Urolithiasis Flashcards
In what populations are stones most common?
M:F = 3:1
Peak age in men is 30
Peak age in woman- bimodal 35 and 55 peaks
50% chance of stone recurrence within 10 years
What is the most common type of stone?
Calcium oxalate
What are the signs and symptoms of urolithiasis?
Renal pain fixed in loin Ureteric colic radiating to groin Dysuria Haematuria Testicular or vulval pain Urinary infection Loin tenderness Pyrexia
How are renal stones investigated?
Blood tests- FBC, U&E, creatinine Calcium, albumin, urate Parathormone Urine analysis and culture 24hr urine collections KUB (kidney, ureter, bladder) scan Ultrasound IVU (intravenous urogram) CT KUB
What are the indications for surgical treatment of stones?
Obstruction Recurrent gross haematuria Recurrent pain and infection Progressive loss of kidney function Patient occupation
How can stones be removed surgically?
Open surgery (rare) Endoscopic surgery ESWL (extracorporeal shock wave lithotripsy)
What are the indications for open surgical stone treatment?
Non functioning infected kidney with large stones necessitating nephrectomy
Cases which cannot be managed by PCNL or ESWL for technical reasons
What are the indications for percutaneous nephrolithotomy?
Large stone burden Associated PUJ stenosis Infundibular stricture Calyceal diverticulum Morbid obesity or skeletal deformity ESWL resistant stones eg cystine Lack of availability of ESWL
What are the contraindications for percutaneous nephrolithotomy?
Uncorrected coagulopathy
Active UTI
Obesity or unusual body hiatus unsuitable for X-ray tables
What are the complications of percutaneous nephrolithotomy?
Pseudoaneurysm or AV fistula Pelvic tear Ureteral tear Stricture of PUJ Injury to adjacent organs Fever Sepsis MI
When is extracorporeal shock wave lithotripsy not used as first line treatment of stones?
When stones >2cm
Less effective for lower pole stones
If not effective after two treatments
Often ineffective for treating cystine stones
What are the indications for ureteroscopy treatment of stones?
Severe obstruction Uncontrollable pain Persistent haematuria Lack of progression Failed ESWL Patient occupation
What are the complications of ureteroscopy?
Major ureteric perforation Ureteric avulsion Ureteral necrosis Stricture formation Haematuria Fever Small ureteric perforation Minor vesico-ureteric reflux
What are the symptoms of bladder stones?
Suprapubic, groin or penile pain Dysuria Frequency Haematuria Persistent UTI Sudden interruption of urinary stream
