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Y4R4 - Surgery II 👨‍⚕️ > L2: Urinary Stones > Flashcards

L2: Urinary Stones Flashcards

1
Q

Incidence of Urolithiasis (Urinary Stones)

A
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2
Q

Sex in Urolithiasis (Urinary Stones)

A

Males > females

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3
Q

Genetic Causes of Urinary Stones

A

Cystinuria & familial RTA (Ca Phosphate stones).

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4
Q

Age in Urolithiasis (Urinary Stones)

A

Occur mainly in middle age group, but no age is exceptional.

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5
Q

Geographic Distribution of Urinary Stones

A

More common in people living in mountains, deserts and tropical areas

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6
Q

RF for Urinary Stones

A
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7
Q

RF for Urinary Stones

  • dehydration
A

a major factor in stone formation.

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8
Q

RF for Urinary Stones

  • Diet
A
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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.
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10
Q

RF for Urinary Stones

  • UTI
A

Stones associated with chronic UTI are called “Struvite Stones”

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11
Q

RF for Urinary Stones

  • Metabolic Conditions
A

a- Renal tubular acidosis.
b- Gout.
c- Cystinuria.

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12
Q

Mechanism of stone formation

A
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13
Q

Mechanism of stone formation

  • Saturation
A
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14
Q

Mechanism of stone formation

  • Supersaturation (Formation product)
A
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15
Q

Mechanism of stone formation

  • Crystallization
A
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16
Q

Mechanism of stone formation

  • Cementation (Matrix formation)
A
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17
Q

Mechanism of stone formation

  • Nucleation
A
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18
Q

Mechanism of stone formation

  • Epitaxy (Growth)
A
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19
Q

Types of Stones

A
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20
Q

Types of Calcium containing stones

A
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21
Q

Compare between Ca-Containing, Struvite, Uric Acid, Cystine stones in terms of

  • Incidence
  • Structure
  • Etiology
  • pH of Urine
  • X-Ray
  • NB
A
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22
Q

CP of Urinary Stones

A
  • Renal
  • Ureteric
  • Bladder
  • Urethral
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23
Q

CP of Renal Stones

A
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24
Q

CP of Ureteric stones

A
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25
Q

Complications of Urinary Stones

A
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25
Q

CP of Bladder stones

A

1) Suprapubic pain.
2) Pain during micturition.
3) Lower Urinary Tract Symptoms (LUTS): Frequency , BM.

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26
Q

CP of Urethral stone

A

1) Sudden interruptions of urine stream.

2) Urinary retention.

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27
Q

INVx for Urinary stone

A
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28
Q

INVx for Urinary stone

  • Labs (urine analysis)
A
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29
Q

INVx for Urinary stone

  • Labs
A
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30
Q

INVx for Urinary stone

  • Labs (Urine Culture)
A

Only if urine analysis showed pyuria or bacteriuria

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31
Q

INVx for Urinary stone

  • Labs (Blood Tests)
A
  • Serum creatinine, CBC
  • Detection of underlying metabolic abnormalities (uric acid).
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32
Q

INVx for Urinary stone

  • Rads
A

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.

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33
Q

Causes of RO Shadow in Hypocondrium

A
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34
Q

Causes of RO Shadow Along the course of the ureter

A
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35
Q

Advantages of Renal US

A

1) Kidneysite,size.

2) Grade of hydronephrosis, Cortical thickening.

3) Cortico-medullary differentiation.

4) Detection of Renal stones, cysts, tumors, perinephric collections.

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36
Q

Disadvantages of Renal US

A
  • Operator dependent
  • Ureteric stones may not be seen by US but the hydronephrosis resulting from obstruction is seen.
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37
Q

Appearence of Stones in Renal US

A

Renal stones appear as Hyper-echoic (white) with posterior acoustic shadow (black)

38
Q

Renal US & Ureteric Stones

A

Ureteric stones may not be seen by US but the hydronephrosis resulting from obstruction is seen.

39
Q

Advantages of Intravenous Pyelogram (IVP)

A
39
Q

Disadvantages of Intravenous Pyelogram (IVP)

A
40
Q

Appearence of Stones in Non-Contrast CT (NCCT)

A

Stones appear as hyperdense (white) area

41
Q

What is the most sensitive investigation in detection of urinary calculi?

A

NCCT

42
Q

Advantages of Non-Contrast CT (NCCT)

A
43
Q

Disadvantages of Non-Contrast CT (NCCT)

A

Radiation exposure

44
Q

Aspects of TTT of Acute Renal Colic

A
  • Medical
  • Renal drainage
45
Q

TTT of Acute Renal Colic

  • Medical
A
46
Q

TTT of Acute Renal Colic

  • Medical (Analgesics)
A
47
Q

Indications for emergency drainage of the obstructed kidney in a case presenting with acute renal colic

A
48
Q

Procedure for emergency drainage of the obstructed kidney in a case presenting with acute renal colic

A

1) Ureteric stent

2) Percutaneous Nephrostomy tube

49
Q

Options for Treatment of Renal Stones

A
50
Q

TTT of RENAL Stones

A

….

