Urolithiasis

Question 1

What is urolithiasis

Answer 1

Urolithiasis is a term used to describe calculi or stones that form the urinary tract.

Question 2

Where can calcifications be found in the urinary system

Answer 2

usually in the kidneys or ureters, but may also affect the bladder or urethra.

Question 3

What is the most common mineral in a stone

Answer 3

Calcium oxalate

Question 4

What is the 2nd most common mineral in a stone

Answer 4

Calcium oxalate and phosphate

Question 5

What is most common age to get calculi

Answer 5

Men aged 30

Question 6

What is to note about womans getting calculi

Answer 6

They have a bipedal peak at 35 years and 55 years

Question 7

What is the chance of recurrence for renal calculi

Answer 7

50% in 10 years

Question 8

What causes renal calculi

Answer 8

Diet
Body weight
Medical conditions
Supplements
Medications
Family history
Obstruction

Question 9

What medications can cause renal calculi

Answer 9

Aspirin
Antaacids
Diuretics

Question 10

What are the presenting symptoms of calculi

Answer 10

Renal pain (fixed in loin)
Ureteric colic (radiating to groin)
Dysuria / haematuria / testicular or vulval pain
Urinary infection
Loin tenderness
Pyrexia

Question 11

What are the investigations for renal calculi

Answer 11

Blood tests - FBC, U&E, Creatinine 
Calcium, Albumin, Urate 
Parathormone (PTH) 
Urine analysis and culture
24hr urine collections
Radiology

Question 12

What radiological procedures are used?

Answer 12

KUB (Kidney/Ureter/Bladder) 
Ultrasound
IVU (intravenous urogram) 
CT KUB 
CT KUB/Urogram – 3D reconstruction

Question 13

What are treatments available for renal calculi

Answer 13

Open Surgery (now very rare)
Endoscopic Surgery
ESWL
Percutaneous Nephrolithotomy (PCNL

Question 14

What are indications for surgical treatment in urolithaisis (x5)

Answer 14

Obstruction.
Recurrent gross haematuria.
Recurrent pain and infection.
Progressive loss of kidney function.
Patient occupation.

Question 15

When is open surgey used for stone removal

Answer 15

• Cases which for technical reasons cannot be managed by PCNL or ESWL.

Question 16

What does PCNL stand for

Answer 16

Percutaneous Nephrolithotomy

Question 17

When is PCNL used?

Answer 17

ESWL resistant stones e.g. Cystine.
Lack of availability of ESWL
Stone larger than 2cm

Question 18

What does ESWL stand for

Answer 18

extracorporeal shockwave lithotripsy

Question 19

What is ESWL

Answer 19

ESWL, or extracorporeal shockwave lithotripsy, is a very common, non-invasive method for treating stones in the kidney or ureter, the tube which drains the urine from the kidney to the bladder. It utilizes an energy source which generates a shock wave that is directed at the stone.

Question 20

When do you use ESWL

Answer 20

It is first line treatment

Question 21

What is uteroscopy

Answer 21

Ureteroscopyis a procedure to address kidney stones, and involves the passage of a small telescope, called aureteroscope, through the urethra and bladder and up the ureter to the point where the stone is located

Question 22

When do you use uteroscopy

Answer 22

• Severe obstruction, uncontrollable pain, persistent haematuria, lack of progression, failed ESWL and patient occupation.
• The rigid ureteroscope is the standard instrument for treating lower ureteric stones with a 90-100% success rate.

Question 23

Why you would check PTH as an investigation into renal calculi

Answer 23

To investigate if its a parathyroid tumour that is causing the calculi precipitation