Kidney Stones - What To Do? Why Are The Symptoms Formed?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Kidney stones in women and men

The article describes the symptoms of kidney stones in women and men. The reasons for their appearance and modern methods of treatment of the disease are given.

Kidney stones in men and women may not show themselves for a long time. A person often finds out about a disease he has at the first attack of renal colic. Meanwhile, urolithiasis is fraught with certain dangers and requires treatment.

The main reason for the formation of kidney stones is a metabolic disorder in the body, which leads to the formation of insoluble salts. The number of stones and the place of their localization can be very diverse.

Urolithiasis is chronic, prone to frequent relapses. Stones can be found in the bladder, in the ureters, and not just in the kidneys.

External factors can also lead to their formation, for example, when a person drinks poor-quality water or adheres to a monotonous diet for a long time. In addition, the reason for the development of urolithiasis is often the climatic conditions in which a person lives, for example, a too hot climate. Other factors leading to the formation of stones are: the presence of a stricture of the ureter, taking certain medications, hyperparathyroidism, deficiency of vitamins A and D, chronic pyelonephritis and cystitis, anomalies in the development of the urinary system. In addition, one should not exclude the factor of transmission of the propensity to develop urolithiasis by inheritance.

There are several types of stones, their composition depends on what caused the salt deposition:

• In 70% of cases, the stones are calcium.
• In 15%, stones are infected.
• In 12% of cases, uric acid stones.
• In 2-3% of cases, the stones are cystine.

Content:

• Why do kidney stones form?
• What are the symptoms of kidney stones?
• Signs of disease in other organs
• What can happen if you have a kidney stone?
• What kind of examination do you need?
• If you have kidney stones - what to do?
• Surgery to remove kidney stones
• Is a relapse possible after removal of kidney stones?
• Conclusion: split, delete or wait?

Why do kidney stones form?

The reason for the formation of kidney stones is a malfunction in the metabolism. Especially dangerous is the water-salt imbalance and failures in the chemical composition of the blood. Metabolic disorders cause the development of many pathologies in the human body, including the cause of the development of urolithiasis. The salt content in urine increases, which leads to the formation of crystals.

Various factors can contribute to a malfunction in the metabolism, which in the future will lead to the formation of stones, among them:

• Regular drinking of water with a high salt content. The harder the water that a person drinks, the faster stones form in his kidneys. The incidence of urolithiasis is especially high in areas where the hardness level of tap water is exceeded. Therefore, people living in such regions should definitely use various methods to mitigate it. For this purpose, you can change filters, do not forget about folk methods of water softening. This can significantly reduce the risk of kidney stones formation.

• Power supply errors. Excessive consumption of sour, salty, spicy and fried foods. Spicy, fried, and fatty foods increase urine acidity, leading to the formation of kidney stones. Also, do not consume too much salt and drink large amounts of mineral water. If you exclude all harmful dishes from the diet, then you can minimize the risks of developing not only urolithiasis, but also many other diseases. Therefore, all doctors recommend eating a healthy diet.
• Lack of fluid in the body The less water the person drinks, the more concentrated the urine will be. Drinking a sufficient volume of liquid helps to dilute it. In addition, the blood becomes less viscous. This will allow the body to quickly get rid of harmful substances, as well as prevent the appearance of stones. A person needs to drink as much liquid as his body requires. The generally accepted norm is 2-3 liters of water per day. However, care must be taken so that this does not adversely affect the work of other systems and organs. This primarily concerns the heart. Therefore, it is necessary to determine the volume of water consumed per day individually.
• Sedentary lifestyle. Lack of exercise is a problem of modern society. Many diseases develop from lack of physical activity, because blood cannot circulate normally in the body, which means that all organs suffer from a lack of oxygen and nutrients.

Bedridden patients are very susceptible to the development of urolithiasis. A sedentary lifestyle is even more dangerous. Statistics show that physical inactivity increases the risk of death by 40%.

The less a person moves, the more his musculoskeletal system suffers, and the faster calcium is washed out of the bone tissue. As a result, the level of calcium in the blood rises, and the body tries unsuccessfully to excrete it along with urine. As a result, stones begin to form in the kidneys.

In order to prevent the development of urolithiasis, you need to lead an active lifestyle, walk more, ride a bike, and refuse to use the elevator. It should be remembered that kidney stones are formed in people who move little.

