Station 9

Question 1

10mm upper pole stone
Assess

Answer 1

focuse history
Pain, Recurrent UTI symptoms, review urine cultures, haematuria

HPC - Stones?- any surgery or other treatments. ?become unwell

RFs. - Fevers, Haematuria, Bone Pain, New lower limb oedema

PMH - Crohn’s, Hyperparathyoidism, Co morbidities
FH - Stones, Genetic disorders (Renal Tubular Acidosis, Homocysteinuria)

DH- Anticoagulants
SH - Smoker, Fitness, Profession

Question 2

10mm upper pole stone
Examine

Answer 2

General health, BMI
?fit for surgery

Abdomen - Renal Angle Tenderness

Question 3

10mm upper pole stone
Investigate

Answer 3

**Urine **
- Dip for infection
- Old cultures
- pH - >7.5 = infectious stones <5.5 = uric acid stones

Bloods
- Renal function, Infection Markers, Calcium, Uric Acid, Clotting

CT KUB

DMSA - ?Thinking about nephrectomy
Stone analysis / 24 hour urine collection

Question 3

10mm upper pole stone
Investigate

Answer 3

**Urine **
- Dip for infection
- Old cultures
- pH - >7.5 = infectious stones <5.5 = uric acid stones

Bloods
- Renal function, Infection Markers, Calcium, Uric Acid, Clotting

CT KUB

DMSA - ?Thinking about nephrectomy
Stone analysis / 24 hour urine collection

Question 4

Management for 10mm upper pole stone 1000HU

Answer 4

Conservative:
Stone prevention - Increase fluid intake. Add Lemon to fluid
Reduce oxalate (animal proteins)
Reduce dietary salt
Weight loss

Intervention
ESWL
Ureteroscopy
PCNL
Nephrectomy

Question 5

EAU Guidelines for renal stones

Answer 5

Question 6

EAU Guidelines for renal stones

Answer 6

Question 7

Consent for URS

Answer 7

Clarify patient details. Explain procedure without jargon using aids such as pictures /BAUS

Confirm laterality of stones and relevant investigations (urine cultures)

Risks
Common - Bleeding / Pain/ Stent insertion
Occasional - Infection, Incomplete Stone Clearance (<15%), Recurrence (50% at 10 years), Failure (5%)
Rare - Damage to surrounding structures - urethra, ureter, bladder, ureteric stricture, anaesthetic risk

Question 8

Consent for PCNL

Answer 8

Clarify patient details. Explain procedure without jargon using aids such as pictures /BAUS

Confirm laterality of stones and relevant investigations (urine cultures).

Review images with radiologist/stone MDT - ?Calyceal access ?eCIRS

Common - Bleeding, Pain
Occasional - infection, Incomplete stone clearance (15%), Recurrence (50%), multiple punctures ( 20%), Pleural effusion
Rare - Damage - Liver, Spleen, Lung, Pancreas, Bowel. Damage to renal vessel needing nephrectomy (1/1000), failed access, anaesthetic risk

Additional - X Ray, Nephrostomy, Catheter