Renal and Urologic Problems Cont'd Flashcards
Urinary Tract Calculi
aka: kidney stone, nephrolithiasis, urolithiasis
Hard deposits made of minerals and salts that form inside kidneys
Urinary Tract Calculi: Patho - concentrated urine
Often stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together
Crystals, when in a supersaturated concentration, can precipitate and form a stone
Urinary Tract Calculi: Patho - Bacterial infection
Obstruction with urinary stasis & urinary infection with bacteria
Bacteria cause the urine to become alkaline and facilitates formation of stones
Infected stones, when entrapped in the kidney, may assume a staghorn configuration as they enlarge
Where do urinary tract calculi occur? and how are they prevented?
Can occur at any place within the urinary tract.
Keeping urine dilute & free flowing reduces risk for recurrent formation
Urinary Tract Calculi Types: Calculus
abnormal stone formation in body tissues by accumulation of mineral salts
Urinary Tract Calculi Types: Lithiasis
refers to stone formation
Urinary Tract Calculi Types: Nephrolithiasis
Formation of stones in the urinary tract
5 Major categories of stone
- Calcium phosphate
- Calcium oxalate
- Uric acid
- Cystine
- Struvite (magnesium-ammonium phosphate)
Calcium is the most common type
Clinical Manifestations Urinary Tract Calculi
- interventions
- SEVERE pain - intense and colicky
- N&V
- Dilauded, flomax (relaxes the ureters), hot bath, drink lots of fluids
Urinary Tract Calculi: Management of acute attack (2)
- Generally with opioids at frequent intervals
- Many stones pass spontaneously but stones > 4mm are unlikely to pass through the ureter
Urinary Tract Calculi: Evaluation of cause & prevention
- family hx of stone formation
- adequate hydration, Na+ restriction, dietary changes, meds to minimize urine formation
Surgery for Urinary Tract Calculi: Indications (6)
- stones too large for spontaneous passage
- stones associated with infection
- stones causing impaired renal function
- persistent pain, nausea, or ileus
- inability to treat pt medically
- pt with one kidney
Surgery: types (4)
- cystoscopy: to remove a small stone in the bladder
- cystolitholaplaxy: a procedure for large stones
- Lithotrite - ‘stone crusher’: an instrument to break up large stones
- open surgery
Urinary Tract Calculi: Endo-urological Procedure - Percutaneous Nephrolithotomy
- insertion of nephoscope through a percutaneous sinus track into the kidney pelvis
- stones are fragmented using ultrasound, electohydraulic, or laser lithotripsy
- stones are removed using grasping forceps, and pelvis irrigated
- usually a nephrostomy tube is left in place to maintain patency of ureter
- Done under x-ray vision, under general anesthetic
Lithotripsy for Urinary Tract Calculi
- use of sound waves to break renal stones into small particles that can pass down ureter
- done under x-ray or ultrasound
Different Lithotripsy techniques (4)
- Extracorporeal shock-wave lithotripsy (most common)
- Laser lithotripsy
- Percutaneous ultrasonic lithotripsy
- Electrohydraulic lithotripsy
Extracorporeal shock-wave lithotripsy
‘First generation’ lithotripsy
- non-invasive, under spinal or general anesthesia
- pt placed in a water bath
- repeated shock waves administered to break up stone
- shock waves are generated by a machine, lithotripter, and focused by x-ray onto the kidney stones
- shock wave travel into the body through the skin, reaching the stone
Post-Lithotripsy care: hematuria
- common after lithotripsy
- often, ureteral stent is placed after procedure to promote passage of fragmented stones (removed in 1-2 weeks)
Post-Lithotripsy care: Pain and Risk of Infection
- as stone fragments pass down ureter
- analgesia
- prophylactic abx may be given as most stones are infected, and shattering can spread infection
Post-Lithotripsy care: Elimination and Activity
- Drink 2-3L in 24 hrs (unless in restriction) to flush out stone fragments
- Resume normal activity
Bladder Cancer Etiology
- 6th most common type of cancer in Canadians
- Most common in men
- The most frequent malignant tumor of urinary tract - transitional cell carcinoma
- Most bladder tumours are growth within the bladder
Clinical Manifestations of Bladder Cancer
- Gross, painless hematuria (chronic or intermittent)
- Dysuria
- Urinary frequency & urgency
Treatment for Bladder Cancer
When the tumor is invasive or it involves the trigone (where the ureters insert into the bladder)
Free from metastasis beyond pelvic area -> treatment of choice is a partial or radical cystectomy with urinary diversion
Partial Cystectomy
Resection of the portion of the bladder wall containing the tumor
Radical Cystectomy
- removal of the bladder, prostate, seminal vesicles in men
- removal of bladder, uterus, cervix, urethra, and ovaries in women
Urinary Diversion:
2 types
Performed to treat cancer of the bladder, neurogenic bladder, congenital anomalies, strictures, trauma to the bladder, and chronic infections with deterioration of renal function
- incontinent urinary diversion
- continent urinary diversion
Incontinent Urinary Diversion
- ileal conduit (ileal loop)
Continent Urinary Diversion
Continent cutaneous reservoir
- intra-abdominal urinary reservoir that is catheterizable or has an outlet controlled by anal sphincter
Neobladder
Ileal conduit (ileal loop)
- a 15-20 cm segment of the ileum is converted into a conduit for urinary drainage
- ureters are anastomosed into one end of the conduit and the other end of the bowel is brought out through the abdominal wall to form a stoma
Continent Urinary Diversion
- reservoirs are constructed from ileum, ileocecal segment, or colon
- the patient needs to self-catheterize q4-6 hrs
- does not need to wear external attachments
Neobladder
- creation of a reservoir made of small intestine and connects it to urethra which allows urination through urethra
- Reservoir mimics the normal storage function of a urinary bladder
- Reservoir inside the pelvis
Post-op Care of Urinary Diversion (5)
- With removal of part of the bowel - paralytic ileus or SBO
- Anytime we manipulate the bowel - NPO for a while and NG tube for 3-5 days
- Mucus in the urine - from intestine
- Assess stoma and dresing
- Assess if there is any urine coming out and what does that look like
