Urolithiasis Flashcards
What is urolithiasis
Urolithiasis is a term used to describe calculi or stones that form the urinary tract.
Where can calcifications be found in the urinary system
usually in the kidneys or ureters, but may also affect the bladder or urethra.
What is the most common mineral in a stone
Calcium oxalate
What is the 2nd most common mineral in a stone
Calcium oxalate and phosphate
What is most common age to get calculi
Men aged 30
What is to note about womans getting calculi
They have a bipedal peak at 35 years and 55 years
What is the chance of recurrence for renal calculi
50% in 10 years
What causes renal calculi
Diet Body weight Medical conditions Supplements Medications Family history Obstruction
What medications can cause renal calculi
Aspirin
Antaacids
Diuretics
What are the presenting symptoms of calculi
Renal pain (fixed in loin) Ureteric colic (radiating to groin) Dysuria / haematuria / testicular or vulval pain Urinary infection Loin tenderness Pyrexia
What are the investigations for renal calculi
Blood tests - FBC, U&E, Creatinine Calcium, Albumin, Urate Parathormone (PTH) Urine analysis and culture 24hr urine collections Radiology
What radiological procedures are used?
KUB (Kidney/Ureter/Bladder) Ultrasound IVU (intravenous urogram) CT KUB CT KUB/Urogram – 3D reconstruction
What are treatments available for renal calculi
Open Surgery (now very rare) Endoscopic Surgery ESWL Percutaneous Nephrolithotomy (PCNL
What are indications for surgical treatment in urolithaisis (x5)
Obstruction. Recurrent gross haematuria. Recurrent pain and infection. Progressive loss of kidney function. Patient occupation.
When is open surgey used for stone removal
- Cases which for technical reasons cannot be managed by PCNL or ESWL.
What does PCNL stand for
Percutaneous Nephrolithotomy
When is PCNL used?
ESWL resistant stones e.g. Cystine.
Lack of availability of ESWL
Stone larger than 2cm
What does ESWL stand for
extracorporeal shockwave lithotripsy
What is ESWL
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.
When do you use ESWL
It is first line treatment
What is uteroscopy
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
When do you use uteroscopy
- 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.
Why you would check PTH as an investigation into renal calculi
To investigate if its a parathyroid tumour that is causing the calculi precipitation
