4th Yr Urology Flashcards
How do renal stones present?
May be asymptomatic and never cause an issue
Renal colic
Excruciating loin to groin pain
Colicky (fluctuating in severity) as the stone moves and settles
May have haematuria, nausea, vomiting and oliguria
May have symptoms of sepsis if infection present (i.e. fever)
What is gold standard for renal stones?
CT KUB (non-contrast scan of kidney, ureters and bladder
What is the intial management for renal stones?
NSAIDs are usually the most effective type of analgesia (e.g. PR diclofenac)
Antiemetic if nausea and vomiting
Fluids
Antibiotics if infection is present
What is the definitive management for renal stones?
Stones less than 6mm have greater than 50% chance of passing without intervention
Spontaneous passage can take several weeks
Tamsulosin (an alpha-blocker) can be used to help aid spontaneous passage of stones
Surgical Interventions in large stones or stones that do not pass
What are the different surgical interventions for renal stones?
Extracorporeal Shock Wave Lithotripsy
Ureteroscopy and Laser Lithotripsy
Percutaneous Nephrolithotomy
What are the different types of renal stone?
Calcium oxalate Uric Acid Calcium Phosphate Struvite Cystine
What is the commonest type of renal stone?
Calcium oxalate 80%
Which type of stone cannot be seen by X ray?
Uric acid
What is the pharmacological management for uric acid stones?
Allopurinol + alkaline citrate
Which bacteria is associated with formation of a staghorn calculus?
Proteus mirabilis as it can hydrolyse the urea in urine to ammonia, creating the solid struvite
What would you advise someone with recurring stones?
Increase oral fluids
Reduce dietary salt intake
Reduce intake of oxalate-rich foods for calcium stones (e.g. spinach, nuts, rhubarb, tea)
Reduce intake of urate- rich foods for uric acid stones (e.g. kidney, liver, sardines)
Limit dietary protein
What can LUTS be grouped into?
storage, voiding, and post-micturition symptoms
What does storage symptoms refer to?
urgency, daytime urinary frequency, nocturia, urinary incontinence, and feeling the need to urinate again just after passing urine
What does voiding symptoms refer to?
hesitancy, weak or intermittent urinary stream sometimes causing splitting or spraying, straining, intermittency, incomplete emptying, and terminal dribbling
What does post-micturition symptoms refer to?
post-micturition dribble and the sensation of incomplete emptying.
