecting a prudential interval between the different lithotripsy sessions, which is estimated at a minimum of 36 to 48 hours.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Obstructive uropathy:<\/b><span style=\"font-weight: 400; user-select: auto;\"> The obstruction of the urinary tract by the fragments generated after lithotripsy is a clinical situation that occurs relatively frequently. Usually this situation is transient when the lithiasic fragments are displaced or eliminated, but in 18% of cases an obstructive uropathy can be constituted when these fragments are impacted. <\/span><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Expulsive phase. The lithiasic street.<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Successful lithotripsy generates a multitude of lithiasic fragments from the original calculus. These are of different sizes depending, mainly, on the crystallographic composition of the calculus, although most of them do not exceed 3 mm. Diuresis and the movement of the collecting system and ureter causes the displacement of these fragments towards the bladder, and if this displacement is massive, there is a usually transient obstruction, which occurs with colic pain. The radiological image obtained at this time is very characteristic and shows the agglomeration of calculus fragments taking the shape of its continent: the ureter. This radiological image is called a &#8220;lithiasic street&#8221;.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The length and thickness of the lithiasic street depends mainly on the size of the treated calculation and\/or its composition.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The spontaneous evolution of the &#8220;lithiasic street&#8221; is the expulsion, although in some cases, given the obstruction it causes, it may require an endoscopic action to be resolved: catheterization and \/ or ureteroscopy.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Post-lithotripsy protocol<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The procedure is performed on an outpatient basis. After a lithotripsy session the patient is transferred to a room, where he is observed for the next few hours. In this period it is identified if any significant immediate complications have taken place. If all is well, during the same day, the patient is discharged with a series of instructions: relative rest for the next 48 hours, abundant fluid intake, analgesic regimen and appointment in consultations with radiological tests. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Subsequent consultations will assess the success of the procedure and determine subsequent follow-up.<\/span><\/p>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_hybjbq0def\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<h2 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Metabolic study of the lithiasic patient<\/b><\/span><\/h2>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Patients with renal lithiasis require investigations to identify underlying medical conditions and other metabolic abnormalities that predispose them to developing stones. The results of these investigations are used to guide preventive treatment. The depth of the study needed depends on several factors, including the person&#8217;s age, medical history, and the number and frequency of stones. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">A variety of dietary and metabolic factors can contribute to or cause kidney stone formation. Dietary factors include a high intake of animal protein, oxalate and sodium, and a low intake of fluids and products that inhibit crystal nucleation, such as citrate and potassium. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The metabolic alterations most frequently associated with lithiasis are hypercalciuria, hypocitraturia, gout, hyperoxaluria and hyperuricosuria. Dietary modifications should be applied in all patients with renal lithiasis, and consist of high fluid intake, oxalate and sodium restriction, a balanced diet of animal proteins and supplemented by adequate intake of fruits and vegetables. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">When dietary modifications are not sufficient to prevent the formation of lithiasis or in the presence of significant metabolic alterations, specific pharmacological intervention is necessary.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Comprehensive evaluation of the Uros Associats Lithiasis Unit<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In our evaluation protocol of the patient with renal lithiasis we include a medical history, physical examination, imaging study and laboratory in blood and urine. Our interest is to identify several factors: number of episodes, frequency of stone formation, age of onset, size of stones, side affected, type of lithiasis, previous urological interventions, presence of concomitant urinary infections, concomitant diseases, habitual medication, family history, occupation, lifestyle and diet. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">With these data we achieve a specific objective, which is to determine in the patient the physiological defects that condition their risk of lithiasis, in order to treat it properly and thus change the natural history of this disease. In addition, we make this study as efficient and economical as possible. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The type and extent of the evaluation will depend on: the severity of the disease, whether it is a first episode or a recurrence, the presence or absence of diseases associated with lithiasis and the presence or absence of family history. For example, the latter increases the risk of recurrence 2.6 times, without distinguishing between genetic and environmental factors.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Nutritional and nephrological study of the lithiasic patient<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">As part of the comprehensive evaluation of the lithiasic patient, we have the multidisciplinary support of specialists in nutrition and nephrology. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><strong style=\"user-select: auto;\"><i style=\"user-select: auto;\">Role of the nutritionist<\/i><\/strong><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In the nutritional consultation we focus on the patient&#8217;s eating habits, emphasizing the daily consumption of liquids and salts. We deliver a nutritional survey at each follow-up and laboratory analysis is carried out periodically.