Renal Calculi

Question 1

Presentation:

Answer 1

1. Sudden, severe pain (10/10)
2. Colicky in nature
3. Loin to groin
4. N/ V
5. Sweating

Question 2

Indications for surgical (procedural) Mx of stones:

Answer 2

1. Failed conservative Mx
2. Stone > 4/52
3. Single kidney
4. Reduced kidney Fx
5. Septic
6. Work - pilot, bus driver

Question 3

What to do if septic w/ obstructing stone?

Answer 3

1. D/W REG - surgical emergency
2. Immediate decompression
3. Sepsis 6 - IV ABx = IV Gent + IV Co-amox

Question 4

Initial investigations for stones:

Answer 4

1. Bloods - FBC, U&E
2. Urine - dipstick, culture
3. Imaging - CT KUB

Question 5

Initial Mx - Medication:

Answer 5

1. Analgesia - IV Paracetamol, PR Diclofenac, severe - Morphine
2. Anti-emetics - Ondansetron, Cyclizine

Question 6

Mx of distal stone < 5 mm in size:

Answer 6

1. D/C home
2. Analgesia
3. Tamsulosin 400 mcg OD
4. OP CT-KUB in 2/52
5. Book Stone clinic in 4/52 (Hot Clinic)

Question 7

Mx of proximal stone / > 5 mm / refractory pain:

Answer 7

1. Admit
2. Analgesia
3. Book for theatre

4. URS + LSF + stent (distal stone)
5. De-obstruct with JJ stent & delayed URS + LSF (after 6/52)
6. ESWL (proximal stones)