Nephro-urolithiasis Flashcards
Which gender is more commonly affected by stones?
Males
M:F ratio of 3:1
Peak age in men is 30
Chance of stone recurrence is 50% within 10 years, 10% within a year
What are the types of stones and their incidence?
¨Calcium oxalate 45%
¨Calcium oxalate + phosphate 25%
¨‘Triple phosphate’ (infective) 20%
¨Calcium phosphate 3%
¨Uric acid 5%
¨Cystine 3%
What are the symptoms and signs?
Renal pain (fixed in loin)
Ureteric colic (radiating to groin)
Dysuria / haematuria /testicular or vulval pain
Urinary infection
Loin tenderness
Pyrexia
What are initial investigations for kidney stones?
Blood tests - FBC, U&E, Creatinine
Calcium, Albumin, Urate
Parathormone
Urine analysis and culture
24hr urine collections
MIght show low citrate - citrate can help prevent crystal formation
What are the readiological investigations for stones?
KUB - kidney, ureter, bladder (shows up the calcium containing stones - over 90% of stones)
U/Sound
IVU - intravenous urogram
CT KUB
What are indications for surgial treatment?
Obstruction.
Recurrent gross haematuria.
Recurrent pain and infection.
Progressive loss of kidney function.
Patient occupation.
What are the techniques for surgical treatment?
Open Surgery (now rare)
Endoscopic Surgery
ESWL - extra corporeal shockwave therapy
Renal stones
Ureteric stones
Bladder stones
What are the advantages and disadvantages of open stone surgery?
The advantage of open surgery is:
Single procedure with the least recurrence rate.
The disadvantages of open surgery are:
arge scar, long hospital stay, general wound complications, longer recovery.
What are indications for open surgical stone treatment?
Non-functioning infected kidney with large stones necessitating nehrectomy
Cases which for technical reasons cannot be managed by PCNL or ESWL.
PCNL - Percutaneous Nephrolithotomy
When is there a need for simple partial and total nephrectomy?
Non functioning kidney with large staghorn stones or elderly frail patients with complex stones and normal contralateral kidney.
Note: ¨Contralateral stone formation in up to 30% after total nephrectomy has been reported.
What are indications for PCNL?
Large stone burden (risk of Steinstrasse)
Associated PUJ stenosis.
Infundibular stricture.
Calyceal diverticulum.
Morbid obesity or skeletal deformity.
ESWL resistant stones e.g. Cystine.
Lack of availability of ESWL.
What are 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.
What are the local complications of PCNL?
Pseudoaneurysm or AV fistula 0.5-1%
UT injury: Pelvic tear 8-15%
Ureteral tear 5%
Stricture of PUJ 0.1-0.8%
What injury to adjacent organs can occur as a result of PCNL?
Adjacent organs:
Bowel injury 0.1%
Pneumothorax 0.1 - 0.3%
Liver, Spleen (very rare)
What are the systemic complications of PCNL?
Fever, sepsis - 0.2-0.6%
Myocardial infarction - 0.1-0.4%