• Climatic conditions. If a person lives in a hot climate, then he often suffers from dehydration, especially against the background of insufficient water intake. The concentration of salts in the urine increases, which leads to the appearance of kidney stones. At risk are those people who lived in a temperate climate zone, and then move to hot areas. The body does not have time to adapt, sweating increases, dehydration increases, etc.
• Disorders in the kidneys and urinary tract. Any kidney injury leads to stagnation of urine in them. For the same reason, narrowing of the ureter, as well as the upper urinary tract, is dangerous. In addition, the risk of infection increases. Such violations must be identified and treated in time.
• Chronic diseases of the digestive system and organs of the genitourinary system. Urinary tract infections. Such diseases of the urinary system as pyelonephritis and cystitis are dangerous. Prostatitis and stomach ulcer often lead to the formation of kidney stones. However, almost any infection is capable of provoking metabolic disorders, so any inflammatory process must be eliminated as soon as possible. Leading a healthy lifestyle is the guarantee that most diseases will bypass a person. It is no secret that disruption of the work of one system leads to disruption of the functioning of the organism as a whole. This is how, step by step, a wide variety of diseases develop.
• Diseases of the bones, trauma. In terms of the formation of kidney stones, diseases such as osteomyelitis, osteoporosis and other diseases of the skeletal system are dangerous. Therefore, it is so important to maintain the health of the musculoskeletal system.
• Hereditary predisposition to the development of the disease If close relatives suffered from kidney stones, then the risk of developing this disease increases. However, it is possible and necessary to fight a hereditary predisposition to stone formation. A healthy lifestyle and proper nutrition come to the rescue.
• Vitamin deficiency, an excess of vitamins. Kidney stones form when vitamin C levels are high in the body. Dangerous deficiency of vitamin D and vitamin A.
• Lack of ultraviolet radiation. If a person rarely goes to the sun, then he has an increased risk of developing urolithiasis.
• Alcoholism, excessive use of diuretics. Taking diuretics helps the body to quickly lose fluid. This leads to an increase in the concentration of urine with the subsequent formation of stones. Therefore, it is so important not to deviate from the doctor's recommendations, to observe the dosage and frequency of taking diuretics, if they have been prescribed. Self-medication with diuretics is unacceptable. Drinking alcohol is also fraught with danger in terms of kidney stones. In general, the abuse of alcoholic beverages contributes to the intoxication of the body.
• Taking certain medications. It is possible to form kidney stones while taking ascorbic acid, sulfonamides and other drugs that lead to a malfunction of metabolic processes.

What are the symptoms of kidney stones?

The main symptoms of kidney stones are as follows:

Kidney pain. The pain is localized in the lumbar region. They can also indicate not only urolithiasis, but also kidney infarction, organ tumor, etc.

An attack of renal colic is characterized by abdominal pain on the left or right side. Pain radiates to the pubis or thigh. Renal colic requires immediate assistance to a person.

Impurities of blood in the urine. The presence of blood in the urine (hematuria) is a formidable symptom. It may indicate kidney stones, stones in the ureter, pyelonephritis, kidney tumors, and other inflammatory diseases of the urinary system.

Blood in urine can often be detected on its own. The liquid excreted by the body becomes like meat slops. Hematuria can develop after trauma to the bladder or kidneys, or after excessive exercise.

Sometimes urine can turn red after ingestion of certain foods containing the corresponding pigment. For example, after eating beets or pomegranates. It has nothing to do with hematuria.

Increased body temperature. A sign such as an increase in body temperature in itself does not indicate kidney stones. However, if the temperature rises against the background of other symptoms of urolithiasis, then it is necessary to seek medical help as soon as possible.

The appearance of edema. With kidney disease, a person always has edema. They are especially noticeable after waking up. Legs and arms swell, bags appear under the eyes. By the evening they subside, and by the morning they increase again. Despite this, people often overlook or simply ignore this sign of kidney disease.

Increased blood pressure. Arterial hypertension is a reason to undergo an examination of the entire urinary system. Very often, disturbances in the functioning of the kidneys and adrenal glands lead to surges in blood pressure.

Pain during urination. Pain during urination may indicate the presence of kidney stones, cystitis, and urethritis. In this case, you need to assess the color of the urine excreted. Normally, it is transparent, with a yellowish tinge. If the color of urine changes, then this may be a sign of not only kidney disease, but also liver, blood, or biliary tract disease.

