Urolithiasis Flashcards
What is the relative incidence of stones?
2-3%
More males than females 3:1
Peak age in men is 30 years
Chance of stone recurrence is 50% in 10 years
What is the common stone types?
Calcium oxalate most common
Calcium oxalate + phosphate, triple phosphate (infective), calcium phosphate, uric acid and cystine
What are the symptoms and signs of stones?
Renal pain (loin), ureteric colic (radiating to groin), dysuria/ haematuria/ testicular or vulva pain, urinary infection, loin tenderness and pyrexia
What investigations are done fore stones?
Blood tests - FBC, U+Es and creatinine
Calcium, albumin and urate
PTH
Urine analysis and culture
24hr urine collection
What radiology is used to investigate stones?
KUB - kidney, bladder and ureter
US
IVU
CT-KUB/ Urogram
What are the indications for surgical treatment?
Obstruction
Recurrent gross haematuria
Recurrent pain and infection
Progressive loss of kidney function
Patient occupation
What are the techniques for surgical treatment?
Open surgery (very rare)
Endoscopic surgery
ESWL
What is the advantages and disadvantages for open surgery for renal stone treatment?
Advantage - single procedure with least recurrence route
Disadvantage - large scar, long hospital stay, general wound complications and longer recovery
What are the indications for open surgery?
Non-functioning infected kidney with large stones necessitating nephrectomy
Cases which for technical reasons cannot be managed by PCNL or ESWL
When is a simple and total nephrectomy used?
Non-functioning kidney with large staghorn stones or elderly frail patients with complex stones and normal contralateral kidney
What are the specific indications for Percutaneous nephrolithotomy (PCNL)?
Large stone burden, associated PUJ stenosis, infundibular stricture, calyceal diverticulum, morbid obesity or skeletal deformity, ESWL resistant stones and lack of ESWL availability
What does a PCNL include?
Guide wire
Retrograde catheter or balloon catheter
Contrast
How is a percutaneous abscess treated?
Renal puncture
Guided by US or X-ray
What are some contraindications for PCNL?
Uncorrected coagulopathy, active UTI, obesity or unusual body habitus unsuitable for X-ray tables, small kidneys and severe perirenal fibrosis
What are some complications of PCNL?
Local - pseudoaneurysm or AV fistula and UT injury (pelvic tear, ureteral tear and stricture)
Injury to adjacent organs
Systemic - fever, sepsis and MI
Explain extracorporeal shock wave lithotripsy (ESWL)
Simple stones which are too large to pass through - shock waves crush stones
Smaller pieces pass out of body in urine
When are ESWL used in treatment?
Commonly used for renal and ureteric calculi as first line treatment
Newer generation lithotripters cause less pain
Can be repeated as often as required
When is ESWL ineffective in treatment?
> 2cm stones and lower pole stones
Ineffective for treating cystine stones
If not effective after 2 treatments then further treatment is not justified
What are the indications for open ureterolithotomy?
Not suitable for laparoscopic approach
Failed ESWL or ureteroscopy
What are the indications for ureteroscopy?
Severe obstruction, uncontrolled pain, persistent haematuria, lack of progression, failed ESWL and patient occupation
What instrument is used for treating lower ureteric stones?
Rigid ureteroscope
What is used for surgery for ureteric/ renal stones?
Flexible ureteroscopes
Flexible lithoclast
Holmium laser
What are some complications of ureteroscopy?
Minor - haematuria, fever, small ureteric perforation and minor ureteric reflux
Major - minor ureteric perforation, ureteric avulsion, ureteral necrosis and stricture formation
What are the symptoms for bladder stones?
Suprapubic, groin or penile pain, dysuria, frequency, haematuria, UTI persistent, sudden interruption of urine stream and strangury
How are most bladder stones treated?
Endoscopically
Larger can be treated by open excision
