Nephrourolithiasis Flashcards
Who are stones most common in?
male, peak at 30 years old
What age do stones usually occur in women?
35 and 55
Most common type of stone
calcium oxalate
What % of stones show up on x-ray and hence contain calcium?
more than 90%
Symptoms and signs of stones
renal pain - fixed in loin
ureteric colic - pain radiating to groin
dysuria, haematuria, testicular or vulvar pain
UTI
loin tenderness
Non radiological investigations for stones
FBC, U+E, creatinine calcium, albumin, urate PTH urine analysis and culture 24 hour urine collections
Radiological investigations for stones
CT KUB
IVU
ultrasound scan
5 indications for surgical treatment (ORRPP)
obstruction - painful recurrent gross haematuria recurrent pain and infection progressive loss of kidney function patient occupation
3 main techniques for surgical removal of stones
open - rare
endoscopic
ESWL
Advantage of open retrieval of stones
single procedure with least recurrence
Disadvantages of open surgery for stones
large scar, long hospital stay and wound complications
What is the 2 main indications for open surgery for stones
non functioning infected with large stones requiring nephrectomy
technical reasons meaning PCNL or ESWL
4 specific indications for PCNL
Large stone burden
associated with PUJ stenosis
Cystine stones resistant to ESWL
morbid obesity and skeletal deformities
What is PCNL guided by?
x-ray or ultrasound scan
5 contraindications of PCNL
coagulopathy uncorrected current UTI obesity unsuitable for x-ray tables small kidneys severe peri-renal fibrosis
Local, adjacent and systemic complications of PCNL
local - pseudoaneurysm, pelvic tear, PUJ stricture
Adjacent - bowel injury, pneumothorax
systemic - fever, sepsis, MI
Briefly describe the principles of ESWL
shock wave crush the stones and small pieces pass out in urine
shock wave generator travelling in water column
simple analgesia
Stones found where have ESWL as first lien treatment?
renal and ureteric
4 disadvantages of ESWL
not used in cysteine stones
not effective after 2 treatments not used again
not first line for >2cm
less effective for lower pole stones
3 contraindications for ESWL
pregnancy
hypertensive
anti-coagulation
2 indications for open urethrolithotomy
not suitable for laparascopic
failed ESWL or ureteroscopy
6 indications for ureteroscopy
severe obstruction uncontrollable pain persistent haemauria patient occupation lack of progression failed ESWL
Does ureteroscopy work better for distal or proximal ureteric stones?
distal
3 ways of surgery for ureteric/renal stones
flexible ureteroscope
flexible lithoclast
holium laser
minor complications of ureteroscopy
haematuria
fever
small perforation
minor VUJ reflux
Major complications of ureteroscopy
major perforation
necrosis and stricture
list some presenting symptoms of bladder stones
recurrent UTI dysuria suprapubic/groin/penile pain haematuria BOO sudden stream interruption frequency
How are bladder stones treated?
endoscopically
larger stones by open excision
