Urolithiasis Flashcards
Epidemiology of Urolithiasis?
lifetime risk 15%, usually young men, 20-40, M:F 3:1
Common sites for stones?
PUJ
crossing the iliac vessels
under vas or uterine artery
PVJ
Types of stone?
Calcium oxalate: incr risk in crohns
Struvite or triple phosphate: may form staghorn, proteu infection
Urate: double risk if confirmed gout
Cystine: fanconi syndrome
Associated factors with stones?
Dehydration hypercalcaemia oxalate excretion utis hyperuricaemia urine tract abnormalities frusemide, thiazides
Presentation of stones?
Ureteric colic: severe loin pain -> groin associated with NandV Pt cannot lie stil . . . .Bladder or urethral obstruction: painful urinary tenesmus suprapubic pain pain and haematuria
plus maybe uti, sterile pyuria, anuria
NO LOIN TENDERNES USUALLY
Imaging of stones:
KUB xray, 90% opaque, us for hydronephrosis, NCCT is gold standard
Prevention of stones?
drink more, treat UTIs decrease oxalate
Rx of stones?
analgesia: diclofenac 75mg IM/PO or 100mg PR
if nsaids C/I pethidine
FLuids if unable to tolerate
abx if infection
Conservative management of stones?
less than 5mm, discharge with analgesia and seive urine to collect stone for opd analysis
what is MET?
Medical expulsive therapy, help slightly bigger stones to pass: nifedipine/tamsulosin
When do you go for surgery?
low liklihood of passage, renal insufficiency, infection
Options for surgery/active removal?
Shocwave lithotripsy: stones <20mm, renal insufficiency
C/I in pregnancy, AAA, Bleeding problems
Uretoendoscopy and basket: if shockwave fails or in renal pelvis
Percutaneous neprolithotomy: big or staghorn
if febrile with renal obstruction?
Emergency, percutaneous nephrostomy or ureteric stent
give cefuroxime iv
