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FRCSC 2020 Guidelines > Surgical Management of Stones AUA 2016 > Flashcards

Surgical Management of Stones AUA 2016 Flashcards

1
Q

What imaging if any is recommended prior to pcnl?

A

non-contrast CT Scan

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2
Q

Can you obtain a CT to select best candidates for SWL vs URS?

A

Yes as per AUA

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3
Q

Should clinicians obtain UA or culture prior to intervention?

A

Yes for UA

and yes for culture if symptoms of infection are present

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4
Q

What period of observation and or MET reasonable?

A

4 to 6 weeks

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5
Q

what is the first line therapy for mid/ distal ureteral stones if met or conservative therapy dont work?

A

URS

and then SWL

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6
Q

What are the criteriae for not stenting after URS as per AUA?

A

1- those without suspected ureteric injury during URS
2-those without evidence of stricture or other anatomic abnormalities to stone clearance
3- those with normal contralateral kidney
4-those wihout renal functional impairment
5- those whom a secondary URS is not planned

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7
Q

What does AUA say about prestenting for URS?

A

Should not be routinely performed

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8
Q

What treatment can be offered to treat stent discomfort?

A

alpha blockers or antimuscaranics

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9
Q

should clinicians offer treatment for caliceal symptomatic stones that are not obstructive wihout any other etiology for pain

A

yes

but if it is asymptomatic you can just offer active surveillance

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10
Q

Should clinicains offer SWL to lower pole renal stones >10mm in size?

A

No

but less than 10mm can offer URs or SWL

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11
Q

Is flexible nephroscopy standard part of PCNL

A

yes

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12
Q

what kind of irrigation should be used for PCNL and URS?

A

NS

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13
Q

is observation and MET(alpha blockers) an option in kids with ureteral stones <10mm?

A

yes

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14
Q

Should CT scan be obtained before performing PCNL in kids?

A

yes, low dose CT

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15
Q

What are treatment options for kids with ureteral stone >20mm?

A

PCNL or ESWL

if ESWL a NT or Stent should be placed

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16
Q

What does AUA say about safety guidewires for endoscopic procedures?

A

A safety guide wire should be placed for all endoscopic procedures
(Expert Opinion)

17
Q

Should you abort stone removal if purulent urine is encountered?

A

Yes, abort, place drainage, get a culture and treat.

18
Q

What is recommended if initial SWL fails?

A

AUA says go to URS

CUA says you can try up to 2 SWL treatments( no more than 2 as diminishing returns)

19
Q

Does ureter have both alpha and beta adrenoreceptors?

A

yes
alpha1 promotes persitalsis
and it has beta too

20
Q

Who does AUA think should try MET?

A

ureteral stones less than 10mm
but really the evidence is for 5-10 mm and for distal ureteral stones but they recommend it for all.
CUA recommendations are more in keeping with literature as they say MET for distal ureteral stones less than 10mm

21
Q

What are indications for intervention for ureteral stones less than 4-6 weeks?

A

repeated visit to ER
hospital admission for parenteral anesthesia
worsening renal function
evidence of urinary tract sepsis

22
Q

What does AUA say occur more with URs in comparison to SWL?

what is all the same ?

A

perforation

stricture, UTI, sepsis, ureteral avulsion are the same

23
Q

URS stone free rates for stones<10mm in size were superior to SWL at all ureteral locations as per AUA metanalysis

A

yes

24
Q

Is URS superior to SWL for ureteral stones >10mm as per AUA?

A

depends

Proximal ureter about the same, distal ureter and middle favors URS

25
Q

Should ureteral stents prior to URS be performed routinely?

A

NO,

CUA says it can be perofmred for stones 10mm or bigger and also it would make URS easier and better SFR.

26
Q

IS combination alpha blocker and antimuscaranics helpful in treating stent pain?

A

not clear

seems like alpha blocker or stent not AND

27
Q

What is the closest the holm:YAG can be activated to the urothelium without risk of injury?

A

0.5 mm

28
Q

Electrohydraluic lithotripsy works like

A

an underwater spark plug, generating a cavitation bubble in all directions therefore the high rate of ureteral injury.

29
Q

Should SWL be offered to pts with renal stones >20mm as per AUA?

A

NO

30
Q

Is a safety wire required when doing URS with access sheath

A

no, access sheath itself acts as a safety wire

31
Q

IS antibitoic prophylaxis required for ESWL?

A

No, not typically

32
Q

is abx prophylaxis recommended for endoscopic procedures?

A

yes

based on urine cultures and local abx patterns

33
Q

Can clinicians give alpha blockers to facilitate passage of stone fragments after swl?

A

yes as per AUA

34
Q

For renal stones >20mm in peds what are treatment opttions>

A

SWL and PCNL

35
Q

what is the maximum radiation exposure permitted during pregnancy as per ACOG

A

50mGy

36
Q

Can you give NSAIDs(ketorolac) during pregnancy for pain control>

A

NO, contraindicated

FRCSC 2020 Guidelines (49 decks)

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