Lecture 22 Nephro-Urolithiasis Flashcards
Nephro-Urolithiasis is most common in what gender group
Men
What is the peak age in men
30 years
What is the bimodal peak in women
35 years
55 years
Name the stone types
Calcium oxalate Calcium oxalate and phosphate Triple phosphate Calcium phosphate Uric acid Cystine
What is the most common type of stone
Calcium oxalate
What type of stone is infective
Triple phosphate
What are the symptom and signs of stones
- Renal pain (fixed in loin)
- Ureteric colic (radiating
- to groin)
- Dysuria / haematuria /
- Testicular or vulval pain
- Urinary infection
- Loin tenderness
- Pyrexia
What initial tests would you do if you suspected stones in the kidney/urinary tract
- Blood tests - FBC, U&E, Creatinine
- Calcium, Albumin, Urate
- Parathormone- hyperparathyroidism (elevated kidney levels)
- Urine analysis and culture
- 24hr urine collections
What imaging techniques would you do if you suspected stones in the kidney/urinary tract
- CT KUB- 3D construction
- Intravenous urogram (IVU) using contrast agent
- Ultrasound
Name the indications for surgical treatment
- Obstruction.
- Recurrent gross haematuria.
- Recurrent pain and infection.
- Progressive loss of kidney function.
- Patient occupation
Name techniques for surgical treatment of stones in the kidney/UT
• Open surgery (rare)
• Endoscopic surgery
• ESWL
PCNL
What are the advantages of open surgery
Single procedure with least recurrence rate
What are the disadvantages of open surgery
– Large scar
– Long hospital stay
– General wound complications
– Longer recovery
Name indications for one surgery
– Non-functioning infected kidney with large stones necessitating nephrectomy
– Cases which for technical reasons cannot be managed by PCNL or ESWL
When would simple, partial or total nephrectomy be used
Non functioning kidney
Stag horn stones
Elderly frail patient with complex stones and normal contralateral kidney
Name indications for PCNL
Multiple fragments of stones lining the ureter PUJ stenosis Infundibulum stricture Calyces diverticulum Morbid obesity Skeletal deformity ESWL resistant stones Lack of availability to ESWL
What stones are most likely to be resistant to ESWL
Cystine
How is percutaneous access guided and what instruments could you use
Guided by US or Xray
• Guide wire
• Retrograde catheter or balloon catheter
• Contrast
What are some contraindications for PCNL
- Uncorrected coagulopathy.
- Active Urinary Tract Infection.
- Obesity or unusual body habitus unsuitable for X-ray tables.
- Relative contraindications include small kidneys and severe perirenal fibrosis.
Name some local complications of PCNL
- Pseudoaneurysm
- AV fistula
- Pelvic tear
- Ureteral tear
- Stricture of PUJ
Name some adjacent organ complications of PCNL
- Bowel injury
- Pneumothorax
- Liver, spleen damage- very rare
Name some systemic complications of PCNL
Fever
Sepsis
Myocardial infarction
What is the first line of treatment for renal and ureteric calculi <2cm
ESWL
What is ESWL ineffective against
Cystine stones
Lower pole stones
Indications or open surgery for ureteric stones
No suitable for laparoscopic approach
Failed ESWL or ureteroscopy
Indications for Ureteroscopy
- Severe obstruction
- Uncontrollable pain
- Persistent haematuria
- Lack of progression
- Failed ESWL
- Patient occupation
What type or ureteroscope is normally used
Rigid
Name minor complications of ureteroscopy
- Haematuria
- Fever
- Small ureteric perforation
- Minor vesico-ureteric reflux
Name major complications of ureteroscopy
- Major ureteric perforation
- Ureteric avulsion
- Ureteral necrosis
- Stricture formation
What are the symptoms of bladder stones
- Suprapubic / groin / penile pain
- Dysuria, frequency, haematuria
- Urinary infection (persistent)
- Sudden interruption of urinary stream
- Usually secondary to outflow obstruction
How are bladder stones treated
- Most treated endoscopically
* Larger stones can be treated by open excision
