Stones - Urology

Question 1

Nephrolithiasis

Etiology

Answer 1

• dehydration, meds
• gout (uric acid stones)
• hyperCa
• UTI (urea-splitting bugs)

Question 2

Nephrolithiasis types

Answer 2

• calcium oxalate + phosphate (MC) (high protein salt intake) = hypercalcuria, hypocitruria
• uric acid (acidic foods, up purine)
• struvite stones (Mg ammonium phosphate) = staghorn cacluli (pelvis) = Bugs (enteric,=urea splitting )
• Cysteine (genetic) = cystinurea only

Question 3

Nephrolithiasis

Dx

Answer 3

• renal colic: sudden, constant, flank/back to groin
• CVA tenderness
• hematuria
• UA = hematuria (micro/gross)
• ***noncontrast CT (gold)
• ultrasound
• KUB radiographs = calcium/struvite

Question 4

Nephrolithiasis

Tx

Answer 4

> 5mm = lithotripsy, cath/stent, percutaneous nephrolithotomy

<5m = Fluids, pain (opiate, keterolac), anti-emetic, Tamsulosin (a blocker) ; Macrobid, Flomax, strainer, 1 week f/u

Question 5

Obstruction

Etiology

Answer 5

• Kids = anatomic abormality
• young adult = calculi
• older: BPH, prostate, tumor, calculi

MALES>

Question 6

Obstructive

Renal insufficiency?

Answer 6

Unilateral no

Bilateral maybe

Question 7

Obstruction workup

Answer 7

UA
CBC
Serum electrolyes
BMP
*urine output? Pain? Palpable mass?

Question 8

Decreased urine output?

Answer 8

• cath

* voiding cystourethrography

Question 9

Stone

Common site

Answer 9

Urterovesical junction

Question 10

Stone manipulation contraindications

Answer 10

• UTI
• bleeding diathesis
• Pregnancy

Question 11

Surgical intervention

Answer 11

• temp stent
• percutaneous nephrostomy/(neprostolitholtomy- larger than 2cm)
• shockwave lithotripsy (smaller (<2cm) stones in upper/mid calyx, no preg)
• uteroscopy (small (1-2) in lower calyx, need stent)
• N

Question 12

Follow up

Answer 12

3 days