Nephro-urolithiasis

Question 1

Lifetime risk in males for renal stones

Answer 1

1:8

Question 2

Which gender gets renal stones more?

Answer 2

M > F 3:1

Question 3

Peak age in men for renal stones

Answer 3

30 y/o

Question 4

Peak ages for women for renal stones

Answer 4

35 y/o

55 y/o

Question 5

What is the % chance of stone recurrence within 10 years? and 1 year?

Answer 5

10 years - 50%

1 year - 10%

Question 6

What is the commonest cause of urological emergency admission?

Answer 6

Colic

Question 7

Types of renal stone

Answer 7

Calcium oxalate 45%
Calcium oxalate + phosphate 25%
"Triple phosphate" - infective 20%
Calcium phosphate 3%
Uric acid 5%
Cystine 3%

Question 8

Presentation of renal stone

Answer 8

Renal pain (fixed in loin)
Ureteric colic (radiating to groin)
Dysuria
Haematuria
Testicular or vulval pain 
Urinary infection 
Loin tenderness
Pyrexia

Question 9

Investigations for renal stone

Answer 9

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

Question 10

What does IVU stand for?

Answer 10

Intravenous urogram

Question 11

Indications for surgical treatment of renal stones

Answer 11

Obstruction 
Recurrent gross haematuria
Recurrent pain and infection 
Progressive loss of kidney function 
Patient occupation

Question 12

Where can you get renal stones?

Answer 12

Renal / kidney stones
Ureteric stones
Bladder stones

Question 13

When would a simple partial or total nephrectomy be used to treat kidney stones?

Answer 13

Non functioning kidney with large staghorn stones

Elderly frail patients with complex stones and a normal contralateral kidney

Question 14

What does PCNL stand for?

Answer 14

Percutaneous nephrolithiotomy

Question 15

Indications for PCNL

Answer 15

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

Question 16

Contraindications for PCNL

Answer 16

Uncorrected coagulopathy 
Obesity or unusual body habitues unsuitable for x ray tables
Relative 
- small kidneys
- severe perirenal fibrosis
acute UTI

Question 17

Complications of PCNL

Answer 17

Pseudoaneurysm or AV fistula
UT injury 
Bowel injury 
Pneumothorax
Fever
Sepsis
MI

Question 18

What does ESWL stand for?

Answer 18

Extracorpeal shock wave lithiotripsy

Question 19

How does ESWL work?

Answer 19

US shock waves crush the stones

Smaller pieces of the stone then can pass out of the body in the urine

Question 20

When is ESWL not the first line treatment for stones?

Answer 20

Stones > 2cm

Lower pole stones

Question 21

Indications for a ureterolithiotomy

Answer 21

Not suitable for laparoscopic approach
Failed ESWL
Failed ureteroscopy

Question 22

Indications for a ureteroscopy

Answer 22

Severe obstruction 
Uncontrollable pain 
Persistent haematuria
Lack of progression 
Failure ESWL
Patient occupation

Question 23

Success rates for rapid uteroscope in treating ureteric stones

Answer 23

Lower stones- 90-100%

Proximal stones - 60-70%

Question 24

Complications of ureteroscopy

Answer 24

Haematuria
Fever
Small ureteric perforation 
Minor vesicoureteric reflux
Ureteric avulsion 
Major ureteric perforation 
Ureteral necoriss
Stricture formation

Question 25

Presentation of bladder stones

Answer 25

Suprapubic/groin/penile pain 
Dysuria
Frequency 
Haematuria
UTI (persistent)
Sudden interruption of urinary stream

Question 26

What are bladder stones usually secondary to?

Answer 26

Outflow obstruction

Question 27

Treatment of bladder stones

Answer 27

Endoscopically

Open excision if larger stones