Nephrolithiasis

Question 1

what is the presentation of nephrolithiasis?

Answer 1

acute renal colic
(acute flank pain radiating to the groin)

may have;

• dysuria
• nausea/vomiting
• loin tenderness / pain
• vulvar or testicular pain
• urinary infection
• pyrexia

Question 2

what are the risk factors for nephrolithiasis?

Answer 2

male sex
obesity
white ancestry
high protein diet
high salt diet 
chronic dehydration
crystaluria

Question 3

what is the first line investigation for suspected nephrolithiasis?

Answer 3

CT scan abdo/pelvis

Question 4

what is the first line treatment for nephrolithiasis?

Answer 4

medical expulsion therapy i.e. Tamsulosin

Question 5

what are the surgical treatments for nephrolithiasis?

Answer 5

ESWL - extracorporeal shock wave therapy
Uteroscopy
PCNL - percutaneous nephrolithotomy
open or endoscopic removal

Question 6

what are the indications for surgical removal of kidney or ureter stones?

Answer 6

obstruction
recurrent gross haematuria
recurrent pain and infection
failure of first line treatments 
progressive loss of renal function
occupation i.e. pilot

Question 7

when is ESWL not suitable?

Answer 7

if the stone is > 2cm

Often ineffective in cystine stones
less effective for lower pole stones

Question 8

what is usually the cause of bladder stones?

Answer 8

usually secondary to outflow obstruction

Question 9

what is the presentation of bladder stones?

Answer 9

suprapubic / groin / penile pain
dysuria, frequency, haematuria
persistant urinary infection
sudden interruption of urinary stream

Question 10

What is the chance of recurrence of stones ?

Answer 10

50% within 10 years

10% within first year

Question 11

what is the most common type of kidney stone?

Answer 11

Sodium oxalate