Change in the volume of urine excreted. The daily volume of urine excreted is reduced to 500 ml (oliguria). This symptom may indicate glomerulonephritis. In addition, oliguria is a sign that a person is not drinking enough fluids, or he has increased sweating.

• The daily urine volume is reduced to 50 ml (anuria). A similar symptom may indicate acute renal failure, intoxication of the body with poisons or narcotic substances, and renal colic. It is possible that anuria may occur when the ureter is blocked by a stone.
• The daily urine volume increases to 10 liters (pollakiuria). This symptom indicates chronic kidney disease, the development of an irreversible process in the tissues of organs. Pollakiuria is also a symptom of diabetes mellitus.

Skin changes. A change in skin color may indicate kidney disease. So, against the background of glomerulonephritis, the skin is dry, pale, with a yellowish tinge. Multiple subcutaneous hemorrhages indicate kidney disease.

Deterioration of general well-being. A person gets tired faster, his appetite worsens, and weight loss occurs.

Signs of disease in other organs

Lumbar discomfort can indicate many diseases. Therefore, it is so important to find out the cause of the pain.

• Acute appendicitis can manifest as pain in the lumbar region. In addition, a person's body temperature rises, nausea and vomiting may join. If you experience these symptoms, you should seek immediate medical attention.
• Inflammation of the reproductive system. Lower back pain can occur during inflammatory processes in the genitals, and the urinary system with the reproductive system has a very close relationship.
• Diseases of the organs located in the abdominal cavity can respond to lumbar discomfort. To find out the nature of pain, you need to consult a doctor for a more accurate diagnosis.
• Osteochondrosis of the spinal column very often leads to pain in the lumbar region. This can also include other pathologies of the musculoskeletal system.

What can happen if you have a kidney stone?

If a person has a kidney stone, the condition requires treatment.

When no therapy is carried out, the following complications may develop:

• In the place where the stone is located, a chronic inflammatory process will occur. This happens especially often after hypothermia, after suffering an acute respiratory viral infection and against the background of a general decrease in immunity. As a result, diseases such as pyelonephritis, urethritis and cystitis join.
• In the future, pyelonephritis can be complicated by paranephritis, possibly the formation of purulent abscesses in the kidney or carbuncle. This threatens organ abscess, death of the renal papillae and sepsis. As a result, a person will need urgent surgical intervention, since such a condition poses a direct threat to life.
• It is possible to develop renal colic, which occurs when the ureter is blocked by a stone. In addition, the blockage of the kidney stone makes it impossible for urine to drain. This can lead to an increase in kidney size, to hydronephrosis, and in the future, to the development of renal failure.
• Stones can grow. Sometimes they reach such sizes that they occupy the entire cup-pelvis system. This, in turn, provokes the appearance of persistent, mild pain in the lumbar region, followed by the development of progressive renal failure.
• The presence of a kidney stone can provoke the development of nephrogenic hypertension, that is, the patient will have high blood pressure, which cannot be controlled with conventional drugs.

Can a kidney stone hurt?

A kidney stone can hurt. The pains are dull, they can appear when the ureter or kidney pelvis is blocked by a stone. If, against the background of pain, urine acquires a cloudy color, a person's body temperature rises and general health worsens, then this will indicate an infection.

The pain is localized in the lumbar region, it can radiate to the back, to the left or right side, to the lower abdomen. Pain can be reminiscent of itself during bladder emptying. Sometimes the pain increases during shaking, for example, when traveling on public transport, or after physical exertion.

Pain with kidney stones can be very mild or very intense (renal colic). Sometimes the pain does not bother a person at all, and he does not even suspect that he has a kidney stone. The first attack of pain can immediately proceed as renal colic.

Renal colic - what is it?

Renal colic is an acute attack of pain that occurs against the background of a sudden violation of the outflow of urine. Most often, renal colic develops when a stone is pinched in one of the parts of the ureter. The condition is accompanied by an increase in blood pressure and renal ischemia.

Renal colic is expressed as cramping pain in the lumbar region. They extend to the ureter and below. Urination also becomes extremely painful. In parallel, a person develops nausea, vomiting may join. The patient is in an agitated state. Renal colic requires immediate medical attention.

