Nephro-urolithiasis Flashcards
Lifetime risk in males for renal stones
1:8
Which gender gets renal stones more?
M > F 3:1
Peak age in men for renal stones
30 y/o
Peak ages for women for renal stones
35 y/o
55 y/o
What is the % chance of stone recurrence within 10 years? and 1 year?
10 years - 50%
1 year - 10%
What is the commonest cause of urological emergency admission?
Colic
Types of renal stone
Calcium oxalate 45% Calcium oxalate + phosphate 25% "Triple phosphate" - infective 20% Calcium phosphate 3% Uric acid 5% Cystine 3%
Presentation of renal stone
Renal pain (fixed in loin) Ureteric colic (radiating to groin) Dysuria Haematuria Testicular or vulval pain Urinary infection Loin tenderness Pyrexia
Investigations for renal stone
Bloods - FBC - U and Es - creatinine Calcium Albumin Urate Parathormone Urine analysis and culture 24 hour urine collections KUB (kidney / ureter / bladder) USS IVU CT KUB
What does IVU stand for?
Intravenous urogram
Indications for surgical treatment of renal stones
Obstruction Recurrent gross haematuria Recurrent pain and infection Progressive loss of kidney function Patient occupation
Where can you get renal stones?
Renal / kidney stones
Ureteric stones
Bladder stones
When would a simple partial or total nephrectomy be used to treat kidney stones?
Non functioning kidney with large staghorn stones
Elderly frail patients with complex stones and a normal contralateral kidney
What does PCNL stand for?
Percutaneous nephrolithiotomy
Indications for PCNL
Large stone burden (risk of steinstrasse) Assosiated PUJ stensois Infundibular stricture Calyceal diverticulum Morbid obesity or skeletal deformity ESWL resistant stones e.g. cystine Lack of availability of ESWL
Contraindications for PCNL
Uncorrected coagulopathy Obesity or unusual body habitues unsuitable for x ray tables Relative - small kidneys - severe perirenal fibrosis acute UTI
Complications of PCNL
Pseudoaneurysm or AV fistula UT injury Bowel injury Pneumothorax Fever Sepsis MI
What does ESWL stand for?
Extracorpeal shock wave lithiotripsy
How does ESWL work?
US shock waves crush the stones
Smaller pieces of the stone then can pass out of the body in the urine
When is ESWL not the first line treatment for stones?
Stones > 2cm
Lower pole stones
Indications for a ureterolithiotomy
Not suitable for laparoscopic approach
Failed ESWL
Failed ureteroscopy
Indications for a ureteroscopy
Severe obstruction Uncontrollable pain Persistent haematuria Lack of progression Failure ESWL Patient occupation
Success rates for rapid uteroscope in treating ureteric stones
Lower stones- 90-100%
Proximal stones - 60-70%
Complications of ureteroscopy
Haematuria Fever Small ureteric perforation Minor vesicoureteric reflux Ureteric avulsion Major ureteric perforation Ureteral necoriss Stricture formation
Presentation of bladder stones
Suprapubic/groin/penile pain Dysuria Frequency Haematuria UTI (persistent) Sudden interruption of urinary stream
What are bladder stones usually secondary to?
Outflow obstruction
Treatment of bladder stones
Endoscopically
Open excision if larger stones
