Nephro-urolithiasis Flashcards

1
Q

Which gender is more commonly affected by stones?

A

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

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2
Q

What are the types of stones and their incidence?

A

¨Calcium oxalate 45%

¨Calcium oxalate + phosphate 25%

¨‘Triple phosphate’ (infective) 20%

¨Calcium phosphate 3%

¨Uric acid 5%

¨Cystine 3%

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3
Q

What are the symptoms and signs?

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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4
Q

What are initial investigations for kidney stones?

A

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

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5
Q

What are the readiological investigations for stones?

A

KUB - kidney, ureter, bladder (shows up the calcium containing stones - over 90% of stones)

U/Sound

IVU - intravenous urogram

CT KUB

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6
Q

What are indications for surgial treatment?

A

Obstruction.

Recurrent gross haematuria.

Recurrent pain and infection.

Progressive loss of kidney function.

Patient occupation.

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7
Q

What are the techniques for surgical treatment?

A

Open Surgery (now rare)

Endoscopic Surgery

ESWL - extra corporeal shockwave therapy

Renal stones

Ureteric stones

Bladder stones

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8
Q

What are the advantages and disadvantages of open stone surgery?

A

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.

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9
Q

What are indications for open surgical stone treatment?

A

Non-functioning infected kidney with large stones necessitating nehrectomy

Cases which for technical reasons cannot be managed by PCNL or ESWL.

PCNL - Percutaneous Nephrolithotomy

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10
Q

When is there a need for simple partial and total nephrectomy?

A

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.

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11
Q

What are indications for PCNL?

A

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.

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12
Q

What are 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.

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13
Q

What are the local complications of PCNL?

A

Pseudoaneurysm or AV fistula 0.5-1%

UT injury: Pelvic tear 8-15%

Ureteral tear 5%

Stricture of PUJ 0.1-0.8%

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14
Q

What injury to adjacent organs can occur as a result of PCNL?

A

Adjacent organs:

Bowel injury 0.1%

Pneumothorax 0.1 - 0.3%

Liver, Spleen (very rare)

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15
Q

What are the systemic complications of PCNL?

A

Fever, sepsis - 0.2-0.6%

Myocardial infarction - 0.1-0.4%

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16
Q

Mechanism of ESWL

A
17
Q

What is often the first line treatment for renal and ureteric calculi?

A

ESWL

¨Treatments are usually done on a on a day-case basis with simple analgesia

Can be repeated as often as required

18
Q

When is ESWL not effective?

A

Not used as first line treatment for stones > 2cms and less effective for lower pole stones

If not effective after two treatments then further treatments not justified

Often ineffective for treating cystine stones

19
Q

What are the common places for a stone to get lodged?

A
20
Q

What is IVU?

A

The IVU is a special diagnostic test that follows the time course of excretion of a radiopaque contrast dye through the kidneys, ureters (the tubes that carry urine from the kidneys to the bladder) and bladder after it is injected into a vein in your arm.

The discovery of X-rays and the use of contrast material in 1906 allowed accurate diagnosis and localisation of ureteric stones.

The introduction of the IVU revolutionised the diagnosis of ureteric stones.

21
Q

Indications for open ureterolithotomy - open surgery for ureteric stones

A

Not suitable for laparoscopic approach.

Failed ESWL or ureteroscopy.

22
Q

Indications for ureteroscopy (endoscopic surgery)

A

Severe obstruction, uncontrollable pain, persistent haematuria, lack of progression, failed ESWL and patient occupation.

Lower ureteric stones have a higher success rate when compared with proximal stones

23
Q

What are the minor and major complications of ureteroscpy?

A

Minor complications: 0-30%

Haematuria, fever, small ureteric perforation, minor vesico-ureteric reflux.

Major complications:

Major ureteric perforation, ureteric avulsion, ureteral necrosis and stricture formation.

24
Q

What are the presenting features of bladder stones?

A

Suprapubic / groin / penile pain

Dysuria, frequency, haematuria

Urinary infection (persistent)

Sudden interruption of urinary stream

Usually secondary to outflow obstruction

25
Q

How are bladder stones usually treated?

A

Most treated endoscopically

Larger stones can be treated

by open excision