L2: Urinary Stones Flashcards
1
Q
Incidence of Urolithiasis (Urinary Stones)
A
2
Q
Sex in Urolithiasis (Urinary Stones)
A
Males > females
3
Q
Genetic Causes of Urinary Stones
A
Cystinuria & familial RTA (Ca Phosphate stones).
4
Q
Age in Urolithiasis (Urinary Stones)
A
Occur mainly in middle age group, but no age is exceptional.
5
Q
Geographic Distribution of Urinary Stones
A
More common in people living in mountains, deserts and tropical areas
6
Q
RF for Urinary Stones
A
7
Q
RF for Urinary Stones
- dehydration
A
a major factor in stone formation.
8
Q
RF for Urinary Stones
- Diet
A
9
Q
RF for Urinary Stones
- Urine Stasis
A
- A fair rate of urine flow would expel crystals before they have the chance to coalesce and grow.
- As in: Ureteric stricture. BPH (SPE), Neurogenic bladder.
10
Q
RF for Urinary Stones
- UTI
A
Stones associated with chronic UTI are called “Struvite Stones”
11
Q
RF for Urinary Stones
- Metabolic Conditions
A
a- Renal tubular acidosis.
b- Gout.
c- Cystinuria.
12
Q
Mechanism of stone formation
A
13
Q
Mechanism of stone formation
- Saturation
A
14
Q
Mechanism of stone formation
- Supersaturation (Formation product)
A
15
Q
Mechanism of stone formation
- Crystallization
A
16
Q
Mechanism of stone formation
- Cementation (Matrix formation)
A
17
Q
Mechanism of stone formation
- Nucleation
A
18
Q
Mechanism of stone formation
- Epitaxy (Growth)
A
19
Q
Types of Stones
A
20
Q
Types of Calcium containing stones
A
21
Q
Compare between Ca-Containing, Struvite, Uric Acid, Cystine stones in terms of
- Incidence
- Structure
- Etiology
- pH of Urine
- X-Ray
- NB
A
22
Q
CP of Urinary Stones
A
- Renal
- Ureteric
- Bladder
- Urethral
23
Q
CP of Renal Stones
A
24
Q
CP of Ureteric stones
A
25
Complications of **Urinary Stones**
25
CP of **Bladder stones**
1) Suprapubic pain.
2) Pain during micturition.
3) Lower Urinary Tract Symptoms (LUTS): Frequency , BM.
26
CP of **Urethral stone**
1) Sudden interruptions of urine stream.
2) Urinary retention.
27
INVx for **Urinary stone**
28
INVx for **Urinary stone**
- Labs (urine analysis)
29
INVx for **Urinary stone**
- Labs
30
INVx for **Urinary stone**
- Labs (Urine Culture)
Only if urine analysis showed pyuria or bacteriuria
31
INVx for **Urinary stone**
- Labs (Blood Tests)
- Serum creatinine, CBC
- Detection of underlying metabolic abnormalities (uric acid).
32
INVx for **Urinary stone**
- Rads
1) Kidney, Ureter & Bladder (KUB) X-Ray.
2) Abdominal and Pelvic Ultrasonography.
3) Intravenous urography “IVU” (Intravenous pyelography “IVP”).
4) Spiral CT (Non-Contrast CT of the abdomen and pelvis) “The Most sensitive”
5) Diuretic renogram.
33
Causes of RO Shadow in Hypocondrium
34
Causes of RO Shadow Along the course of the ureter
35
Advantages of **Renal US**
1) Kidneysite,size.
2) Grade of hydronephrosis, Cortical thickening.
3) Cortico-medullary differentiation.
4) Detection of Renal stones, cysts, tumors, perinephric collections.
36
Disadvantages of **Renal US**
- Operator dependent
- Ureteric stones may not be seen by US but the hydronephrosis resulting from obstruction is seen.
37
Appearence of Stones in Renal US
Renal stones appear as Hyper-echoic (white) with posterior acoustic shadow (black)
38
Renal US & Ureteric Stones
Ureteric stones may not be seen by US but the hydronephrosis resulting from obstruction is seen.
39
Advantages of **Intravenous Pyelogram (IVP)**
39
Disadvantages of **Intravenous Pyelogram (IVP)**
40
Appearence of Stones in **Non-Contrast CT (NCCT)**
Stones appear as hyperdense (white) area
41
What is the most sensitive investigation in detection of urinary calculi?
NCCT
42
Advantages of **Non-Contrast CT (NCCT)**
43
Disadvantages of **Non-Contrast CT (NCCT)**
Radiation exposure
44
Aspects of TTT of Acute Renal Colic
- Medical
- Renal drainage
45
TTT of Acute Renal Colic
- Medical
46
TTT of Acute Renal Colic
- Medical (Analgesics)
47
Indications for emergency drainage of the obstructed kidney in a case presenting with acute renal colic
48
Procedure for emergency drainage of the obstructed kidney in a case presenting with acute renal colic
1) Ureteric stent
2) Percutaneous Nephrostomy tube
49
Options for Treatment of Renal Stones
50
TTT of RENAL Stones
....
