7. Urolithiasis (Kidney Stones)

Question 1

What percentage of the populations present with Kidney Stones?

Answer 1

2-3%

Question 2

What is the recurrence rate of Kidney Stones, within 10 years?

Answer 2

50%

Question 3

Are Kidney Stones more common in Males or Females?

Answer 3

Males - 3 times more common - 1:8 lifetime risk

Question 4

What is the peak age of onset for Kidney Stones in males?

Answer 4

30 years old

Question 5

What are the peak ages for Kidney Stones in females?

Answer 5

1. 35 years old (peri-menopausal)

2. 55 years old (post-menopausal)

Question 6

What are the different stone types? And what are there relative incidences?

Answer 6

1. Calcium Oxalate - 45%
2. Calcium Oxalate + Phosphate - 25%
3. “Triple Phosphate” - 20%
4. Uric Acid - 5%
5. Calcium Phosphate - 3%
6. Cystine - 3%

Question 7

What is the pathology of Kidney Stones?

Answer 7

1. Due to a blockage / obstruction of urine, urine sits for excessive time in a certain place, which allows sediment to form.
2. This sediment can coagulate to form Kidney Stones

Question 8

What are the clinical features of Kidney Stones?

Answer 8

1. Pain
2. Ureteric Colic
3. Dysuria
4. Haematuria
5. Recurrent UTI’s
6. Pyrexia

Question 9

How is the pain described?

Answer 9

Fixed in the loin but can occur in the Testicles / Vulva

Question 10

Where can the Ureteric Colic radiate to?

Answer 10

The Groin

Question 11

What investigations are necessary for Kidney Stones?

Answer 11

1, Blood Tests

2. Urinalysis and Culture
3. Intravenous Urogram
4. Renal Ultrasound
5. Plain X-Ray
6. CT-KUB

Question 12

What blood tests will occur? And what will they be looking for?

Answer 12

1. Full Blood Count - Signs of Infection
2. Urea, Electrolytes and Creatinine - To assess Renal Function
3. Calcium, Albumin and Urate - To assess for Renal Dysfunction
4. Parathyroid Hormone - To assess as an aetiology for Renal Damage

Question 13

What is the purpose of the Urinalysis and Culture?

Answer 13

To exclude a UTI as a cause

Question 14

What is the purpose of an Intravenous Urogram / Renal Ultrasound?

Answer 14

To assess for a stone

Question 15

What is the best test for identifying a kidney stone?

Answer 15

CT-KUB

Followed by a Plain X-Ray

Question 16

What treatments are required for Kidney Stones?

Answer 16

1. Endoscopic Surgery
2. Extracorporeal Shock Wave Therapy (ESWT)
3. Percutaneous Nephrolithotomy (PCNL)
4. Open Surgery:
   a) Simple Partial Nephrectomy
   b) Total Nephrectomy

Question 17

How are most bladder stones treated?

Answer 17

Endoscopic Surgery

Question 18

How does Extracorporeal Shock Wave Therapy work?

Answer 18

This uses shock waves to crush the stones into passable abjects

Question 19

When is Percutaneous Nephrolithotomy used?

Answer 19

For a large stone when Extracorporeal Shock Wave Therapy is not an option
This is used alongside a Radiologist

Question 20

When is open surgery used? What is the advantage / disadvantage?

Answer 20

Very rarely
Advantage - Least recurrence rate
Disadvantage - more risks / worse scar