Urinary tract calculi

Question 1

Define urinary tract calculi

Answer 1

Crystal deposition within the urinary tract (AKA nephrolithiasis)

Question 2

Aetiology of urinary tract calculi (4)

Answer 2

Idiopathic
Metabolic
Infection
Drugs

Question 3

Aetiology of urinary tract calculi - metabolic

4

Answer 3

Hypercalciuria
Hyperuricaemia
Hypercystinuria
Hyperoxaluria

Question 4

Aetiology of urinary tract calculi - infection

1

Answer 4

Hyperuricaemia

Question 5

Aetiology of urinary tract calculi - drugs

1

Answer 5

Indinavir

Question 6

Types of stone

4

Answer 6

Calcium oxalate - most common
Struvite - quite common
Urate - 5%
Cysteine - 2%

Question 7

Epidemiology of urinary tract calculi

prevalence, gender, age, location x2

Answer 7

COMMON (2-3% pop)
3x more common in males
Affects 20-50 yr olds
Bladder stones more common in developing countries, upper urinary tract stones more common in industrialised

Question 8

Presenting symptoms of urinary tract calculi

1 + 4

Answer 8

Often ASYMPTOMATIC

SEVERE loin to groin pain
N&V
Urinary urgency, frequency or retention
Haematuria

Question 9

Signs of urinary tract calculi on physical examination

3 + differential

Answer 9

Loin to groin lower abdominal tenderness
NO signs of peritonism
Signs of systemic sepsis if there’s an obstruction & infection above the stone

Leaking AAA is main differential to consider in older men

Question 10

Investigations for urinary tract calculi

7

Answer 10

Bloods 
Urine
Xray KUB
IVU (IV urography)
US
Non enhance spiral CT
Isotope radiography

Question 11

Investigations for urinary tract calculi - bloods

5

Answer 11

FBC - high WCC if infection
U&Es - check renal function
Calcium
Urate
Phosphate

Question 12

Investigations for urinary tract calculi - urine

2

Answer 12

Dipstick - haematuria is common

MC&S

Question 13

Investigations for urinary tract calculi - X-ray KUB

Answer 13

80% kidney stones are radio-opaque

Question 14

Investigations for urinary tract calculi - IVU

Answer 14

Allows visualisation of kidneys & ureters

Question 15

Investigations for urinary tract calculi - US

Answer 15

May show hydronephrosis & hydroureter

Question 16

Investigations for urinary tract calculi - non enhanced spiral CT

Answer 16

Can also be used to image stones

Question 17

Investigations for urinary tract calculi - isotope radiography

Answer 17

Used to assess kidney function

Question 18

Branches of management of urinary tract calculi

4

Answer 18

Acute presentation
Removal of calculi
Treatment of cause
Advice

Question 19

Management of urinary tract calculi - acute presentation

5

Answer 19

Analgesia
Bed rest
Fluid replacement
Urine collection to try & retrieve any stone that has passed
An obstructed, infected kidney is an emergency & should be treated ASAP to relieve obstruction

Question 20

Management of urinary tract calculi - removal of calculi

3

Answer 20

Urethroscopy
Extracorporeal shock wave lithotripsy
Percutaneous nephrolithotomy

Question 21

Management of urinary tract calculi - treatment of cause

3

Answer 21

Depends on cause
Parathyroidectomy if hypercalcaemia due to hyperparathyroidism
Allopurinol if hyperuricaemia

Question 22

Management of urinary tract calculi - advice

1

Answer 22

Increase oral fluid intake

Question 23

Complications can arise from…

3

Answer 23

Stones
Ureteroscopy
Lithotripsy

Question 24

Complications of stones

3

Answer 24

Infection - PYLONEPHRITIS
Septicaemia
Urinary retention

Question 25

Complications of ureteroscopy

2

Answer 25

Perforation

False passage

Question 26

Complications of lithotripsy

2

Answer 26

Pain

Haematuria

Question 27

Prognosis of urinary tract calculi

general, problem, recurrence

Answer 27

GOOD
Infection of calculus can lead to irreversible renal scarring
Recurrence about 50% over 5 yrs