The causes of renal colic. When the ureter is blocked by a stone, the pressure in the renal pelvis sharply increases, the pelvis is stretched. Since there are many pain receptors in the wall of the pelvis, the pain is usually very severe. When the size of the stone is not more than 0.5–0.6 cm, the stone can come out by itself with urine. If the stone is large or the urinary tract is narrowed, or for other reasons the stone is in the urinary tract for a long time, preventing urine from leaving, the pressure in the renal pelvis remains high for a long time or it grows constantly, and this can lead to dysfunction and even death of the kidney.

Can a kidney stone dissolve?

The kidney stone may dissolve, but this will require specific therapy in conjunction with diet. Only uric acid stones are reliably soluble with the help of litholytic therapy.

Oxalate and urate stones can be dissolved with an alkaline drink. Sometimes small urate stones can be dissolved by switching to an increased drinking regime (ordinary water is suitable for this purpose).

Can kidney stones increase blood pressure?

Kidney stones can increase blood pressure. This condition is called secondary arterial hypertension syndrome. Most often, the pressure rises when complications of urolithiasis join, for example, chronic calculous pyelonephritis. In such patients, blood pressure is increased in 12-64% of cases. Also, blood pressure always rises against the background of an attack of renal colic.

Can kidney stones come out on their own?

Whole stones that pass from the kidneys through the urethra are extremely rare. Most often, they come out with urine in the form of sand. In this case, a person will experience pain, which intensifies when making sudden movements, possibly increased urination, an increase in body temperature, a change in the composition and color of urine.

If not a grain of sand comes out of the kidney, but a stone, then the patient will have renal colic, with all the accompanying symptoms. When the stone is flattened, has an elongated shape, it can enter the ureter from the kidney and begin to move along it. However, the ureters are curved, which is a natural obstacle to the movement of even a small stone, so they often get stuck in narrow places. Sometimes stones pass through the entire ureter, but linger at the exit to the bladder, completely or partially blocking the flow of urine. Against the background of a complete violation of the passage of urine, surgical intervention is necessary.

What kind of examination do you need?

Diagnosis of kidney stones is a prerequisite that must be met before starting treatment. A high-quality examination allows you to select the optimal therapeutic measures for a particular patient. During the diagnosis, it is very important to establish where the stones are located and what their size is.

So, to detect kidney stones you will need:

• Undergo an ultrasound of the kidneys and bladder. This method has its advantages. For example, when performing an X-ray examination, urate stones cannot be detected, but they are clearly visible on ultrasound.
• X-ray examination allows you to detect stones of large sizes - from 3 cm or more. The images will show oxalate calculi. Urate stones are not visible to x-rays, as they simply pass them through. Kidney x-rays are an adjunct, not the primary, method for detecting stones.
• Delivery of laboratory tests allows you to identify violations of metabolic processes, as well as make a conclusion about the chemical composition of stones. According to the analysis of blood and urine, one can suspect the presence of an inflammatory process in the body.
• Excretory radiopaque urography of the kidneys allows to determine the location of the stone and its exact coordinates. For this type of study, a special substance is injected into a vein, which enters the kidneys and accumulates in them. Then the patient is examined using an X-ray method. The danger of this type of research is reduced to the occurrence of an allergic reaction to the injected drug.
• CT of the kidneys. Tomography is one of the most informative research methods that allows you to give maximum information about kidney stones.

If you have kidney stones - what to do?

For the treatment of kidney stones, both surgical and conservative therapy are used. It is possible to determine the optimal method of getting rid of urolithiasis only in conjunction with a urologist. The tactics of patient management is determined based on his age, stone location, stone size, disease symptoms, anatomical and physical characteristics of a person. In addition, it is important to clarify whether the patient develops renal failure.

Selection of diet. The food that a patient with kidney stones takes should not contribute to the formation of new stones. In addition, a person must receive enough fluids so that the daily urine output is at least 1.5 liters. Although the diet should be varied, the total amount of food should be cut back.

Depending on the composition of the stones, the following recommendations can be given:

• With urate stones, you need to limit the intake of protein into the body, completely abandon the use of coffee, chocolate, spicy and fatty foods. You can not take alcohol, meat, pates, sausages are also excluded.
• With calcium oxalate stones, you need to limit the use of chocolate, milk, cheese, cottage cheese, nuts, strawberries, lettuce, sorrel, spinach. You shouldn't drink strong tea. From fruits, all citrus fruits are banned.
• If the patient has calcium phosphate stones, then you can not eat cottage cheese, cheese, berries, pumpkin, all green vegetables, potatoes and beans. Milk and alkaline mineral water are banned from drinks.

