Urology II Flashcards
Describe the difference in percutaneous nephrostomy and percutaneous nephrolithotomy [1]
nephrostomy - focuses on draining urine to relieve obstruction
- e.g A 23-year-old male is admitted with left sided loin pain and fever. His investigations demonstrate a left sided ureteric calculi that measures 0.7cm in diameter and associated hydronephrosis.
nephrolithotomy - focuses on removing kidney stones
- e.g. A 30-year-old male presents with left sided loin pain. His investigations demonstrate a large left sided staghorn calculus that measures 2.3cm in diameter.
A 34-year-old female presents to her General Practitioner after noticing sudden-onset hair growth, particularly in the facial region. She is becoming increasingly embarrassed by this. She is keen to have the problem sorted. Blood tests were performed, with the only abnormality being a testosterone level of 10.4 nmol/l l (reference range 0.8–3.1 nmol/l).
What is the next step in her management? [1]
A 34-year-old female presents to her General Practitioner after noticing sudden-onset hair growth, particularly in the facial region. She is becoming increasingly embarrassed by this. She is keen to have the problem sorted. Blood tests were performed, with the only abnormality being a testosterone level of 10.4 nmol/l l (reference range 0.8–3.1 nmol/l).
Refer to Endocrinology as a suspected cancer referral
This patient’s history of sudden-onset hair growth and her raised testosterone level necessitates an urgent referral for suspected malignancy.
Describe the treatment algorithim for a patient who has a confirmed obstructed kidney stone? [2]
1.urgent decompression:
- ureteric stent past the obstruction and achieve drainage.
- a percutaneous nephrostomy tube can be placed by interventional radiology.
- urgent antibiotics
Calcium phosphate stones are commonly found in which structure? [1]
Bladder - found with urinary stasis
When lasering a kidney stone is smells of egg. Which type of renal stone is this? [1]
Cysteine
State reasons why hypercalciuria [4] and hyperoxaluria [3] may be occurring and thus causing calcium stones
Hypercalciuria:
- Hyperparathyroidism
- Excess Ca2+ intake
- Increased Ca2+ gut absorption
- Poylcystic ovaries or medullary sponge disease
Hyperoxaluria:
- High diet in oxalates
- Low dietary Ca2+ (leading to decreased binding to oxalate)
- Increased intestinal resorption (e.g Crohns)
Which radiological investigations would you conduct for renal stones? [5]
1. CT-KUB - Non-contrast Computerised Tomography
- GOLD STANDARD
- can measure how hard stone is (can determine treatment), position and size
- If CT-KUB is postive; then perform KUBXR to look at stone position
3. Ultrasound:
- Shows kidney stones and renal pelvis dilatation well but ureteric stones can be missed
- useful in pregnant and younger recurrent stone-formers (no radiation risk)
- IVU (intravenous urogram)
- Rarely used - MRI
- used for pregnancy
Which anti-emetics are prescribed for kidney stones? [3]
Anti-emetics to prevent vomiting: metoclopramide, prochlorperazine or cyclizine
A 48-year-old women presents with recurrent loin pain and fevers. Investigation reveals a staghorn calculus of the left kidney. Infection with which of the following organisms is most likely?
Staphylococcus saprophyticus
Proteus mirabilis
Klebsiella
E-Coli
Staphylococcus epidermidis
A 48-year-old women presents with recurrent loin pain and fevers. Investigation reveals a staghorn calculus of the left kidney. Infection with which of the following organisms is most likely?
Staphylococcus saprophyticus
Proteus mirabilis
Klebsiella
E-Coli
Staphylococcus epidermidis
Infection with Proteus mirabilis accounts for 90% of all proteus infections. It has a urease producing enzyme. This will tend to favor urinary alkalinisation which is a relative per-requisite for the formation of staghorn calculi.
State the medical expulsive therapy that can be used for treating kidney stones [2]
Medical expulsive therapy:
- nifedipine
- tamulosin (alpha blocker)
Describe the treatment plan for a renal stone < 10 mm that fails to pass despite initial conservative management [3]
Offer shock wave lithotripsy (SWL)
Consider ureteroscopy if SWL is contraindicated, fails, or is not indicated because of anatomical reasons
Consider percutaneous nephrolithotomy (PCNL) if SWL and ureteroscopy are not suitable options or have failed.
Name two AEs of shock wave litrotripsy [2]
The passage of shock waves can result in the development of solid organ injury.
Fragmentation of larger stones may result in the development of ureteric obstruction
What is the first line treatment for pregnant person with stone? [1]
If the patient has no evidence of infection, the specialist will arrange ureteroscopy. Ureteroscopy has been demonstrated to be safe in pregnancy.[74]
Describe the treatment plan for a renal stone > 20 mm [1]
Percutaneous nephrolithotomy
A 32-year-old female with a history of Crohn’s disease presents for review with left loin pain consistent with renal colic. On examination she has a large midline abdominal scar suggestive of previous small bowel resection. Plain abdominal X-ray reveals multiple renal calculi.
What type of renal calculi fit best with this clinical picture?
Uric acid stones
Cystine stones
Calcium oxalate stones
Calcium carbonate stones
Magnesium carbonate stones
A 32-year-old female with a history of Crohn’s disease presents for review with left loin pain consistent with renal colic. On examination she has a large midline abdominal scar suggestive of previous small bowel resection. Plain abdominal X-ray reveals multiple renal calculi.
What type of renal calculi fit best with this clinical picture?
Uric acid stones
Cystine stones
Calcium oxalate stones
Calcium carbonate stones
Magnesium carbonate stones
Increased urinary oxalate may be genetic (primary oxaluria), idiopathic or enteric (either due to severe bowel inflammation and malabsorption or to extensive small bowel resection, as is the case here).