51
Q

Indications of Conservative TTT of RENAL Stones

A

For incidentally discovered calyceal stones < 5 mm & not causing :

  • Infection,
  • Obstruction
  • Hematuria.
52
Q

Follow Up in TTT of RENAL Stones

A

By ultrasonography, every 3 months

53
Q

Indications for active treatment of Renal stones

A

1) Developed pain.
2) Infection.
3) Obstruction.
4) Increased in size.

54
Q

TTT of RENAL Stones

  • Procedure of Extracorporeal Shock Wave Lithotripsy (ESWL)
A
55
Q

TTT of RENAL Stones

  • Indications of Extracorporeal Shock Wave Lithotripsy (ESWL)
A
56
Q

TTT of RENAL Stones

  • Advanatges of Extracorporeal Shock Wave Lithotripsy (ESWL)
A
57
Q

TTT of RENAL Stones

  • CI of Extracorporeal Shock Wave Lithotripsy (ESWL)
A
58
Q

TTT of RENAL Stones

  • Complications of Extracorporeal Shock Wave Lithotripsy (ESWL)
A
59
Q

TTT of RENAL Stones

  • Procedure of Percutaneous Nephrolithotomy (PCNL)
A
60
Q

TTT of RENAL Stones

  • Indications of Percutaneous Nephrolithotomy (PCNL)
A
61
Q

TTT of RENAL Stones

  • Advantages of Percutaneous Nephrolithotomy (PCNL)
A
62
Q

TTT of RENAL Stones

  • CI of Percutaneous Nephrolithotomy (PCNL)
A
63
Q

TTT of RENAL Stones

  • Complications of Percutaneous Nephrolithotomy (PCNL)
A
64
Q

TTT of RENAL Stones

  • Procedure of Flexible Ureteroscopy
A

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
Q

TTT of RENAL Stones

  • Indications of Flexible Ureteroscopy
A

Renal stones < 20 mm at any site

66
Q

TTT of RENAL Stones

  • Advantages of Flexible Ureteroscopy
A
67
Q

TTT of RENAL Stones

  • Disadvantages of Flexible Ureteroscopy
A
  1. Expensive instruments (flexible URS, Laser, Basket).
  2. Needs experienced surgeon.
68
Q

TTT of RENAL Stones

  • Open Surgery
A
  • 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
Q

TTT of RENAL Stones

  • Laproscopy
A
70
Q

TTT of RENAL Stones

  • The possible operations include ……
A

1) Pyelolithotomy
2) Nephrolithotomy
3) Pyelonephrolithotomy
4) Lower polar partial nephrectomy
5) Nephrectomy

71
Q

Options in Treatment of Ureteric Stones

A
72
Q

Treatment of Ureteric Stones

  • Indications of Conservative TTT
A

Stones of < 5 mm that did not cause hydronephrosis or infection.

73
Q

Treatment of Ureteric Stones

  • Methods of Conservative TTT
A

The patient is treated with analgesics

74
Q

Treatment of Ureteric Stones

  • What to do if Conservative TTT Fails?
A

If the stone did not pass spontaneously within 2 weeks another line of treatment is indicated.

75
Q

Treatment of Ureteric Stones

  • Indications of MET
A

for Distal Ureteric stones 5 - 10 mm.

76
Q

Treatment of Ureteric Stones

  • Examples of MET
A
  1. Use of medications to facilitate spontaneous stone passage.
  2. Alpha-receptorBlockers:Tamsulosin
77
Q

Treatment of Ureteric Stones

  • Indications of ESWL
A
  • Stone size: < 10 mm.
  • Stone Site: in the upper (proximal) ureter.
78
Q

Treatment of Ureteric Stones

  • CI of ESWL
A

As renal stones

79
Q

Treatment of Ureteric Stones

  • Indications of Rigid URS
A
80
Q

Treatment of Ureteric Stones

  • Complications of Rigid URS
A
  • Hematuria.
  • Sepsis.
  • Ureteric wall injury (Perforation, Avulsion).
81
Q

Treatment of Ureteric Stones

  • Surgery
A

Ureterolithotomy

82
Q

Treatment of bladder calculi

A
83
Q

First line treatment for of each stone

  • Renal < 20 mm (not in lower calyx)
A

ESWL or Flexible URS

84
Q

First line treatment for of each stone

  • Renal < 10 mm in lower calyx
A

ESWL or Flexible URS

85
Q

First line treatment for of each stone

  • Renal > 20 mm
A

PCNL

86
Q

First line treatment for of each stone

  • Renal Staghorn stones
A

PCNL

87
Q

First line treatment for of each stone

  • Ureteric proximal < 10 cm
A

ESWL or Flexible URS

88
Q

First line treatment for of each stone

  • ureteric Proximal > 10 cm
A

Flexible URS or push back and PCNL

89
Q

First line treatment for of each stone

  • Ureteric Distal 5-10 cm
A

Trial MET

90
Q

First line treatment for of each stone

  • Ureteric Distal > 10 cm
A

Rigid URS

91
Q

First line treatment for of each stone

  • Huge stone or failed other treatments
A

Laparoscopic or open surgery

Y4R4 - Surgery II 👨‍⚕️ (16 decks)

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