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year 2 renal > Nephro-urolithiasis > Flashcards

Nephro-urolithiasis Flashcards

1
Q

What is the relative incidence of stones?

A

Prevalance in general population 2-3%

Lifetime risk in males 1:8

M:F ratio 3:1

Peak age in men is 30 years

Women bimodal peak – 35 and 55 years

Chance of stone recurrence is 50% within 10 years (with 10% within a year)

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2
Q

What is the commonest cause of urological emergency admission?

A

‘Colic’ is the commonest cause of urological emergency admission

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3
Q

What is the relative incidence of stone types?

A

Calcium oxalate 45%

Calcium oxalate + phosphate 25%

‘Triple phosphate’ (infective) 20%

Calcium phosphate 3%

Uric acid 5%

Cystine 3%

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4
Q

what are the symptoms and signs of stones?

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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5
Q

what investigations can be done for stones?

A

Blood tests - FBC, U&E, Creatinine

Calcium, Albumin, Urate

Parathormone

Urine analysis and culture

24hr urine collections

radiology

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6
Q

what radiology investigation is shown here?

A

KUB (KIDNEY/URETER/BLADDER)

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7
Q

what radiology investigation is shown here?

A

Ultrasound

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8
Q

what radiology investigation is shown here?

A

IVU

(intravenous urogram)

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9
Q

what radiology investigation is shown here?

A

CT KUB

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10
Q

what radiology investigation is shown here?

A

CT KUB/Urogram – 3D reconstruction

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11
Q

Historical Background
of stone surgery

A

Dates back to 4800 BC to Egyptian and Greek and Roman civilisations

Hippocrates (credited with the first renal operation) theorised the cause of stones to be ingestion of lime containing water

The operative removal of stones usually occurred secondary to the drainage of renal abscess

The intrarenal vascular anatomy was described by Hyrtl in 1872 and re-described by Brodel in 1901 (The Intrinsic Blood Vessels of the Kidney and Their Significance in Nephrotomy)

This allowed safe removal of renal stones with minimal damage to the kidney

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12
Q

What are indications for Surgical Treatment?

A

Obstruction

Recurrent gross haematuria

Recurrent pain and infection

Progressive loss of kidney function

Patient occupation

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13
Q

what are techniques for surgical treatment?

A

Open Surgery (now very rare)

Endoscopic Surgery

ESWL

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14
Q

What is ESWL?

A

Extracorporeal shock wave lithotripsy (ESWL) is a type of treatment for kidney stones. It uses high-energy shock waves to break down the kidney stones into small crystals. After the procedure, the kidney stones should be small enough to pass out of your body in your urine

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15
Q

what type of stones may you get?

A

Renal stones

Ureteric stones

Bladder stones

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16
Q

renal stone treatment - is open surgery more or less common now?

A

Open stone surgery has greatly reduced over the past four decades with the advent of PCNL and ESWL

(PCNL - Percutaneous nephrolithotomy is a minimally-invasive procedure to remove stones from the kidney by a small puncture wound through the skin)

17
Q

what is the advantage of open surgery?

A

Single procedure with the least recurrence rate

18
Q

what are the disadvantgaes of open surgery?

A

Large scar, long hospital stay, general wound complications, longer recovery

19
Q

what are the indications for open surgery?

A

Non functioning infected kidney with large stones necessitating nephrectomy

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

20
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

21
Q

Who would deal with Percutaneous Access?

A

In an ideal world it should be a joint venture between urologist and interventional radiologist

Both should understand the intrarenal anatomy and adjacent viscera

22
Q

Percutaneous Access - renal puncture, what is it guided by?

A

Guided by Ultrasound or X-Ray

23
Q

PCNL gets access to what?

A

the collecting system

24
Q

what are contraindications for PCNL?

A

Uncorrected coagulopathy (a condition in which the blood’s ability to coagulate (form clots) is impaired)

Active Urinary Tract Infection

Obesity or unusual body habitus unsuitable for X-ray tables

Relative contraindications include small kidneys and severe perirenal fibrosis

25
Q

what are some ocmplications of PCNL?

A

Serious complications - in the 3-8% range

Local complications includes:

  • Pseudoaneurysm or AV fistula 0.5-1%
  • 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%
26
Q

What is ESWL?

A

Extracorporeal Shock Wave Lithotripsy

a type of treatment for kidney stones. It uses high-energy shock waves to break down the kidney stones into small crystals. After the procedure, the kidney stones should be small enough to pass out of your body in your urine

27
Q

What is now commonly used for renal and ureteric calculi as first line treatment?

A

ESWL?

28
Q

Is ESWL painful?

A

Newer generation lithotriptors cause less pain

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

Can be repeated as often as required

29
Q

What is EWSL not effective in?

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

30
Q

What are some indications for open ureterolithotomy?

A

Not suitable for laparoscopic approach

Failed ESWL or ureteroscopy

31
Q

Endoscopic Surgery - Ureteric Stones

What are some indications for ureteroscopy?

A

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

The rigid ureteroscope is the standard instrument for treating lower ureteric stones with a 90-100% success rate

The success rate for proximal stones is lower at 60-70%

32
Q

What are different surgeries for Ureteric/Renal Stones?

A

Flexible ureteroscopes

Flexible lithoclast

Holmium laser

33
Q

What are some Complications of Ureteroscopy?

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

34
Q

what does bladder stones cause?

A

Suprapubic / groin / penile pain

Dysuria, frequency, haematuria

Urinary infection (persistent)

Sudden interruption of urinary stream

35
Q

what are bladder stones usually secondary to?

A

Usually secondary to outflow obstruction

36
Q

what is the treamtent of bladder stones?

A

Most treated endoscopically

Larger stones can be treated by open excision

37
Q

Theme: Urinary Tract Stones

An A&E doctor orders a plain KUB x-ray in someone with right loin/RUQ pain.

Urinary tract stone is suspected - What percentage of Renal tract Stones are likely to be visible on this plain x-ray ?

A. All renal tract stones

B. Approximately 90%

C. About half

D. Approximately 10%

E. None of them

A

Correct Answer: ?

38
Q

Theme: Urinary Tract Stones.

An A&E doctor sees a man with right loin/ groin pain and suspects a Urinary tract stone.

What is the most sensitive imaging modality to detect a stone in the kidney or ureter?

A. Abdominal X-ray

B. Plain KUB X-ray

C. Ultrasound of the Renal Tract/Abdomen/Pelvis

D. CT KUB

E. MAG3 Renography

A

Correct Answer: ?

CT KUB i believe

year 2 renal (26 decks)

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