Nephro-Urolithiasis Flashcards
Urolithiasis?
Process of forming stones in the kidney, bladder, and/or urethra (urinary tract)
What is the prevalence of nephro-urolithiasis?
2-3%
What is the M:F of nephro-urolithiasis?
3:1
What are the peak ages for nephro-urolithiasis?
- 30 in males
- 35 and 55 years in females
What is the most common cause of urological emergency admission?
‘Colic’
What are the different stone types?
- Calcium oxalate 45%
- Calcium oxalate and phosphate 25%
- Triple phosphate 20%
- Calcium phosphate 3%
- Uric acid 5%
- Cystine 3%
What is the presentation of urolithiasis?
- Renal pain (fixed in loin)
- Ureteric colic (radiating to groin)
- Dysuria/haematuria/testicular or vulval pain
- Urinary infection
- Loin tenderness
- Pyrexia
Describe the renal pain due to urolithiasis?
- Renal pain (fixed in loin)
What investigations are done for urolithiasis?
- Blood tests
- FBC, U&E, creatinine
- Calcium, albumin, urate
- Parathoromone
- Urine analysis and culture
- 24 hour urine collections
- Radiology
- KUB (kidney/ureter/bladder)
- Ultrasound
- IVU (intravenous urogram)
- CT KUB
- CT KUB/urogram – 3D reconstruction
What are indications for surgical treatment of urolithiasis?
- Obstruction
- Recurrent gross haematuria
- Recurrent pain and infection
- Progressive loss of kidney function
- Patient occupation
What are techniques for surgical removal of urolithiasis?
- Open surgery (now very rare)
- Endoscopic surgery
- ESWL
What are the different types of stones?
- Renal stones
- Ureteric stones
- Bladder stones
What are advantages and disadvantages of open surgery for treatment of renal stones?
- Advantage of open surgery is single procedure with the least recurrence rate
- Disadvantage is large scar, long hospital stay, general wound complications, longer recovery
What are indications for open surgery for treatment of renal stones?
- Non-functioning infected kidney with large stones necessitating nephrectomy
- Cases which for technical reasons cannot be managed by PCNL or ESWL
What is simple pyelolithotomy?
Surgical incision of the renal pelvis of a kidney for removal of a kidney stone
What is simple radial nephrotomy?
Surgical procedure wherein the kidney is incised, typically for removal of kidney stones
What are 2 kinds of open surgery for kidney stones?
Simple pyelolithotomy
Simple radial nephrotomy
What does PCNL stand for?
Percutaneous nephrolithotomy
What are indications for percutaneous nephrolithotomy (PCNL)?
- Large stone burden (risk of Steinstrasse)
- Associated PUJ stenosis
- Infundibular stricture
- Calyceal diverticulum
- Morbid obesity or skeletal deformity
- ESWL resistant stones such as cystine
- Lack of availability of ESWL
What is PCNL guided by?
Ultrasound of x-rayu
What are contraindications for PCNL?
- Uncorrected coagulopathy
- Active urinary tract infection
- Obesity or unsuitable body habitus unsuitable for x-ray tablets
- Relative contraindications include small kidneys and severe perirenal fibrosis
What are some complications of PCNL?
- Serious complications occur 3-8%
- Local complications include
- Pseudoaneurysm or AV fistulas 0.5-
- 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%
What is ESWL?
Extracorporeal shock wave lithotripsy
What are indications for ureteroscopy?
- Severe obstruction, uncontrollable pain, persistent haematuria, lack of progression, failed ESWL and patient occupation
