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Urinary System > Nephro-Urolithiasis > Flashcards

Nephro-Urolithiasis Flashcards

1
Q

What is the prevalence of urinary system stones in the general population?

A

2-3%

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2
Q

What is the lifetime risk of urinary system stones in males?

A

1:8

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3
Q

What is the M:F ratio of incidence of urinary system stones?

A

M:F 3:1

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4
Q

What is the peak age of incidence of urinary system stones in males?

A

30 years

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5
Q

What is the peak age of incidence of urinary system stones in females?

A

Bimodal peak - 35 and 55 years

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6
Q

What is the risk of stone recurrence within 1 year?

A

10%

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7
Q

What is the risk of stone recurrence within 10 years?

A

50%

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8
Q

What is the most common cause of urological emergency admission?

A

Colic

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9
Q

What are the stone types?

A 
Calcium oxalate - 45% 
Calcium oxalate + phosphate - 25% 
Triple phosphate (infective) - 20% 
Calcium phosphate - 3% 
Uric acid - 5% 
Cysteine - 3%
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10
Q

What are the symptoms and signs of urinary tract stones?

A 
Renal pain - fixed in loin, or in flank if stones are lodged higher up
Ureteric colic, may be radiating to groin
Dysuria
Haematuria
Testicular or vulval pain 
Urinary infection 
Loin tenderness
Pyrexia
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11
Q

What are the investigations for renal tract stones?

A 
Blood tests - FBC, U&Es, creatinine 
Calcium, albumin, urate
Parathormone 
Urine analysis and culture
24 hour urine collections
Ultrasound
IVU 
CT KUB 
Urogram reconstruction
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12
Q

What are the indications for surgical treatment of urinary tract stones?

A 
Obstruction - if stones don't pass naturally 
Recurrent gross haematuria
Recurrent pain and infection 
Progressive loss of kidney function 
Patient occupation
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13
Q

What are the surgical techniques for treatment of urinary tract stones?

A

Open surgery - rare
Endoscopic surgery more common
ESWL
PCLN

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14
Q

What are the advantages and disadvantages of open surgery?

A

Advantages
Single procedure with the least recurrence rate

Disadvantages
Large scar
Long hospital stay
General wound complications
Longer recovery
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15
Q

What are the indications for open surgery of urinary tract stones?

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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16
Q

When is a single partial or total nephrectomy indicated?

A

Non-functioning kidney with large stag horn stones or elderly frail patients with complex stones and a normal contralateral kidney

17
Q

What is the percentage of contralateral stone formation after total nephrectomy?

A

Up to 30%

18
Q

What are the indications for percutaneous nephrolithotomy (PCNL)?

A 
Large stone burden (risk of stenosis) 
Associated PUJ stenosis 
Infundibular stricture
Calyceal diverticulum 
Morbid obesity or skeletal deformity 
ESWL resistant stones e.g. cysteine 
Lack of availability of ESWL
19
Q

How should percutaneous access be achieved?

A

Should be joint between urologist and interventional radiologist, intra-renal and adjacent viscera anatomy should be understood by both
Renal puncture - guided by ultrasound or x-ray

20
Q

What are the contraindications for PCNL?

A

Uncorrected coagulopathy
Active UTI
Obesity or unusual body habitus unsuitable for x-ray tables
Relative contraindications include small kidneys and severe peri-renal fibrosis

21
Q

What are the complications of PCNL?

A

3-8% have serious complications

Pseudoaneurysm or AV fistula 0.5-1% 
UT injury - pelvic tear 8-15%, ureteral tear 5%, stricture of PUJ 0.1-0.8% 
Bowel injury 
Pneumothorax 
Liver and spleen injury (very rare) 
Fever and sepsis 
MI
22
Q

What is ESWL?

A

Extracorporeal Shock Wave Lithotripsy

23
Q

When is ESWL commonly used as first-line treatment?

A

For renal and ureteric calculi

Generally done on a day case with simple analgesia

24
Q

When is ESWL not the first line treatment?

A

For stones > 3cm

Also less effective for lower pole stones

25
Q

When is ESWL no longer effective?

A

After 2 treatments

Often ineffective for treating cysteine stones

26
Q

What are the indications for open ureterolithotomy?

A

Not suitable for laparoscopic approach

Failed ESWL or ureteroscopy

27
Q

What are the indications for ureteroscopy?

A 
Severe obstruction
Uncontrollable pain
Persistent haematuria
Lack of progression 
Failed ESWL 
Patient occupation
28
Q

What is the standard instrument for treating lower ureteric stones with ureteroscopy? What is the success rate?

A

Rigid ureteroscope

90-100% success rate

29
Q

What is the success rate of ureteroscopy for proximal stones?

A

60-70%

30
Q

What are the instrument options for surgery for ureteric/renal stones?

A

Flexible ureteroscope
Flexible lithoclast
Holmium laser

31
Q

What are the potential complications of ureteroscopy?

A 
Minor complications in 0-30%:
Haematuria 
Fever
Small ureteric perforation
Minor vesico-ureteric reflux

Major complications:
Major ureteric perforation
Ureteric avulsion
Ureteral necrosis and stricture formation

32
Q

What is the presentation of bladder stones?

A 
Suprapubic/groin/penile pain
Dysuria
Frequency 
Haematuria 
UTI (persistent) 
Sudden interruption of urinary stream 
Usually secondary to outflow obstruction
33
Q

What is the treatment of bladder stones?

A

Most treated endoscopically

Larger stones can be treated by open excision

Urinary System (22 decks)

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