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Year 2- Urinary > Urolithiasis > Flashcards

Urolithiasis Flashcards

1
Q

Urolithiasis?

A

Formation of stones in the bladder or urinary tract

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2
Q

Are males or females more likely to develop urinary stones?

A

Males

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3
Q

Stones of the urinary tract often contain what?

A

Calcium

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4
Q

Which technique is used for monitoring purposes of urinary stones?

A

Plain xrays

->this is due to their high calcium content

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5
Q

What is the peak age in men of urinary stones?

A

30 years

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6
Q

How likely is stone reoccurence?

A

50% within 10 years

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7
Q

What is the most common type of stone?

A

Calcium oxalate

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8
Q

List some other types of stone, apart from calcium oxalate.

A

Calcium oxalate + phosphate
Triple phosphate
Calcium phosphate
Uric acid
Cystine

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9
Q

What are the symptoms of urolithiasis?

A

Renal pain, often fixed in loin
Ureteric colic, radiating to the groin
Dysuria
Haematuria
Urinary infection
Loin tenderness
Pyrexia

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10
Q

What investigations can be done for urolithiasis?

A

Blood tests- FBC, U&E, Creatinine
Urine analysis and culture
24hr urine collection
Calcium, Albumin, Urate
Parathormone

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11
Q

What does CT-KUB stand for?

A

CT of the kidney, ureter and bladder

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12
Q

Which imaging investigations can be done for urolithiasis?

A

CT-KUB
Ultrasound
IVU (intravenous urogram)

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13
Q

What are the indications for surgery in someone with urolithiasis?

A

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

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14
Q

What is the most sensitive way to pick up stones in the urinary tract?

A

CT

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15
Q

What are the surgical techniques used for patients with urolithiasis?

A

Endoscopic surgery
ESWL (extracorporeal shock wave lithotripsy)
Open surgery but now very rare

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16
Q

What are the pros and cons of open stone surgery?

A

Pros: single procedure, least recurrence rate

Cons: large scar, long hospital stay, general wound complications, longer recovery

17
Q

What is an indication for open stone surgery?

A

Non-functioning infected kidney with large stones requiring nephrectomy

18
Q

When might a patient get a simple partial or total nephrectomy?

A

Non-functioning kidney with large staghorn stones
Elderly frail patients with complex stones and normal contralateral kidney

19
Q

List some of the indications for Percutaneous Nephrolithotomy (PCNL) .

A

-Large stone burden
-Associated PUJ stenosis
-Infundibular stricture
-Calyceal diverticulum
-Morbid obesity or skeletal deformity
-ESWL resistant stones
-Lack of ESWL availability

20
Q

Give an example of a s tone which is ESWL resistant.

A

Cystine

21
Q

What are some contraindications of Percutaneous Nephrolithotomy (PCNL) ?

A

Uncorrected coagulopathy
Active UTI
Obesity or unusual body habitus unsuitable for x-ray tables
Small kidneys, severe perirenal fibrosis

22
Q

What are some of the local complications of Percutaneous Nephrolithotomy (PCNL)?

A

Pseudoaneurysms
AV fistula
Pelvic/ureteral tear
Stricture of PUJ

23
Q

Percutaneous Nephrolithotomy (PCNL) can lead to injury of which adjacent organs, although rare?

A

Bowel injury
Pneumothorax
Liver
Spleen

24
Q

What are some systemic complications of Percutaneous Nephrolithotomy (PCNL)?

A

Sepsis
Fever
Myocardial infarction

25
Q

ESWL?

A

Extracorporeal Shock Wave Lithotripsy

26
Q

What does ESWL allow for?

A

Shock waves crush large stones into small fragments so they can be passed out of the body in urine

27
Q

What is the first line treatment for renal and ureteric calculi?

A

ESWL

28
Q

When is ESWL not the first line for treatment of stones?

A

If stones are >2cm
Less effective for lower pole stones
Often ineffective for cystine stones

29
Q

What are the surgical indications for open surgery of ureteric stones?

A

If patient is not suitable for laparoscopic approach
Patient has had failed ESWL or ureteroscopy

30
Q

What are some indications for uteroscopy?

A

Severe obstruction
Uncontrollable pain
Persistent haematuria
Failed ESWL
Patient occupation
Lack of progression

31
Q

What are some of the minor complications of ureteroscopy?

A

Haematuria
Fever
Small ureteric perforation
Minor vesico-ureteric reflux

32
Q

What are some of the major complications of ureteroscopy?

A

Major ureteric perforation
Ureteric avulsion
Ureteral necrosis
Stricture formation

33
Q

What is the presentation of bladder stones?

A

Suprapubic/groin/penile pain
Dysuria
Frequency
Haematuria
Persistent UTI
Sudden interruption of urinary stream

34
Q

How are bladder stones usually treated?

A

Most treated endoscopically but larger stones can be treated by open excision

35
Q
A

Year 2- Urinary (22 decks)

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