Urolithiasis

Question 1

what is urolithiasis

Answer 1

stone disease in the urinary tract

Question 2

ratio of men to women who get urolithiasis

Answer 2

M:F 2:1

Question 3

where can you get the stones

Answer 3

upper urinary tract (renal stones, ureteric stones)

lower urinary tract (bladder, prostatic, urethral stones)

Question 4

cause urolithiasis

Answer 4

anatomical - congenital (horseshoe, spina bifida) or acquired (obstruction, trauma, reflux)
urinary factors - dehydration, calcium / urate / crystine, metastable urine
infection

Question 5

pathogenesis urolithiasis

Answer 5

nucleation theory - stones form from crystals in supersaturated urine
80% are calcium based - oxalate and phosphate
10% are uric acid

Question 6

prevention of stones

Answer 6

overhydration
low sodium diet
normal dietary intake
healthy protein intake
reduce BMI
active lifestyle

Question 7

symptoms urolithiasis

Answer 7

asymptomatic 
loin pain
renal colic
UTI symptoms - dysuria, urgency, frequency
recurrent UTIs
haematuria

Question 8

what is “renal” colic

Answer 8

pain radiates from upper urinary tract obstruction
Site - unilateral loin pain
Onset - rapid
Character - unable to get comfortable - writhing
Radiation - radiates to groin and ipsilateral labia / testes
Associated features - nausea/ vomiting
Timing - spasmodic / colicky
Exacerbating - worse w fluid loading
Severity - classically severe 12/10 - worse than labour

Question 9

investigation renal colic

Answer 9

ABC & analgesia
urinalysis
FBC, U+E, calcium, uric acid

Question 10

rx kidney stones

Answer 10

conservative if small, safe location, asymptomatic, static size
extracorporeal shock wave lithotripsy (ESWL) - uses acoustic pulse shock waves to break the stone up
uteroscopic
percutaneous nephrolithotomy