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renal system > Nephro-Urolithiasis > Flashcards

Nephro-Urolithiasis Flashcards

1
Q

Who is affected by stones?

A
  • Prevalance in the general population 2-3%
  • M:F ratio 3:1
  • Peak age in men is 30 years
  • Women biomodal peak 35 and 55 years
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2
Q

What is the chance of stone recurrence?

A

50% within 10 years (with 10% within a year)

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3
Q

What is the commonest cause of urological emergency admission?

A

Colic

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4
Q

What types of kidney stones are there?

A
  • Calcium oxalate 45%
  • Calcium oxalate + phosphate 255
  • Triple phosphate (infective) 20%
  • Calcium phosphate 3%
  • Uric acid 5%
  • Cystine 3%
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5
Q

What are the signs and symptoms of kidney 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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6
Q

How are kidney stones investigated?

A

-Blood tests - FBP, U&E, Creatinine
-Calcium, Albumin, Urate
-Parathormone
-Urine analysis and culture
-24hr urine collections
-KUB x-ray
-Ultrasound
-IVU
-CT KUB
3D reconstruction

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7
Q

What are the indications for surgical treatment of the stones?

A
  • Obstruction.
  • Recurrent gross haematuria.
  • Recurrent pain and infection.
  • Progressive loss of kidney function.
  • Patient occupation
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8
Q

What techniques are the for surgical treatment of stones?

A
  • Opens surgery (now rare)
  • Endoscopic surgery
  • ESWL
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9
Q

Why has open surgery been reduced as a treatment?

A

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

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10
Q

What is the advantage of open surgery?

A

Single procedure with the least recurrence rate

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11
Q

What are the disadvantages of open surgery?

A
  • Large scar
  • Long hospital stay
  • General wound complications
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12
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.
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13
Q

Who may a simple partial and total nephrectomy be performed in?

A

Non functioning kidney with large staghorn stones or elderly frail patients with complex stones and normal contralateral kidney

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14
Q

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

A

Up to 30%

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15
Q

What are the specific indication 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.
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16
Q

Briefly describe how PCNL is carried out.

A
  • Guide wire
  • Retrograde catheter or balloon catheter
  • Contrast injected
  • Renal puncture guided by ultrasound or xray
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17
Q

What are the contraindications for PCNL?

A
  • Uncorrected coagulopathy.
  • Active Urinary Tract Infection.
  • Obesity or unusual body habitus unsuitable for X-ray tables.
  • Relative contraindications include small kidneys and severe perirenal fibrosis.
18
Q

What local complications can occur with PCNL?

A
  • Pseudoaneurysm or AV fistula 0.5-1%
  • Pelvic tear 8-15%
  • Ureteral tear 5%
  • Stricture of PUJ 0.1-0.8%
19
Q

What is the risk of serious complications in PCNL?

A

3-8%

20
Q

What injury can occur to adjacent organs in PCNL?

A
  • Bowel injury 0.1%
  • Pneumothorax 0.1-0.3%
  • Liver, spleen very rare
21
Q

What systemic complications can occur with PCNL?

A
  • Fever, sepsis 0.2-0.6%

- Myocardial infarction 0.1-0.4%

22
Q

What does ESWL stand for?

A

Extracorporeal shock wave lithotripsy

23
Q

Briefly describe how ESWL works?

A
  • ‘Simple’ stones too large to pass through
  • Shock waves crush stones
  • Smaller pieces pass out of body urine
24
Q

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

A

ESWL

25
Q

How do new generation lithotripters compare to the old generation?

A

More powerful but less painful

26
Q

How is ESWL usually carried out?

A

As a day case with some simple analgesia

27
Q

When is ESWL not used as first line treatment?

A

Stones> 2cms

28
Q

When is ESWL not effective?

A
  • Less effective for lower pole stones
  • Often ineffective for treating cysteine stones
  • If not effective after 2 treatments then further treatments not justified
29
Q

What are the indications for open ureterolithotomy?

A
  • Not suitable for laparoscopic approach.

- Failed ESWL or ureteroscopy.

30
Q

What are the indications for ureteroscopy?

A
  • Severe obstruction
  • Uncontollable pain
  • Persistent haematuria
  • Lack of progression
  • Failed ESWL
  • Patient occupation
31
Q

What is the standard instrument for treating lower ureteric stones?

A

Rigid ureteroscope with a 90-100% success rate

32
Q

What is the success rate of rigid ureteroscope in proximal stones?

A

60-70%

33
Q

What surgery can be carried out for ureteric stones?

A
  • Flexible ureteroscopes
  • Flexible lithoclast
  • Holmium laser
34
Q

What is the risk of minor complications in ureteroscopy?

A

0-30%

35
Q

What is the risk of major complications in ureteroscopy?

A

Up to 8%

36
Q

What are the possible minor complications of urteroscopy?

A
  • Haematuria
  • Fever
  • Small ureteric perforation
  • Minor vesico-reflux
37
Q

What are the possible major complications of ureteroscopy?

A
  • Major ureteric perforation
  • Ureteric avulsion
  • Ureteral necrosis
  • Stricture formation
38
Q

How can bladder stones present?

A
  • Suprapubic / groin / penile pain
  • Dysuria, frequency, haematuria
  • Urinary infection (persistent)
  • Sudden interruption of urinary stream
39
Q

How are most bladder stones treated?

A

Endoscopically

40
Q

How can larger bladder stones be treated?

A

Open excision

renal system (26 decks)

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