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Urinary Systems > Urolithiasis > Flashcards

Urolithiasis Flashcards

1
Q

What is the epidaemiology of stones?

A

Prevalence in general population = 2-3%

Lifetime risk in males 1:8

M:F = 3:1

Peaks:

  • Men = 30
  • Women = Bimodal at 35 and 50

Chance of stone recurrence is 50% within 10 years (with 10% within a year)

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2
Q

Give the different stone types

A

Calcium oxalate = 45%

Calcium oxalate + phosphate = 25%

“Triple phosphate” infective = 20%

Calcium phosphate = 3%

Uric acid = 5%

Cystine = 3%

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3
Q

What are the symptoms and signs of stones?

A

Renal pain (fixed in loin)

Ureteric colic (radiating to groin)

Dysuria / haematuria / testicular or vulval pain

Urinary infection

Loin tenderness

Pyrexia

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4
Q

What are the investigations for stones?

Not imaging

A

Blood tests - FBC, U+E, Creatinine

Calcium, Albumin, Urate
-Hypercalcaemia should be excluded

Parathormone

Urine analysis and culture

24 hr urine collections

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5
Q

What radiological investigations can you use in stones?

A

X-ray KUB
-Can show up to 90% of stones

Ultrasound
-May show hydronephrosis

IVU (intravenous urogram)

CT-KUB

  • GOLD STANDARD
  • Very sensitive
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6
Q

What are the indications for surgical treatment?

A

Obstruction

Recurrent gross haematuria

Recurrent pain and infection

Progressive loss of kidney function

Patient occupation

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7
Q

What are the techniques for surgical treatment of stones?

A

Open surgery (now rare)

Endoscopic surgery

ESWL

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8
Q

Open surgery has become far less common with the advent of PCNL and ESWL

What are the advantages and disadvantages of open stone surgery?

A

Advantage
-Single procedure with least recurrence rate

Disadvantages

  • Large scar
  • Long hospital stay
  • General wound complications
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9
Q

What are the indications for open surgery?

A

Non functioning infected kidney with large stones necessitating nephrectomy

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

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10
Q

What is a simple pyelolithotomy?

What is a simple radial nephrotomy?

A

Small incision made to renal pelvis to remove stone

Having to cut into actual kidney tissue to get to calyx stone

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11
Q

What are the indications for simple partial and total nephrectomy?

A

Non functioning kidney with large staghorn stones or elderly frail patients with complex stones and normal contralateral kidney.

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12
Q

How common is contralateral stone formation after a total nephrectomy?

A

Up to 30%

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13
Q

What does PCNL stand for?

A

Percutaneous Nephrolithotomy

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14
Q

What type of stone gives the characteristic staghorn stone appearance?

A

Triple phosphate

Staghorn calculi are the result of recurrent infection and are thus more commonly encountered in women

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15
Q

What are the specific indications for PCNL?

A

Large stone burden (risk of Steinstrasse)

Associated PUJ stenosis

Infundibular stricture

Calyceal diverticulum

Morbid obestity or skeletal deformity

ESWL resistant stones
e.g. Cystine

Lack of availability of ESWL

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16
Q

What is steinstrasse?

A

“Stone street”

Break up large stone but all the smaller stones black the ureter

17
Q

Why is infundibular stricture and calyceal diverticuluman indication for PCNL?

A

Can be treated in the same operation

May remove stone with other options but your not dealing with the underlying problem

18
Q

How does PCNL work?

A

Cystoscopy

Guide wire passed up ureter

Retrograde catheter or balloon catheter

Contrast

Guided by ultrasound or X-ray

19
Q

What are the contraindications for PCNL?

A

Uncorrected coagulopathy

Active Urinary Tract infection

Obesity or unusual body habitus unsuitable for X-ray tables
-e.g. spinal abnormalities

Relative contraindications include small kidneys and severe perirenal fibrosis

20
Q

What are the complications of PCNL?

A

Serious complications in the 3-8% range

Local complications:
-Pseudoaneurysm or AV fistula 0.5-1%

  • UT injury:
  • –Pelvic tear 8-15%
  • –Ureteral tear 5%
  • –Stricture of PUJ 0.1-0.8%

Injury to adjacent organs:

  • Bowel injury 0.1%
  • Pneumothorax 0.1-0.3%
  • Liver spleen (very rare)

Systemic complications

  • Fever, sepsis 0.2-0.6%
  • MI 0.1-0.4%
21
Q

What is ESWL?

A

Extracorporeal Shock Wave Lithotripsy

Shock waves crush stones and smaller pieces pass out of body in urine

Newer generation lithotriptors cause less pain

Treatments are usually done on a day-care basis with simple analgesia

Can be repeated as often as required

22
Q

ESWL is now commonly used for renal and ureteric calculi as first line treatment.

When is it not such a good idea?

A

Not used as first line treatment for stones >2cms and less effective for lower pole stones

If not effective after 2 treatments then further treatments not justified

Often ineffective for treating cystine stones

23
Q

What are the indications for open ureterolithotomy?

A

Not suitable for laparoscopic approach

Failed ESWL or ureteroscopy

24
Q

What are the indications for ureteroscopy?

A

Sever obstruction,

Uncontrollable pain

Persistent haematuria

Lack of progression

Failed ESWL and patient occupation

25
Q

What is the standard instument for treating lower ureteric stones?

A

Rigid ureteroscope
-90-100% success rate

For proximal stones the success rate is lower at 60-70%

26
Q

Apart from rigid ureteroscope what other options do you have for endoscopic ureteric stone surgery?

A

Flexible ureteroscope

Flexible lithoclast

Holmium laser

27
Q

What are the complications of ureteroscopy?

A

Minor:
-Haematuria, fever, small ureteric perforation, minor-ureteric reflux

Major:
-Major ureteric perforation, ureteric avulsion, ureteral necrosis and stricture formation

28
Q

What are the signs and symptoms of bladder stones?

A

Suprapubic/ groin/ penile pain

Dysuria, frequency, haematuria

Urinary inefction (persistent)

Sudden interuption of urinary stream

Usually secondary to outflow obstruction

29
Q

How are bladder stones treated?

A

Most treated endoscopically

Larger stones can be treated by open excision

30
Q

What percentage of gallstones are radio-opaque (i.e. visible on non-contrast X-ray)?

A

About 10 %

Urinary Systems (26 decks)

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