Urinary Stones Flashcards
List the common stone types in desc order?
Calcium OXalate - 45% Calcium Oxalate & Phosphate - 25% Triple Phosphate - 20% (infective) URic Acid - 5% Cystine - 3% Calcium Phosphate - 3%
What is a staghorn stone?
One that involved the renal pelvis and calyces
Describe the gender differences in stones?
Men are 3x more likely.
Men peak in their 30s
Women peak at 35 & 55
How do Urinary stones present?
Dysuria
~Pyrexia
Recurrent UTIs
Haematuria
Bladder stones can cause frequency and sudden interruption of stream
Pain depends on location of stone:
- Loin Pain
- Ureteric colic radiating to groin
- Testicualar/vulvar pain
- Suprapubic, groin or penile pain (bladder stones)
What blood tests would you run for a stone?
- FBC
- U&E
- Creatinine
- Ca
- Urate
- PTH
What other tests can you do for stones?
Urinalysis & culture
24 hr urine collection
CT-KUB
US
IV Urogram
What are the types of surgery for stones?
Endoscopic:
- Rigid or Flexible Ureteroscopy
- Flexible Lithoclast
- Holmium Laser
ESWL (Extracorporeal Shock Wave Lithotripsy)
PCNL (Percutaneous Nephrolithotomy)
Open (Partial, simple or total nephrectomy)
When would you use ESWL?
ESWL is the first line treatment for most upper tract stones.
Except those >2cm.
When would you use Endoscopic treatments?
For bladder stones
Or higher if theres uncontrollable pain, severe obstruction, persistant haematuria or failed ESWL
When would you use PCNL?
If the stones are ESWL resistant such as cystine stones
What are the types of open stone removal?
Partial Nephrectomy - removes part of the kidney
Simple nephrectomy - removes the whole kidney
Total nephrectomy - removes the kidney, suprarenal gland and surrounding tissue
When do you do open surgery?
IF a large stone –> Infection and non-function necessitates kidney removal
Or ESWL/PCNL aren’t available
What kind of stones are not visible on CT
Uric acid
Cystine stones
Aetiology of urolithiasis
Men High Protein High Salt Dehydration Obesity
