Nephro-Urolithiasis Flashcards
Urolithiasis?
Process of forming stones in the kidney, bladder, and/or urethra (urinary tract)
What is the prevalence of nephro-urolithiasis?
2-3%
What is the M:F of nephro-urolithiasis?
3:1
What are the peak ages for nephro-urolithiasis?
- 30 in males
- 35 and 55 years in females
What is the most common cause of urological emergency admission?
‘Colic’
What are the different stone types?
- Calcium oxalate 45%
- Calcium oxalate and phosphate 25%
- Triple phosphate 20%
- Calcium phosphate 3%
- Uric acid 5%
- Cystine 3%
What is the presentation of urolithiasis?
- Renal pain (fixed in loin)
- Ureteric colic (radiating to groin)
- Dysuria/haematuria/testicular or vulval pain
- Urinary infection
- Loin tenderness
- Pyrexia
Describe the renal pain due to urolithiasis?
- Renal pain (fixed in loin)
What investigations are done for urolithiasis?
- Blood tests
- FBC, U&E, creatinine
- Calcium, albumin, urate
- Parathoromone
- Urine analysis and culture
- 24 hour urine collections
- Radiology
- KUB (kidney/ureter/bladder)
- Ultrasound
- IVU (intravenous urogram)
- CT KUB
- CT KUB/urogram – 3D reconstruction
What are indications for surgical treatment of urolithiasis?
- Obstruction
- Recurrent gross haematuria
- Recurrent pain and infection
- Progressive loss of kidney function
- Patient occupation
What are techniques for surgical removal of urolithiasis?
- Open surgery (now very rare)
- Endoscopic surgery
- ESWL
What are the different types of stones?
- Renal stones
- Ureteric stones
- Bladder stones
What are advantages and disadvantages of open surgery for treatment of renal stones?
- Advantage of open surgery is single procedure with the least recurrence rate
- Disadvantage is large scar, long hospital stay, general wound complications, longer recovery
What are indications for open surgery for treatment of renal stones?
- Non-functioning infected kidney with large stones necessitating nephrectomy
- Cases which for technical reasons cannot be managed by PCNL or ESWL
What is simple pyelolithotomy?
Surgical incision of the renal pelvis of a kidney for removal of a kidney stone
What is simple radial nephrotomy?
Surgical procedure wherein the kidney is incised, typically for removal of kidney stones
What are 2 kinds of open surgery for kidney stones?
Simple pyelolithotomy
Simple radial nephrotomy
What does PCNL stand for?
Percutaneous nephrolithotomy
What are indications for percutaneous nephrolithotomy (PCNL)?
- Large stone burden (risk of Steinstrasse)
- Associated PUJ stenosis
- Infundibular stricture
- Calyceal diverticulum
- Morbid obesity or skeletal deformity
- ESWL resistant stones such as cystine
- Lack of availability of ESWL
What is PCNL guided by?
Ultrasound of x-rayu
What are contraindications for PCNL?
- Uncorrected coagulopathy
- Active urinary tract infection
- Obesity or unsuitable body habitus unsuitable for x-ray tablets
- Relative contraindications include small kidneys and severe perirenal fibrosis
What are some complications of PCNL?
- Serious complications occur 3-8%
- Local complications include
- Pseudoaneurysm or AV fistulas 0.5-
- UT injury
- Pelvic tear 8-15%
- Ureteral tear 5%
- Stricture of PUJ 0.1-0.8%
- Injury to adjacent organs
- Bowel injury 0.1%
- Pneumothorax 0.1-0.3%
- Liver, spleen (very rare)
- Systemic complications
- Fever, sepsis 0.2-0.6%
- Myocardial infarction 0.1-0.4%
What is ESWL?
Extracorporeal shock wave lithotripsy
What are indications for ureteroscopy?
- Severe obstruction, uncontrollable pain, persistent haematuria, lack of progression, failed ESWL and patient occupation
What is extracorporeal shock wave lithotripsy (ESWL) commonly used as first line treatment for?
Renal and ureteric calculi
What is calculi?
A stone in the kidney
When is ESWL not used as first line treatment?
Not used for first line treatment for stones >2cm and less effective for lower pole stones:
- If not effective after 2 treatments then further treatment not justified
- Often ineffective for treating cystine stones
What are indications for open ureterolithotomy?
- Not suitable for laparoscopic approach
- Failed ESWL or ureteroscopy
What is ureteroscopy?
What is the standard treatment for treating lower ureteric stones?
Rigid ureteroscope is the standard instrument for treating lower ureteric stones with a 90-100% success rate:
- Success rate for proximal stones is lower at 60-70%
What are the different kinds of ureteroscopy?
- Flexible ureteroscopes
- Flexible lithoclast
- Holmium laser
What are complications of ureteroscopy?
- Minor complications 0-30%
- Haematuria
- Fever
- Small ureteric perforation
- Minor vesico-ureteric reflux
- Major complications
- Major ureteric perforation
- Ureteric avulsion
- Ureteral necrosis
- Stricture formation
What is the presentation of bladder stones?
- Suprapubic/groin/penile pain
- Dysuria, frequency, haematuria
- Urinary infection (persistent)
- Sudden interruption of urinary stream
- Usually secondary to outflow obstruction
Describe the pain due to bladder stones?
- Suprapubic/groin/penile pain
What is the treatment of bladder stones?
- Most treated endoscopically
- Larger stones can be treated by open excision
