Sand pouring is a common ailment today due to changes in diet or lifestyle. It is stated that 10% of people in a society shed sand at least once in their life. Today, the presence of the disease can be understood in the urinalysis performed as a result of some symptoms noticed in the kidneys of the patient. In this analysis, blood cells such as erythrocytes and leukocytes can be seen in the urine in the case of sand pouring, while some crystals can also be found. The patient who has certain symptoms and is found to have shed sand should usually start with antibiotics and painkillers. These patients should receive service from the urology services of the hospital.
What is sand pouring?
Sand casting is the fact that crystals such as phosphate, cystine, and oxalate are not soluble in the urine at the temperature of the body and remain in the urine as solid pieces. In the human body, the urinary system functions in the form of carrying urine from the kidneys to the urinary bladder through the thin urinary channels, and from here to the outside of the body. If there is sand or stone in the urine that goes from the kidneys to the bladder, the urine cannot easily travel through the thin urinary canals and causes accumulation there. As a result of this accumulation, swelling occurs in the kidneys, and this swelling causes severe pain, sometimes nausea and vomiting. As the stone begins to descend into the thin urinary channels, the pain becomes more widespread in the body and the urge to urinate becomes more frequent.
In this process, as the color of the urine becomes dark, there is also the possibility of blood in the urine. During urination, a burning sensation may occur. Since the pain felt in cases of sand casting or stone falling is generally very severe, patients apply to the hospital and this condition is called renal colic. Renal colic is frequently encountered in emergency services, and it can be said that it is the most common urinary system disorder in emergency services.
The size of the crystals that remain insoluble in this urine is important. The larger the crystals, the more difficult it is to be excreted in the urine. In such cases, it is very unfavorable to hold the urine because the small crystals that remain insoluble in the urine settle to the bottom during the period of holding the urine and become larger crystals by fusing together. Unless it is not eliminated, continuous severe pain is felt in the kidneys. In some people, such pain may not be felt during kidney sand pouring.
The probability of recurrence of this situation is 50% in the first 10 years in people with sand casting. The possibility of recurrence increases even more if the correct treatment is not applied to the person in the first sand casting experience.
When a person with sand pouring symptoms admits to the hospital, urine and blood tests are performed. In these hospital tests, kidney function tests (urea-creatinine), blood electrolyte levels (sodium, potassium, chlorine, calcium), and infection marker tests (such as blood count, CRP, urinalysis, and culture) are checked. In some patients, increased kidney function may be observed, and in this case, it is recommended to avoid drugs that will further increase kidney function.
Infection may also occur in the urinary tract as a result of the inability of the sand, which is formed as a result of the insoluble crystals in the urine, to move in the fine urinary canals and cause accumulation. Infected patients should be followed closely and this infection should be corrected with appropriate antibiotics. After the infection status is corrected with appropriate antibiotic treatment, appropriate treatment methods should be applied to ensure the smooth flow of urine through the ducts.
After it is understood that the patient has poured sand, it may be necessary to make a film to observe where the falling stone or sand is located in the canal and to see the size of the swelling that occurs as a result of the obstruction in the kidney and to suggest a treatment method according to these situations. The method used for this purpose is usually urinary tract ultrasonography. In this method, patients are not exposed to radiation and thus can be used safely in pregnant women and children. However, very small stones may not be seen, and in this case, it is appropriate to use computed tomography. Computed tomography is the best method to show kidney stones or sand and provides the clearest imaging.
Sand pouring is more common in men than in women. Having this situation in the family or being prone to be seen may increase the risk of sand spillage. Nutrition and living area have a great effect on sand casting. High functioning as mountainous areas and drought in the region more visible and present in this case in Turkey are also more likely to be seen by the West because of the excess mountainous areas in the eastern region.
Sand pouring symptoms
The most obvious symptom of sand shedding is severe pain in the kidneys, which is heard on the sides of the abdomen, and sometimes even spreads to the groin and back. Burning sensation when urinating, darkening of the color of the urine, and sometimes visible blood in the urine as a result of the tests, and the feeling of incomplete emptying of the urine despite frequent urination are among the most common symptoms.
In addition to these symptoms, symptoms such as nausea and vomiting caused by accumulation in the kidneys can be seen. Sand spillage is sometimes accompanied by infection, and this can be an example of kidney sand symptoms. Kidney sands or stones can grow inside without any symptoms for a long time. It is necessary to be careful against this situation.
How can we avoid spilling sand?
- To reduce salt consumption,
- Drinking up to 2-3 liters of water a day,
- Feeding vegetables-based foods with a fibrous structure,
- Since exercise is thought to prevent crystal accumulation, adopting an active lifestyle can be counted among the measures that can be taken to pour sand or dropstones.
Treatment of patients who shed sand
The size of the crystals that fall into the thin urinary canals from the kidneys, that is, the stone or sand, is important for the treatment and this size is determined by the film method. If the size is less than 5mm as a result of the determination, it is said that the possibility of spontaneous falling is high. This probability is up to 70-85%. The use of painkillers to reduce pain is considered sufficient for this size of sand or stone. In addition to pain relief treatment, it is recommended that the patient consume plenty of fluids to increase the amount of urine and thus facilitate the excretion of small crystals found. At the same time, additional exercise to the treatments seen, especially frequent skipping is a good method for falling sand or stone. These exercises accelerate the downward movement of the accumulated crystals. Prostate drugs, which have the effect of widening the thin urinary channels, are among the drugs that can be used for treatment. These prostate medications are used for stones or sands larger than 5mm, usually 5-10mm in size.
Stone breaking treatment with sound wave (ESWL) can be applied to kidney stones that are smaller than 5 mm, but do not respond to painkiller treatment and do not fall out. If no response can be obtained as a result of this treatment method because the stone is hard or the patient is not actually suitable for this treatment, endoscopic laser stone breaking treatment (URS) is considered appropriate.
In addition to the treatments applied to prevent nausea, which is one of the sand pouring symptoms, nausea-relieving drugs can be applied to the patient. In order to prevent the infection accompanying sand casting in some cases, appropriate antibiotic treatment can also be started for the patient. Appropriate antibiotic selection is important in patients who will be treated with antibiotics, otherwise there is a possibility of antibiotic resistance in the patient. During the treatment, it is observed whether the kidney functions are restored or how the size of the swelling in the kidney has changed and the treatment is continued accordingly.
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