Nephro-urolithiasis (STONES) Flashcards

1
Q

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

A
  • Peak age in men is 30

- Women peak at 35 and then again at 55

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2
Q

What is the relative incidence of different stone types?

A

Calcium oxalate 45%

Calcium oxalate + phosphate 25%

‘Triple phosphate’ (infective) 20%

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3
Q

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

A

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

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4
Q

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

A
  • Renal pain fixed in loin
  • Ureteric colic (radiating to loin)
  • Dysuria / haematuria
  • Testicular or vulval pain
  • Urinary infection
  • Loin tenderness
  • Pyrexia
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5
Q

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

A
  • 97% have microscopic haematuria
  • Bloods: FBC, U&E, Creatinine
  • Calcium, albumin, urate
  • Parathormone
  • Urine analysis and culture
  • 24h urine collection
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6
Q

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

A
  • CT KUB (kidney/ureter/bladder) - gold standard
  • IVU scan (intravenous urogram)
  • USS
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7
Q

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

A

Obstruction.

Recurrent gross haematuria.

Recurrent pain and infection.

Progressive loss of kidney function.

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8
Q

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

A
  • E.S.W.L. (Extracorporeal Shock Wave Lithotripsy)
  • PCNL (Percutaneous Nephrolithotomy)
  • Open surgery
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9
Q

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

A
  • Non functioning infected kidney with large stones necessitating nephrectomy.
  • Technical reasons obstruct use of PCNL or ESWL
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10
Q

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

A
  • Simple Pyelolithotomy (incision made at renal pelvis)

- Simple Radial Nephrotomy

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11
Q

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

A
  • 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
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12
Q

What are some contraindications for PCNL?

A

Uncorrected coagulopathy.

Active Urinary Tract Infection.

Obesity or body unsuitable for X-ray tables.

Small kidneys and severe perirenal fibrosis.

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13
Q

What is ESWL? When is it indicated?

A
  • 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
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14
Q

What type of stones are not particularly responsive to ESWL?

A

Stones with high cystine content

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15
Q

What is the standard treatment for lower ureteric stones?

A
  • 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
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16
Q

What are some symptoms of bladder stones?

A

Suprapubic / groin / penile pain

Dysuria, frequency, haematuria

Urinary infection (persistent)

Sudden interruption of urinary stream

17
Q

How are most bladder stones treated?

A
  • Endoscopically (ureteroscopy)
18
Q

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

A

Pelvic-ureteric junction

Pelvic brim

Vesico-ureteric junction (where ureter enters bladder)