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Urology > Lecture 22 Nephro-Urolithiasis > Flashcards

Lecture 22 Nephro-Urolithiasis Flashcards

1
Q

Nephro-Urolithiasis is most common in what gender group

A

Men

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2
Q

What is the peak age in men

A

30 years

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3
Q

What is the bimodal peak in women

A

35 years

55 years

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4
Q

Name the stone types

A 
Calcium oxalate
Calcium oxalate and phosphate
Triple phosphate
Calcium phosphate
Uric acid
Cystine
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5
Q

What is the most common type of stone

A

Calcium oxalate

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6
Q

What type of stone is infective

A

Triple phosphate

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7
Q

What are the symptom and signs of stones

A
  • Renal pain (fixed in loin)
  • Ureteric colic (radiating
  • to groin)
  • Dysuria / haematuria /
  • Testicular or vulval pain
  • Urinary infection
  • Loin tenderness
  • Pyrexia
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8
Q

What initial tests would you do if you suspected stones in the kidney/urinary tract

A
  • Blood tests - FBC, U&E, Creatinine
  • Calcium, Albumin, Urate
  • Parathormone- hyperparathyroidism (elevated kidney levels)
  • Urine analysis and culture
  • 24hr urine collections
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9
Q

What imaging techniques would you do if you suspected stones in the kidney/urinary tract

A
  • CT KUB- 3D construction
  • Intravenous urogram (IVU) using contrast agent
  • Ultrasound
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10
Q

Name the indications for surgical treatment

A
  • Obstruction.
  • Recurrent gross haematuria.
  • Recurrent pain and infection.
  • Progressive loss of kidney function.
  • Patient occupation
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11
Q

Name techniques for surgical treatment of stones in the kidney/UT

A

• Open surgery (rare)
• Endoscopic surgery
• ESWL
PCNL

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12
Q

What are the advantages of open surgery

A

Single procedure with least recurrence rate

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13
Q

What are the disadvantages of open surgery

A

– Large scar
– Long hospital stay
– General wound complications
– Longer recovery

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14
Q

Name indications for one surgery

A

– Non-functioning infected kidney with large stones necessitating nephrectomy
– Cases which for technical reasons cannot be managed by PCNL or ESWL

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15
Q

When would simple, partial or total nephrectomy be used

A

Non functioning kidney
Stag horn stones
Elderly frail patient with complex stones and normal contralateral kidney

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16
Q

Name indications for PCNL

A 
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
17
Q

What stones are most likely to be resistant to ESWL

A

Cystine

18
Q

How is percutaneous access guided and what instruments could you use

A

Guided by US or Xray
• Guide wire
• Retrograde catheter or balloon catheter
• Contrast

19
Q

What are some contraindications for PCNL

A
  • 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.
20
Q

Name some local complications of PCNL

A
  • Pseudoaneurysm
  • AV fistula
  • Pelvic tear
  • Ureteral tear
  • Stricture of PUJ
21
Q

Name some adjacent organ complications of PCNL

A
  • Bowel injury
  • Pneumothorax
  • Liver, spleen damage- very rare
22
Q

Name some systemic complications of PCNL

A

Fever
Sepsis
Myocardial infarction

23
Q

What is the first line of treatment for renal and ureteric calculi <2cm

A

ESWL

24
Q

What is ESWL ineffective against

A

Cystine stones

Lower pole stones

25
Q

Indications or open surgery for ureteric stones

A

No suitable for laparoscopic approach

Failed ESWL or ureteroscopy

26
Q

Indications for Ureteroscopy

A
  • Severe obstruction
  • Uncontrollable pain
  • Persistent haematuria
  • Lack of progression
  • Failed ESWL
  • Patient occupation
27
Q

What type or ureteroscope is normally used

A

Rigid

28
Q

Name minor complications of ureteroscopy

A
  • Haematuria
  • Fever
  • Small ureteric perforation
  • Minor vesico-ureteric reflux
29
Q

Name major complications of ureteroscopy

A
  • Major ureteric perforation
  • Ureteric avulsion
  • Ureteral necrosis
  • Stricture formation
30
Q

What are the symptoms of bladder stones

A
  • Suprapubic / groin / penile pain
  • Dysuria, frequency, haematuria
  • Urinary infection (persistent)
  • Sudden interruption of urinary stream
  • Usually secondary to outflow obstruction
31
Q

How are bladder stones treated

A
  • Most treated endoscopically

* Larger stones can be treated by open excision

Urology (26 decks)

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