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The nutritional survey applied in our follow-up program aims to detect negative habits and educate the patient. It quantifies the approximate consumption of calcium, the daily consumption and type of liquids ingested daily, the frequency of consumption of animal protein (non-dairy), the periodicity of consumption of fruits and vegetables (to estimate the consumption of citrate and potassium), the approximate intake of sodium and the frequency of consumption of other lithogenic foods (rich in purines and oxalate). This allows us a nutritional management oriented according to the specific alterations investigated in the metabolic evaluation and also in the analysis of the calculation. We instill in our patients certain changes in nutritional habits that must be maintained over time to prevent recurrence, since they are generally chronic conditions. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><strong style=\"user-select: auto;\"><i style=\"user-select: auto;\">Role of the nephrologist<\/i><\/strong><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">At Uros Associats we believe that the nephrologist must actively intervene in the diagnosis, treatment and follow-up of lithiasic patients. Some patients, especially those with nephrocalcinosis or associated parenchymal loss, may develop chronic kidney disease, requiring measures to help preserve kidney function for as long as possible. The nephrologist will help determine the quality of renal fluid and electrolyte management, their acidification capacity, the effect of lithiasis on the glomerular filtration rate of the affected renal unit and the overall functional prognosis of the kidneys. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Likewise, there are certain syndromic medical conditions that are susceptible to medical-pharmacological treatment, and whose control would contribute to the reduction of the frequency of presentation of lithiasic pathology. The specialized management of these drugs is done by the nephrologist. <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><strong style=\"user-select: auto;\">Commonly used laboratory tests are:<\/strong><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><strong style=\"user-select: auto;\"><i style=\"user-select: auto;\">Blood tests:<\/i><\/strong><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Sodium<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Potassium<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Calcium<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Phosphorus<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Uric acid<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Creatinine<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Bicarbonate<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">PTH<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Vitamin d<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><strong style=\"user-select: auto;\"><i style=\"user-select: auto;\">Urinalysis:<\/i><\/strong><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Urinary pH<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Sediment<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Crystalluria<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Urine culture<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><strong style=\"user-select: auto;\"><i style=\"user-select: auto;\">24-hour urine:<\/i><\/strong><span style=\"font-weight: 400; user-select: auto;\"> Harvesting should be done with the patient&#8217;s usual diet and physical activity. It is also suggested that samples be collected on an outpatient basis and not during hospitalization. In 24-hour urine is recorded:<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\"><strong style=\"user-select: auto;\">Urinary volume:<\/strong> It has been determined that the urinary volume in patients presenting with their first episode of lithiasis is 250 to 350 ml lower than control subjects. In general, a greater urinary volume of 2 to 2.5 liters per day is recommended, without neglecting the intake at night when physiologically the urine is more concentrated.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Creatinine<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Calciuria<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Uricosuria<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Citraturia<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Oxaluria<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Potassium &#8211; urine<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Sodium &#8211; urine<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Magnesuria<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Ammonium<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Cystinuria<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Phosphaturia<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In Uros Associats we have specialists of the highest level at national and international level in the treatment of urinary lithiasis, recognized with prizes and awards in different courses and congresses, being innovators in new surgical techniques, and specialists in the medical treatment of urinary lithiasis.<\/span><\/p>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_dg5zs9ota\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<ul style=\"user-select: auto;\">\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL)<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">URETERORRENOSCOPY (URS)<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">LASER TREATMENT OF URETERAL AND RENAL LITHIASIS<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">INTRARENAL RETROGRADE SURGERY (RIRS)<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">PERCUTANEOUS NEPHROLITHOTOMY (NLP)<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">ENDOSCOPIC CYSTOLITHECTOMY <\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">PLACEMENT OF URETERAL CATHETERS<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">DOUBLE CATHETER J<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div><\/div>\n<\/div>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"cmsmasters_row_\" class=\"cmsmasters_row cmsmasters_color_scheme_default cmsmasters_row_top_default cmsmasters_row_bot_default cmsmasters_row_boxed\">\n<div class=\"cmsmasters_row_outer_parent\">\n<div class=\"cmsmasters_row_outer\">\n<div class=\"cmsmasters_row_inner\">\n<div class=\"cmsmasters_row_margin\">\n<div id=\"cmsmasters_column_\" class=\"cmsmasters_column 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