Water impacts to wash the kidneys. If, as a result of ultrasound, microliths (small crystals), and not stones, were found, then it is possible to wash the kidneys with water. To do this, a person will need to drink 0.5-1 liter of water on an empty stomach, or a decoction of dried fruits. If there are no medical prohibitions, then this procedure can be repeated once a week. This method allows you to get rid of microliths and prevent the formation of stones.

Medical treatment. If the stones go away on their own, then the patients are prescribed drugs from the terpene group. They have a sedative, antispasmodic and bacteriostatic effect.

To dissolve cystine stones, the drug Uralit can be used. To get rid of oxalate stones - the drug Spill. For phosphate stones, it is recommended to take the drug Prolit.

The most important factor influencing the course of urolithiasis is metabolic disorder, therefore it must be brought back to normal. Allopurinol and Benzbromarone are taken to lower uric acid levels. It is possible to supplement these preparations with citrate mixtures. Also, patients are prescribed vitamins A and E, as powerful antioxidants that normalize the functioning of the cell membranes of the kidneys. The dose, frequency of administration and the choice of a specific drug are selected individually for each patient.

With the development of renal colic, the patient is shown taking antispasmodics (Drotaverin or Metamizole sodium), as well as thermal procedures (taking a bath, applying a heating pad). If antispasmodics are ineffective, and the attack of renal colic is delayed, it is necessary to introduce a novocaine blockade of the spermatic cord or uterine ligament.

With the addition of inflammatory processes, antibiotics are indicated. It is important to understand that it will be impossible to completely get rid of pyelonephritis or other diseases provoked by urolithiasis as long as the stone remains in the kidneys.

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Distance lithotripsy method

The method of distance lithotripsy allows crushing stones from 4 mm to 1.5 cm in diameter. It is also used to get rid of small stones that are resistant to conservative therapy.

Remote lithotripsy can be used to treat patients of any age, as it is a non-contact method of treatment. Contraindications to the procedure are:

• Pregnancy;
• Body weight over 130 kg;
• Aortic aneurysm;
• Hemophilia;
• Acute myocardial infarction;
• Exacerbation of gastrointestinal and kidney diseases.

The procedure itself lasts about 40 minutes. The patient is placed on a special lithotripter table, then the apparatus is brought to the affected area. He, without touching the body, begins to crush stones. At this time, a person may feel only a slight tingling sensation.

Abroad, distance lithotripsy is performed on an outpatient basis. In Russia, it is customary to hospitalize a patient for up to 3 days. After the procedure, stones begin to come out of the kidneys. The time of their removal depends on the state of the human body, on the age of the patient, on the chemical composition of the stone. Often, the sand comes out almost painlessly. After a day, the patient's kidneys are completely cleansed. In other cases, the stones can go out for more than a month, while the person will experience pain like cystitis.

1-2 days after lithotripsy, you must come to the urologist. It is necessary to repeat the visit to the doctor after 30 days. At the same time, an ultrasound examination of the kidneys is performed. Most often, 1 or 2 procedures are enough for complete removal of stones.

Surgery to remove kidney stones

Indications for surgery to remove kidney stones are:

• Hematuria.
• Severe pain syndrome.
• Frequent relapses of pyelonephritis.
• Hydronephrosis of the kidney.

Doctors, when choosing the type of surgery, should follow the least traumatic path. If earlier the only way to remove a stone was an open operation, which often led to the removal of the kidney itself, then modern technologies make it possible to avoid this. An open operation is performed only in the presence of large stones, with increasing renal failure, if it is impossible to implement other methods of treatment for one or another contraindication. Also, stones are removed in an open way when purulent pyelonephritis is attached.

Types of open kidney surgery:

• Pielolithotomy. It is performed on condition that a stone is found in the renal pelvis. Posterior, inferior and anterior pyelolithotomy is performed.
• If the stones are large, contact crushing is required. We will apply a method such as nephrolitholapaxy. In this case, the patient is given anesthesia (spinal or general), after which the skin is pierced over the kidney, with the help of bougie, its internal space is expanded and the stone begins to crush. The stones are crushed with ultrasound, pneumatic devices or laser. The whole procedure is monitored by X-ray and ultrasound.
• Ureterolithotomy. This operation is performed on condition that the stone is in the ureter. This method is rarely used in modern surgery.

