Stones

Question 1

CT Findings for ureteric obstruction

Answer 1

Hydronephrosis
Increased Renal Size
Peri ureteric/nephric Stranding
Ureteric wall oedema/soft tissue cuff

Question 2

What did MIMIC study show

Answer 2

Stone size and position important determining factors in SSP.
<5mm - 89%
5-7mm - 49%
>7 mm - 29%
Upper ureter - 52%
Mid Ureter- 70%
Lower Ureter - 83%

Question 3

Contraindications to ESWL

Answer 3

Absolute - Pregnancy, ANticoagulation, Sepsis, Aneurysm

Complications - Failure, UTI/Sepsis, Steinstrasse, Bleeding

Question 4

EAU Guidelines:
Proximal Stone >10mm
PRoximal Stone <10mm

Distal Stone >10mm
Distal Stone <10mm

Renal:
> 2 cm
1-2cm
<1cm

Answer 4

EAU Guidelines:
Proximal Stone >10mm - SWL = URS
PRoximal Stone <10mm - SWL > URS

Distal Stone >10mm - URS > SWL
Distal Stone <10mm - SWL = URS

Renal:

2 cm: PCNL > (FURS/SWL)
1-2cm: SWL = Endourology
1cm: SWL/FURS > PCNL

Question 5

Things predictive of failed stone clearance in ureteroscopy

Answer 5

Proximal Stones
Inexperienced SUrgeon
Impacted Stone
Stone width

Question 6

ESWL vs Ureteroscopy for ureteric Stones by location

Answer 6

Distal: Ureteroscopy (94%) > SWL (74%)
Mid: Ureteroscopy (86%) > SWL (73%)
Proximal: <10 mm SWL (90%) > URS (80%)
>10mm URS (79%) > SWL (68%)

Question 7

Stone free rate in Ultra-Mini PCNL / Super Mini etc. versus standard PCNL

Answer 7

Stone free rate is the same
Operative Time is Longer

All other measurable outcomes favourable
Similar complication rate

Question 8

Stone free rate in Ultra-Mini PCNL / Super Mini etc. versus standard PCNL

Answer 8

Stone free rate is the same
Operative Time is Longer

All other measurable outcomes favourable
Similar complication rate

Question 9

Favourable factors for ESWL

Answer 9

Density (<600 HU)
STS Distance (<12 cm)
Ellipstoid stone volume <150 microL

Question 10

Favourable/Unfavourable factors for URS in ureteric stones (SF Rate)

Answer 10

Stone location - Mid / Distal Ureter
Pre-stenting (97 vs 87 percent)

Unfavourable:
Stone size
Number of stones
Cumulative stone burden

Question 11

Frequency of stent symptoms

Answer 11

> 80% stent pain impacting ADL
78% bothersome LUTS

Question 12

Flexi URS - Unfavourable factors SFR

Answer 12

Increasing stone Size:
>20mm - 30%
10-20mm - 80%
<10mm - 90%
In Summary FURS best performed for intrarenal stones under 15mm

Location (Lower Pole)

Question 13

Access Sheath:
Risk Factors for injuries
Benefit

Answer 13

RFS:Male, Older patient, Not pre-stented

Benefit - Reduced urinary tract infections.

Question 14

Laser Settings

Answer 14

Fragment - High energy, Low rate, Short pulse width
Dusting- Low energy, high Rate, Long pulse width
popcorn - High energy, High Rate, Short pulse width

Question 15

Unfavourable outcome groups for PCNL

Answer 15

Severe CKD
Solitary kidney
Elderly patients