URINARY STONE

Question 1

Men are more frequently affected by urolithiasis than women, with a ratio of

Answer 1

2.5:1.

Question 2

There are five major types of urinary stones. The most common types are composed of

Answer 2

calcium (85%), and for that reason most urinary stones are radiopaque (visible) on plain abdominal radiographs.

Question 3

(4)High humidity and elevated temperatures are contributing factors, and the incidence of
symptomatic ureteral stones is greatest in such areas during hot summer months.
(5)Higher incidence rates of stones have also been associated with sedentary lifestyle,
hypertension, carotid calcification, and cardiovascular disease.
(6)High protein and salt intake as well as inadequate hydration appear to be the most
important dietary factors in the development of urinary stones. Metrorrhagia- bleeding
between periods

Answer 3

FIX THIS CARD

Question 4

Pertinent Anatomy of a patient with Urinary Stone.

Answer 4

(1) Kidneys
(2) Ureters
(3) Bladder
(4) Urethra

Question 5

Signs and symptoms

Answer 5

(1) Pain most often occurs suddenly
(2) It is typically localized to the flank.
(a) May be associated with nausea and vomiting.
(b) Patients with kidney stones are constantly moving trying to find a comfortable position.
(3) The pain may occur episodically and may radiate anteriorly over the abdomen.
(a) As stone progresses down the ureter pain may be referred into the ipsilateral groin.
(4) Obstructing urinary stones usually present with acute, unremitting and severe colic.
(5) Typically, minimal pain with passage through the urethra.
(6) Stone size does not correlate with the severity of the symptoms.

Question 6

Differential Diagnosis

Answer 6

(1) Appendicitis
(2) Ectopic pregnancy
(3) Ovarian torsion
(4) Diverticular disease
(5) Bowel obstruction
(6) Epididymitis
(7) Other abdominopelvic diseases that cause unilateral pain

Question 7

e. Laboratory findings

(1) Urinalysis

Answer 7

(a) Usually reveals microscopic or gross hematuria (~90%).
(b) Absence of hematuria DOES NOT exclude urinary stones.
(c) Urinary pH is a valuable clue into the cause of the possible stone

Question 8

Imaging

Answer 8

(1) KUB
(2) Renal ultrasound
(3) Spiral CT with patient in prone position

Question 9

Treatment

medical

Answer 9

(a) Medical expulsive therapy may increase the rate of spontaneous stone passage and appears to be most effective for distal stones.
1) alpha-blockers (tamsulosin, 0.4 mg orally once daily)**
2) nonsteroidal anti-inflammatory agent (ibuprofen 800 mg orally three times per day),
3) With or without a short course of a low-dose oral corticosteroid
a) Prednisone

Question 10

Treatment

surgical

Answer 10

(1) Stones that require surgical removal include those that are showing signs of obstruction or infection.**
a) Ureteroscopic stone extraction
b) Extracorporeal shock wave lithotripsy

Question 11

Prevention

Answer 11

(1) dietary modification is important.
(a) Fluid intake
(b) Sodium intake
(c) Animal protein intake

Question 12

Complications

Answer 12

(1) Obstructing stone with associated infection is a medical emergency. (MEDEVAC).**
(a) Require urology consultation and prompt drainage by a ureteral stent or a percutaneous nephrostomy tube.
(b) Antibiotics alone are inadequate and only used as an adjunct to urinary drainage of the obstruction.
(c) Signs of infection, including associated fever, tachycardia, or elevated white blood cell count may indicate a urinary tract infection behind the obstructing stone.**

Question 13

Follow up

(1) Referral to urology is warranted if

Answer 13

(a) Obstructing stone with signs of infection
(b) The stone fails to pass within 4 weeks.
(c) Fever
(d) Intolerable pain
(e) Persistent nausea or vomiting.

These indicate instability**