Nephrourolithiasis

Question 1

Who are stones most common in?

Answer 1

male, peak at 30 years old

Question 2

What age do stones usually occur in women?

Answer 2

35 and 55

Question 3

Most common type of stone

Answer 3

calcium oxalate

Question 4

What % of stones show up on x-ray and hence contain calcium?

Answer 4

more than 90%

Question 5

Symptoms and signs of stones

Answer 5

renal pain - fixed in loin
ureteric colic - pain radiating to groin
dysuria, haematuria, testicular or vulvar pain
UTI
loin tenderness

Question 6

Non radiological investigations for stones

Answer 6

FBC, U+E, creatinine 
calcium, albumin, urate
PTH
urine analysis and culture 
24 hour urine collections

Question 7

Radiological investigations for stones

Answer 7

CT KUB
IVU
ultrasound scan

Question 8

5 indications for surgical treatment (ORRPP)

Answer 8

obstruction - painful 
recurrent gross haematuria 
recurrent pain and infection 
progressive loss of kidney function 
patient occupation

Question 9

3 main techniques for surgical removal of stones

Answer 9

open - rare
endoscopic
ESWL

Question 10

Advantage of open retrieval of stones

Answer 10

single procedure with least recurrence

Question 11

Disadvantages of open surgery for stones

Answer 11

large scar, long hospital stay and wound complications

Question 12

What is the 2 main indications for open surgery for stones

Answer 12

non functioning infected with large stones requiring nephrectomy
technical reasons meaning PCNL or ESWL

Question 13

4 specific indications for PCNL

Answer 13

Large stone burden
associated with PUJ stenosis
Cystine stones resistant to ESWL
morbid obesity and skeletal deformities

Question 14

What is PCNL guided by?

Answer 14

x-ray or ultrasound scan

Question 15

5 contraindications of PCNL

Answer 15

coagulopathy uncorrected 
current UTI 
obesity unsuitable for x-ray tables 
small kidneys 
severe peri-renal fibrosis

Question 16

Local, adjacent and systemic complications of PCNL

Answer 16

local - pseudoaneurysm, pelvic tear, PUJ stricture
Adjacent - bowel injury, pneumothorax
systemic - fever, sepsis, MI

Question 17

Briefly describe the principles of ESWL

Answer 17

shock wave crush the stones and small pieces pass out in urine
shock wave generator travelling in water column
simple analgesia

Question 18

Stones found where have ESWL as first lien treatment?

Answer 18

renal and ureteric

Question 19

4 disadvantages of ESWL

Answer 19

not used in cysteine stones
not effective after 2 treatments not used again
not first line for >2cm
less effective for lower pole stones

Question 20

3 contraindications for ESWL

Answer 20

pregnancy
hypertensive
anti-coagulation

Question 21

2 indications for open urethrolithotomy

Answer 21

not suitable for laparascopic

failed ESWL or ureteroscopy

Question 22

6 indications for ureteroscopy

Answer 22

severe obstruction 
uncontrollable pain 
persistent haemauria 
patient occupation 
lack of progression 
failed ESWL

Question 23

Does ureteroscopy work better for distal or proximal ureteric stones?

Answer 23

distal

Question 24

3 ways of surgery for ureteric/renal stones

Answer 24

flexible ureteroscope
flexible lithoclast
holium laser

Question 25

minor complications of ureteroscopy

Answer 25

haematuria
fever
small perforation
minor VUJ reflux

Question 26

Major complications of ureteroscopy

Answer 26

major perforation

necrosis and stricture

Question 27

list some presenting symptoms of bladder stones

Answer 27

recurrent UTI 
dysuria
suprapubic/groin/penile pain 
haematuria 
BOO 
sudden stream interruption 
frequency

Question 28

How are bladder stones treated?

Answer 28

endoscopically

larger stones by open excision