Nephrourolithiasis Flashcards
Name six types of renal stones that can form
Calcium oxalate Calcium oxalate + phosphate ‘Triple phosphate’ (infective) Calcium phosphate Uric acid Cystine
What are the signs and symptoms of renal stones?
Renal pain (fixed in loin) Ureteric colic (radiating to groin) Dysuria Haematuria Testicular or vulval pain Urinary infection Loin tenderness Pyrexia
What investigations should be done looking for stones?
Blood tests - FBP, U&E, Creatinine Calcium, Albumin, Urate Parathormone Urine analysis and culture 24hr urine collections CT KUB IVU US
What are indications for surgical removal of stones?
Obstruction. Recurrent gross haematuria. Recurrent pain and infection. Progressive loss of kidney function. Patient occupation
What is PCNL?
Percutaneous nephrolithotomy
What are some indications for PCNL?
Large stone burden (risk of Steinstrasse) Associated PUJ stenosis. Infundibular stricture. Calyceal diverticulum. Morbid obesity or skeletal deformity. ESWL resistant stones e.g. Cystine. Lack of availability of ESWL.
What are contraindications for PCNL?
Uncorrected coagulopathy.
Active Urinary Tract Infection.
Obesity or unusual body habitus unsuitable for X-ray tables.
Relative contraindications include small kidneys and severe perirenal fibrosis.
What are some complications of PCNL?
Pseudoaneurysm or AV fistula UT injury: Pelvic tear Ureteral tear Stricture of PUJ Bowel Injury Pneumothorax Sepsis MI
What is ESWL?
Extracorporeal Shock Wave Lithotripsy
Shock waves break up the stones so they can be passed in the urine
When is ESWL not indicated?
Not used as first line treatment for stones > 2cms and less effective for lower pole stones
If not effective after two treatments then further treatments not justified
Often ineffective for treating cystine stones
What are some bladder stones signs and symptoms?
Suprapubic / groin / penile pain Dysuria, frequency, haematuria Urinary infection (persistent) Sudden interruption of urinary stream Usually secondary to outflow obstruction
