Urinary Stones

Question 1

Urinary Stones Pathophysiology

Answer 1

• When urine is supersaturated with minerals
• 60-80% contain calcium
• Vary in size
• Randall’s plaques
• Bladder stones are 5% of urinary tract stones and usually occur due to foreign bodies, obstruction or infection, most common cause is urinary stasis

Question 2

Urinary Stones Epidemiology

Answer 2

• Common
• Men more commonly affected
• Peak age between 30 and 50

Question 3

Urinary Stones RFs

Answer 3

-Anatomical anomalies
-FHx
-HTN
-Gout
Hyperparathyroidism…

Question 4

Urinary Stones Presentation

Answer 4

• Many are asymptomatic
• Sudden severe pain from stones causing dilation, stretching and spasm
• Pain starts in loin and moves to groin sometimes with haematuria
• As it moves down, pain will move from loin to groin
• Pain is more constant than in biliary or intestinal colic, often periods of relief before it returns
• Patient able to localise pain quite well
• May be rigors, dysuria, haematuria, urinary retention, N/V
• Often writhing, in contrast with those with peritoneal irritation who lie still

Question 5

Urinary Stones Differentials

Answer 5

• Biliary colic
• AAA
• Pyelonephritis

Question 6

Urinary Stones Investigations

Answer 6

• Urine dip
• Microscopy with C/S
• Bloods
• Clotting
• CT
• AXR useful for watching progress of stone

Question 7

Urinary Stones Management

Answer 7

• NSAIDS
• If <10mm, tamsulosin and wait
• If >10mm, surgery