W3L7 Urinary Stone

Question 1

Etio UROLITHIASIS

Answer 1

• Common disorder
• M>F
• > middle age(all age)
• > mountains, deserts, tropical areas

Question 2

RISK FACTORS

Answer 2

1. Dehydration
2. High dietary intake
   - animal protein
3. Underlying metabolic conditions
   - uric acid stones
   - cystine stone
   - xanthine stone
4. Urine stasis
5. Infection

Question 3

Types of Stones

Answer 3

1. Calcium containing stones: 80%
   - Calcium oxalate(most common)
   - Calcium phosphate
2. Struvite : 10-15%
3. Uric acid: 5-10%
4. Cystine: 1-3%
5. Xanthine: very rare

Question 4

C/P: Renal and ureteral calculi

Answer 4

– Renal colic:
– Hematuria:
– LUTS: if it is in the lower ureter 
– Symptoms of complications
– Asymptomatic
– No specific signs

Question 5

Complications of urinary calculi

Answer 5

1. Obstruction
2. Infection
3. Deterioration renal fx
   - Metaplasia urinary epithelium

Question 6

Investigations

Answer 6

1. Laboratory inv
   - Urine analysis
   - Blood tests
   - Stone analysis
2. Radiological inv
   - KUB(90% radio-opaque)
   - I.V.U
   - Renal U.S
   - Spiral CT(Most sensitive)
   - Diureticrenogram

Question 7

Management of renal calculi

Answer 7

1. Ttt acute renal colic
2. Conservative treatment
3. Surgical management
   a) Extracorporeal shock wave lithotripsy (ESWL)
   b) Percutaneous nephrolithotomy (PCNL)
   c) Open surgery
4. Metabolic work up to decrease recurrence

Question 8

Treatment of acute renal colic?

Answer 8

1. Parentral analgesics:
2. NSAID
3. Anti-emetics & IV fluids
4. Ab

Question 9

Conservative treatment when..

Answer 9

A) Small renal stones < 5mm
B) No evidence of back pressure effect C) No evidence of infection
D) No evidence of distal obstruction

Question 10

Extracorporeal shock wave lithotripsy (ESWL) idea?

Answer 10

Generate shock waves outside body & deliver to stones through coupling media(water cushion) using X-ray/ ultrasonic imaging

Question 11

ESWL indication & CI

Answer 11

1. Indications
   - Stones <2cm
2. Contraindications
   - uncorrected bleeding disorders
   - uncorrected hypertension
   - untreated UTI
   - pregnancy
   - Distal obstruction

Question 12

ESWL advantages & complication

Answer 12

1. Advantages:
   - noninvasive technique

2. Complications
– Transient attacks of hematuria 
– Failure to disintegrate stone
– UTI
– UT obs by stone fragments

Question 13

Percutaneous nephrolithotomy (PCNL) idea?

Answer 13

Create track from skin to pelvicalyceal system under fluoroscopic/ us control Track dilated to accommodate nephroscope then stone removed through sheath

Question 14

PCNL indi & CI?

Answer 14

1. Indications:
   - stones >2cm
   - Hard stones (cystine, COM)
   - Failure of ESWL
   - Stag horn stones
2. Contraindications:
   - Uncorrected coagulation disorder
   - Untreated UTI
   - Uncontrolled HTN

Question 15

PCNL adv & comp?

Answer 15

1. Advantages:
   - Small endoscopic wound
   - Mild postoperative pain
   - Short hospital stay
2. Complications:
   - Bleeding
   - Injury adjacent organs(colon spleen pleura)
   - Residual stones

Question 16

Open surgery for renal calculi

Answer 16

Indi in CI to ESWL & PCNL

Question 17

Management of ureteral calculi

Answer 17

1. Ttt of acute renal colic
2. Conservative treatment
3. Surgical management
   a) ESWL
   b) Ureteroscopy (URS)
   c) Open surgery
4. Metabolic work up to decrease recurrence

Question 18

Surgical indicate in?

Answer 18

a) Evidence of back pressure effect
b) Evidence of secondary infection
c) Failure of conservative treatment
d) Persistent pain

Question 19

Ureteroscopy idea?

Answer 19

Urteroscope passed through ureteric orifice & pass up in ureter. When stone visualized it removed

Question 20

Ureteroscopy comp?

Answer 20

• Perforate/ avulsion ureter
• Infection
• Migrate stone to kidney
• Ureteric stricture later on as a result of ureteral injury