When deciding on the method of surgical treatment, it is very important to pay attention to such criteria as:

• Stone size;
• Its location in the urinary tract;
• Ability to visualize the stone using X-ray equipment (X-ray negative or X-ray positive stone).

As for the chemical composition of the stone, you should pay attention to it when choosing the most optimal diet for the patient. This will determine the set of permitted and prohibited products included in the patient's menu. In addition, the mineral composition of the stone makes it possible to determine the choice of drugs that will facilitate its dissolution.

Is a relapse possible after removal of kidney stones?

Relapse after removal of kidney stones is possible. Therefore, it is so important to adhere to medical recommendations after the treatment. You should follow a diet, limit the use of fish and meat dishes. This must be done due to the fact that meat and fish contain purines, they provoke the production of uric acid, which further leads to the formation of stones.

Another important recommendation is to drink enough liquid. Drink 1.5 liters of water at least a day. This will dilute the urine and make it less concentrated. As a result, the creation of an unfavorable environment for starting the process of stone formation.

It is also possible to use phytotherapeutic drugs. They have a certain diuretic and antiseptic effect. In addition, patients who have undergone treatment for urolithiasis need to take urine tests once every 3-6 months. Ultrasound of the entire urinary system is done once every 6 months.

Urolithiasis often leads to various diseases of an inflammatory nature. During their exacerbation, kidney stones are not removed. First you need to carry out a LHC-sowing on the microbial flora and eliminate inflammation.

Inflammation of the kidneys is treated with antibiotics. Only after the elimination of the inflammatory process will it be possible to start surgery. The exception is emergency operations, they are carried out without prior treatment.

Conclusion: split, delete or wait?

The method of treatment is determined by the size of the stones, as well as by the disorders in the body that they provoked. Stones significantly increase the risk of developing inflammatory processes not only in the kidneys themselves, but also in the ureters, as well as in the bladder. They can provoke the development of pyelonephritis, cystitis, renal failure, heart attack and kidney death. In the future, a person will need hemodialysis and organ transplantation.

Therefore, if the doctor insists on an operation, then you should not refuse it.

The risks of developing urolithiasis are increased in the following categories of people:

• Patients with a genetic predisposition;
• Patients with diseases of the digestive system and organs of the genitourinary system;
• Osteoporosis patients;
• Patients with disorders of the parathyroid glands;
• People who eat a lot of spicy, sour and salty foods, as well as protein foods;
• People who follow a monotonous diet;
• People who drink substandard hard water containing a large amount of salts.

Open-type operations for kidney stones are rarely performed, for example, against the background of narrowing of the ureter or in violation of the passage of urine.

The most commonly used methods of treatment are:

• Remote lithotripsy. Using this method, stones up to 1.5 cm in size are removed. The procedure is performed using special equipment. In this case, invasive intervention in the body does not occur.
• Transurethral, contact or percutaneous nephrolitholapaxy. These methods are applicable when the stones are large, or when there are many of them. To implement each procedure, the patient will need to be anesthetized. Any operation is performed under the control of ultrasound and X-ray. Punctures in the skin and crushing stones are performed using special tubes. The stone is crushed with a laser, ultrasound, electrical impulse or pneumatics. This procedure allows not only to destroy stones, but also to remove their remnants from the kidney.

Thanks to modern technologies, the recovery period after surgery has been significantly reduced when compared with open surgical techniques previously performed. However, the choice of the method of treatment should be made by a specialist.

It is possible to suspect urolithiasis by such signs as:

• Discomfort and pain in the lumbar region;
• Pain in the lower abdomen with irradiation to the groin and genitals;
• The presence of blood impurities in the urine;
• Increased urination, painful urination, cloudy urine;
• The appearance of edema;
• Increased body temperature.

Author of the article: Lebedev Andrey Sergeevich | Urologist

Education: Diploma in the specialty "Andrology" received after completing residency at the Department of Endoscopic Urology of the Russian Medical Academy of Postgraduate Education in the urological center of the Central Clinical Hospital No. 1 of JSC Russian Railways (2007). Postgraduate studies were completed here by 2010.