Kidney Stones

Question 1

What is the classic pain presentation with kidney stones?

Answer 1

Loin to groin pain secondary to a urinary stone

Question 2

How is a kidney stone diagnosed?

Answer 2

CT KUB non-contrast is gold standard. Ultrasound if pregnant woman or child

CT KUB = CT scan of kidneys, ureters and bladder

Question 3

How are kidney stones managed acutely?

Answer 3

1. IV fluids
2. Analgesia - PR diclofenac

Question 4

When can a watchful wait approach be taken?

Answer 4

When pain is managed sufficiently and no complex history such as large stones or recurrence. The stone (if <5mm) should pass by itself within 4 weeks.

Question 5

Which medicine can be used in the management of larger kidney stones?

Answer 5

Tamsulosin - an alpha blocker, helps the passage of larger stones that are <10mm.

Benefit in larger stone management though not routine

Question 6

What are the surgical management options of kidney stones?

Answer 6

1. Percutaenous nephrolithotomy
2. Ureteroscopy
3. Lithotripsy

Question 7

When is percutaneous nephrolithotomy used?

Answer 7

Complex or staghorn renal calculi

Staghorn - shaped like one and looks like one on KUB

Question 8

When is ureteroscopy usually used?

Answer 8

When stone(s) are <20mm and the person is pregnant

Question 9

When is lithotripsy used?

Answer 9

When stones are <20mm and the person is not pregnant

Question 10

When are kidney stones classed as a surgical emergency?

Answer 10

If there are signs of obstruction and infection