Urolithiasis

Question 1

Types of renal calculi

Answer 1

Red opaque

Non-opaque

Question 2

Red opaque causes of renal calculi

Answer 2

Calcium phosphate/oxalate

Struvite( infection)

Cystine

Question 3

Non opaque causes of renal calculi

Answer 3

Indinavir

Uric acid

Question 4

Metabolic abnormalities ass. with calcium stones

Answer 4

Hypercalcaemia

Hypercalcuria

Hyperuricosuria

Hyperoxaluria

Low citrate or Mg

Question 5

Pathogenesis of struvite infections

Answer 5

UTI causing organisms besides Ecoli

Organisms produce urease, uric acid broken down, ammonia produced, alkaline pH

Precipitation of proteins in urine +pus cells+organisms to make stone matrix

Crystalline part made of electrolytes

Once stone has formed infection persists rapid stone growth- staghorn configuration

Question 6

Factors associated with uric acid stone formation

Answer 6

Low urine volume-dehydration

Low urine pH

High red meat intake

chronic diarrhoea

increased urine uric acid-gout, myeloproliferative diseases

Question 7

Cystine stone causes

Answer 7

Autosomal recessive aminoaciduria-homozygous childhood presentation

COLA excreted in increased amounts

Cystine

Ornithine

Lysine

Arginine

Question 8

Indinavir stones

Answer 8

PI used in HIV

soft stones not showing on CT

Question 9

Complications of renal calculi

Answer 9

UTI

Obstruction

Chronic irritation

Question 10

UTI renal calculi complications

Answer 10

pyelonephritis

pyonephrosis

perinephric abscess and fistulae

Question 11

Obstruction renal calculi complications

Answer 11

Hydronephrosis

Renal failure if kidney

Question 12

Chronic irritation renal calculi complications

Answer 12

Leukoplakia leading to SCC of renal pelvis

Question 13

Clinical presentation oof renal calculi

Answer 13

Haematuria

Pain

Complications

Question 14

Renal calculi special investigations

Answer 14

Urine

Abdominal X-ray

IVP

Serum electrolytes

24 hour urine electriloytes

Stone analysis

Question 15

General renal calculi mx measures

Answer 15

Hydration

Reduce salt intake

Reduce red meat intake

Question 16

Uric acid stone tx

Answer 16

Urine alkalinasation

When reached pH of >6.8 -dtone dissolution

Allopurinol

Question 17

Calcium stone tx

Answer 17

Metabolic abn medical tx

thiazide diuretics for normocalcaemic hypercalciuria

Potassium citrate or hypocitraturia

Question 18

Infective stone tx

Answer 18

Ab/Antiseptics after stone removal

Question 19

Cystine stone tx

Answer 19

Urine alkalinasation and Penicillamine

Question 20

Renal calculi surgical tx.

Answer 20

Extracorporeal shock wave lithotripsy

Percutneous nephrolithotomy

Open surgery

Combination

Chemolysis

Nephrectomy

Question 21

Primary cause of bladder calculi

Answer 21

Usually in children

Protein calorie malnutrition and recurrent gastroenteritis

Question 22

Secondary causes of bladder calculi

Answer 22

Bladder outflow obstruction

Foreign bodies

• encrusting from indwelling catheter
• Non-absorbable sutures
• foreign body inserted by patient

Stasis and infection (bladder diverticulumand neuropathic bladder)

Stone from upper tract

Metabolic (prim. hyperparathyroidism, cystnuria)

Question 23

Clinical features of bladder calculi

Answer 23

Suprapubic pain

Dysuria

Haematuria

Intermittent interruption of urinary stream

Sx of bladder flow obstruction

Irritative sx. dt sec infection

Question 24

Dx of bladder calculi

Answer 24

U/S

Abdominal U/S

Cystoscopy

Question 25

Treatment of bladder calculus

Answer 25

Endoscopic stone fragmentation (cystolitholapaxy) Open cystolithotomy (multiple stone or open prostatecomy)

Question 26

Treatment of bladder outflow obstruction

Answer 26

TURP Transurethral resection of prostate