51
Indications of Conservative TTT of RENAL Stones
For incidentally discovered calyceal stones < 5 mm & not causing :
- Infection,
- Obstruction
- Hematuria.
52
Follow Up in TTT of RENAL Stones
By ultrasonography, every 3 months
53
Indications for active treatment of Renal stones
1) Developed pain.
2) Infection.
3) Obstruction.
4) Increased in size.
54
TTT of RENAL Stones
- Procedure of **Extracorporeal Shock Wave Lithotripsy (ESWL)**
55
TTT of RENAL Stones
- Indications of **Extracorporeal Shock Wave Lithotripsy (ESWL)**
56
TTT of RENAL Stones
- Advanatges of **Extracorporeal Shock Wave Lithotripsy (ESWL)**
57
TTT of RENAL Stones
- CI of **Extracorporeal Shock Wave Lithotripsy (ESWL)**
58
TTT of RENAL Stones
- Complications of **Extracorporeal Shock Wave Lithotripsy (ESWL)**
59
TTT of RENAL Stones
- Procedure of **Percutaneous Nephrolithotomy (PCNL)**
60
TTT of RENAL Stones
- Indications of **Percutaneous Nephrolithotomy (PCNL)**
61
TTT of RENAL Stones
- Advantages of **Percutaneous Nephrolithotomy (PCNL)**
62
TTT of RENAL Stones
- CI of **Percutaneous Nephrolithotomy (PCNL)**
63
TTT of RENAL Stones
- Complications of **Percutaneous Nephrolithotomy (PCNL)**
64
TTT of RENAL Stones
- Procedure of **Flexible Ureteroscopy**
1) Reach the renal stones through the urethra, bladder, and ureter.
2) Disintegrate the stone using Laser.
3) Then fragments can be removed by a basket.
65
TTT of RENAL Stones
- Indications of **Flexible Ureteroscopy**
Renal stones < 20 mm at any site
66
TTT of RENAL Stones
- Advantages of **Flexible Ureteroscopy**
67
TTT of RENAL Stones
- Disadvantages of **Flexible Ureteroscopy**
1. Expensive instruments (flexible URS, Laser, Basket).
2. Needs experienced surgeon.
68
TTT of RENAL Stones
- Open Surgery
- The role of open surgery for treatment of urinary stones is markedly decreased because of development of many endoscopic methods such as URS & PCNL.
69
TTT of RENAL Stones
- Laproscopy
70
TTT of RENAL Stones
- The possible operations include ......
1) Pyelolithotomy
2) Nephrolithotomy
3) Pyelonephrolithotomy
4) Lower polar partial nephrectomy
5) Nephrectomy
71
Options in Treatment of Ureteric Stones
72
Treatment of Ureteric Stones
- Indications of Conservative TTT
Stones of < 5 mm that did not cause hydronephrosis or infection.
73
Treatment of Ureteric Stones
- Methods of Conservative TTT
The patient is treated with analgesics
74
Treatment of Ureteric Stones
- What to do if Conservative TTT Fails?
If the stone did not pass spontaneously within 2 weeks another line of treatment is indicated.
75
Treatment of Ureteric Stones
- Indications of MET
for Distal Ureteric stones 5 - 10 mm.
76
Treatment of Ureteric Stones
- Examples of MET
1. Use of medications to facilitate spontaneous stone passage.
2. Alpha-receptorBlockers:Tamsulosin
77
Treatment of Ureteric Stones
- Indications of ESWL
- Stone size: < 10 mm.
- Stone Site: in the upper (proximal) ureter.
78
Treatment of Ureteric Stones
- CI of ESWL
As renal stones
79
Treatment of Ureteric Stones
- Indications of Rigid URS
80
Treatment of Ureteric Stones
- Complications of Rigid URS
- Hematuria.
- Sepsis.
- Ureteric wall injury (Perforation, Avulsion).
81
Treatment of Ureteric Stones
- Surgery
Ureterolithotomy
82
Treatment of bladder calculi
83
First line treatment for of each stone
- Renal < 20 mm (not in lower calyx)
ESWL or Flexible URS
84
First line treatment for of each stone
- Renal < 10 mm in lower calyx
ESWL or Flexible URS
85
First line treatment for of each stone
- Renal > 20 mm
PCNL
86
First line treatment for of each stone
- Renal Staghorn stones
PCNL
87
First line treatment for of each stone
- Ureteric proximal < 10 cm
ESWL or Flexible URS
88
First line treatment for of each stone
- ureteric Proximal > 10 cm
Flexible URS or push back and PCNL
89
First line treatment for of each stone
- Ureteric Distal 5-10 cm
Trial MET
90
First line treatment for of each stone
- Ureteric Distal > 10 cm
Rigid URS
91
First line treatment for of each stone
- Huge stone or failed other treatments
Laparoscopic or open surgery
