Surgical Management of Stones AUA 2016 Flashcards
What imaging if any is recommended prior to pcnl?
non-contrast CT Scan
Can you obtain a CT to select best candidates for SWL vs URS?
Yes as per AUA
Should clinicians obtain UA or culture prior to intervention?
Yes for UA
and yes for culture if symptoms of infection are present
What period of observation and or MET reasonable?
4 to 6 weeks
what is the first line therapy for mid/ distal ureteral stones if met or conservative therapy dont work?
URS
and then SWL
What are the criteriae for not stenting after URS as per AUA?
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
What does AUA say about prestenting for URS?
Should not be routinely performed
What treatment can be offered to treat stent discomfort?
alpha blockers or antimuscaranics
should clinicians offer treatment for caliceal symptomatic stones that are not obstructive wihout any other etiology for pain
yes
but if it is asymptomatic you can just offer active surveillance
Should clinicains offer SWL to lower pole renal stones >10mm in size?
No
but less than 10mm can offer URs or SWL
Is flexible nephroscopy standard part of PCNL
yes
what kind of irrigation should be used for PCNL and URS?
NS
is observation and MET(alpha blockers) an option in kids with ureteral stones <10mm?
yes
Should CT scan be obtained before performing PCNL in kids?
yes, low dose CT
What are treatment options for kids with ureteral stone >20mm?
PCNL or ESWL
if ESWL a NT or Stent should be placed
What does AUA say about safety guidewires for endoscopic procedures?
A safety guide wire should be placed for all endoscopic procedures
(Expert Opinion)
Should you abort stone removal if purulent urine is encountered?
Yes, abort, place drainage, get a culture and treat.
What is recommended if initial SWL fails?
AUA says go to URS
CUA says you can try up to 2 SWL treatments( no more than 2 as diminishing returns)
Does ureter have both alpha and beta adrenoreceptors?
yes
alpha1 promotes persitalsis
and it has beta too
Who does AUA think should try MET?
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
What are indications for intervention for ureteral stones less than 4-6 weeks?
repeated visit to ER
hospital admission for parenteral anesthesia
worsening renal function
evidence of urinary tract sepsis
What does AUA say occur more with URs in comparison to SWL?
what is all the same ?
perforation
stricture, UTI, sepsis, ureteral avulsion are the same
URS stone free rates for stones<10mm in size were superior to SWL at all ureteral locations as per AUA metanalysis
yes
Is URS superior to SWL for ureteral stones >10mm as per AUA?
depends
Proximal ureter about the same, distal ureter and middle favors URS
