Nephro-urolithiasis (STONES)

Question 1

When are men and women most likely to get kidney stones?

Answer 1

• Peak age in men is 30

- Women peak at 35 and then again at 55

Question 2

What is the relative incidence of different stone types?

Answer 2

Calcium oxalate 45%

Calcium oxalate + phosphate 25%

‘Triple phosphate’ (infective) 20%

Question 3

What is “colic” in terms of the renal system?

Answer 3

a type of pain you get when urinary stones block part of your urinary tract

Question 4

What are some symptoms and signs of Nephro-urolithiasis (kidney stones)?

Answer 4

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

Question 5

What are some non-radiological investigations for suspected Nephro-urolithiasis (stones)?

Answer 5

• 97% have microscopic haematuria
• Bloods: FBC, U&E, Creatinine
• Calcium, albumin, urate
• Parathormone
• Urine analysis and culture
• 24h urine collection

Question 6

What are some radiological investigations for suspected Nephro-urolithiasis (stones)?

Answer 6

• CT KUB (kidney/ureter/bladder) - gold standard
• IVU scan (intravenous urogram)
• USS

Question 7

What are some indications for surgery for patients with kidney stones?

Answer 7

Obstruction.

Recurrent gross haematuria.

Recurrent pain and infection.

Progressive loss of kidney function.

Question 8

What are the treatment options for patients with kidney stones causing significant side effects?

Answer 8

• E.S.W.L. (Extracorporeal Shock Wave Lithotripsy)
• PCNL (Percutaneous Nephrolithotomy)
• Open surgery

Question 9

What are some indications for open surgery to treat nephro-urolithiasis?

Answer 9

• Non functioning infected kidney with large stones necessitating nephrectomy.
• Technical reasons obstruct use of PCNL or ESWL

Question 10

What are two examples of open surgery to remove kidney stones?

Answer 10

• Simple Pyelolithotomy (incision made at renal pelvis)

- Simple Radial Nephrotomy

Question 11

What is PCNL? When is it used? Give a brief description.

Answer 11

• Percutaneous Nephrolithotomy: a scope is inserted into the back of the patient and into the kidney, where it can remove the stone
• Indicated for large stones (>2cm diameter) or when stones are blocking more than one branch of the collecting system of the kidney

Question 12

What are some contraindications for PCNL?

Answer 12

Uncorrected coagulopathy.

Active Urinary Tract Infection.

Obesity or body unsuitable for X-ray tables.

Small kidneys and severe perirenal fibrosis.

Question 13

What is ESWL? When is it indicated?

Answer 13

• Extracorporeal shock wave lithotripsy: uses shock waves to break kidney stones into smaller pieces that may pass through the urinary system
• First line treatment for stones > 2cms

Question 14

What type of stones are not particularly responsive to ESWL?

Answer 14

Stones with high cystine content

Question 15

What is the standard treatment for lower ureteric stones?

Answer 15

• Ureteroscopy
• Involves passing a ureteroscope into the urethra and then through to the bladder and then on into the ureter (and kidney if needed)
• 90-100% success rate for lower ureteric stones

Question 16

What are some symptoms of bladder stones?

Answer 16

Suprapubic / groin / penile pain

Dysuria, frequency, haematuria

Urinary infection (persistent)

Sudden interruption of urinary stream

Question 17

How are most bladder stones treated?

Answer 17

• Endoscopically (ureteroscopy)

Question 18

What are some common locations for obstruction to occur in the urinary system?

Answer 18

Pelvic-ureteric junction

Pelvic brim

Vesico-ureteric junction (where ureter enters bladder)