Urolithiasis Flashcards
Urolithiasis?
Formation of stones in the bladder or urinary tract
Are males or females more likely to develop urinary stones?
Males
Stones of the urinary tract often contain what?
Calcium
Which technique is used for monitoring purposes of urinary stones?
Plain xrays
->this is due to their high calcium content
What is the peak age in men of urinary stones?
30 years
How likely is stone reoccurence?
50% within 10 years
What is the most common type of stone?
Calcium oxalate
List some other types of stone, apart from calcium oxalate.
Calcium oxalate + phosphate
Triple phosphate
Calcium phosphate
Uric acid
Cystine
What are the symptoms of urolithiasis?
Renal pain, often fixed in loin
Ureteric colic, radiating to the groin
Dysuria
Haematuria
Urinary infection
Loin tenderness
Pyrexia
What investigations can be done for urolithiasis?
Blood tests- FBC, U&E, Creatinine
Urine analysis and culture
24hr urine collection
Calcium, Albumin, Urate
Parathormone
What does CT-KUB stand for?
CT of the kidney, ureter and bladder
Which imaging investigations can be done for urolithiasis?
CT-KUB
Ultrasound
IVU (intravenous urogram)
What are the indications for surgery in someone with urolithiasis?
Obstruction
Recurrent gross haematuria
Recurrent pain and infection
Progressive loss of kidney function
Patient occupation e.g. pilot- can’t work if they have a known kidney stone
What is the most sensitive way to pick up stones in the urinary tract?
CT
What are the surgical techniques used for patients with urolithiasis?
Endoscopic surgery
ESWL (extracorporeal shock wave lithotripsy)
Open surgery but now very rare
What are the pros and cons of open stone surgery?
Pros: single procedure, least recurrence rate
Cons: large scar, long hospital stay, general wound complications, longer recovery
What is an indication for open stone surgery?
Non-functioning infected kidney with large stones requiring nephrectomy
When might a patient get a simple partial or total nephrectomy?
Non-functioning kidney with large staghorn stones
Elderly frail patients with complex stones and normal contralateral kidney
List some of the indications for Percutaneous Nephrolithotomy (PCNL) .
-Large stone burden
-Associated PUJ stenosis
-Infundibular stricture
-Calyceal diverticulum
-Morbid obesity or skeletal deformity
-ESWL resistant stones
-Lack of ESWL availability
Give an example of a s tone which is ESWL resistant.
Cystine
What are some contraindications of Percutaneous Nephrolithotomy (PCNL) ?
Uncorrected coagulopathy
Active UTI
Obesity or unusual body habitus unsuitable for x-ray tables
Small kidneys, severe perirenal fibrosis
What are some of the local complications of Percutaneous Nephrolithotomy (PCNL)?
Pseudoaneurysms
AV fistula
Pelvic/ureteral tear
Stricture of PUJ
Percutaneous Nephrolithotomy (PCNL) can lead to injury of which adjacent organs, although rare?
Bowel injury
Pneumothorax
Liver
Spleen
What are some systemic complications of Percutaneous Nephrolithotomy (PCNL)?
Sepsis
Fever
Myocardial infarction
ESWL?
Extracorporeal Shock Wave Lithotripsy
What does ESWL allow for?
Shock waves crush large stones into small fragments so they can be passed out of the body in urine
What is the first line treatment for renal and ureteric calculi?
ESWL
When is ESWL not the first line for treatment of stones?
If stones are >2cm
Less effective for lower pole stones
Often ineffective for cystine stones
What are the surgical indications for open surgery of ureteric stones?
If patient is not suitable for laparoscopic approach
Patient has had failed ESWL or ureteroscopy
What are some indications for uteroscopy?
Severe obstruction
Uncontrollable pain
Persistent haematuria
Failed ESWL
Patient occupation
Lack of progression
What are some of the minor complications of ureteroscopy?
Haematuria
Fever
Small ureteric perforation
Minor vesico-ureteric reflux
What are some of the major complications of ureteroscopy?
Major ureteric perforation
Ureteric avulsion
Ureteral necrosis
Stricture formation
What is the presentation of bladder stones?
Suprapubic/groin/penile pain
Dysuria
Frequency
Haematuria
Persistent UTI
Sudden interruption of urinary stream
How are bladder stones usually treated?
Most treated endoscopically but larger stones can be treated by open excision
