Urolithiasis Flashcards

1
Q

What is the relative incidence of stones?

A

2-3%
More males than females 3:1
Peak age in men is 30 years
Chance of stone recurrence is 50% in 10 years

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2
Q

What is the common stone types?

A

Calcium oxalate most common
Calcium oxalate + phosphate, triple phosphate (infective), calcium phosphate, uric acid and cystine

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3
Q

What are the symptoms and signs of stones?

A

Renal pain (loin), ureteric colic (radiating to groin), dysuria/ haematuria/ testicular or vulva pain, urinary infection, loin tenderness and pyrexia

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4
Q

What investigations are done fore stones?

A

Blood tests - FBC, U+Es and creatinine
Calcium, albumin and urate
PTH
Urine analysis and culture
24hr urine collection

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5
Q

What radiology is used to investigate stones?

A

KUB - kidney, bladder and ureter
US
IVU
CT-KUB/ Urogram

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6
Q

What are the indications for surgical treatment?

A

Obstruction
Recurrent gross haematuria
Recurrent pain and infection
Progressive loss of kidney function
Patient occupation

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7
Q

What are the techniques for surgical treatment?

A

Open surgery (very rare)
Endoscopic surgery
ESWL

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8
Q

What is the advantages and disadvantages for open surgery for renal stone treatment?

A

Advantage - single procedure with least recurrence route
Disadvantage - large scar, long hospital stay, general wound complications and longer recovery

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9
Q

What are the indications for open surgery?

A

Non-functioning infected kidney with large stones necessitating nephrectomy
Cases which for technical reasons cannot be managed by PCNL or ESWL

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10
Q

When is a simple and total nephrectomy used?

A

Non-functioning kidney with large staghorn stones or elderly frail patients with complex stones and normal contralateral kidney

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11
Q

What are the specific indications for Percutaneous nephrolithotomy (PCNL)?

A

Large stone burden, associated PUJ stenosis, infundibular stricture, calyceal diverticulum, morbid obesity or skeletal deformity, ESWL resistant stones and lack of ESWL availability

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12
Q

What does a PCNL include?

A

Guide wire
Retrograde catheter or balloon catheter
Contrast

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13
Q

How is a percutaneous abscess treated?

A

Renal puncture
Guided by US or X-ray

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14
Q

What are some contraindications for PCNL?

A

Uncorrected coagulopathy, active UTI, obesity or unusual body habitus unsuitable for X-ray tables, small kidneys and severe perirenal fibrosis

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15
Q

What are some complications of PCNL?

A

Local - pseudoaneurysm or AV fistula and UT injury (pelvic tear, ureteral tear and stricture)
Injury to adjacent organs
Systemic - fever, sepsis and MI

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16
Q

Explain extracorporeal shock wave lithotripsy (ESWL)

A

Simple stones which are too large to pass through - shock waves crush stones
Smaller pieces pass out of body in urine

17
Q

When are ESWL used in treatment?

A

Commonly used for renal and ureteric calculi as first line treatment
Newer generation lithotripters cause less pain
Can be repeated as often as required

18
Q

When is ESWL ineffective in treatment?

A

> 2cm stones and lower pole stones
Ineffective for treating cystine stones
If not effective after 2 treatments then further treatment is not justified

19
Q

What are the indications for open ureterolithotomy?

A

Not suitable for laparoscopic approach
Failed ESWL or ureteroscopy

20
Q

What are the indications for ureteroscopy?

A

Severe obstruction, uncontrolled pain, persistent haematuria, lack of progression, failed ESWL and patient occupation

21
Q

What instrument is used for treating lower ureteric stones?

A

Rigid ureteroscope

22
Q

What is used for surgery for ureteric/ renal stones?

A

Flexible ureteroscopes
Flexible lithoclast
Holmium laser

23
Q

What are some complications of ureteroscopy?

A

Minor - haematuria, fever, small ureteric perforation and minor ureteric reflux
Major - minor ureteric perforation, ureteric avulsion, ureteral necrosis and stricture formation

24
Q

What are the symptoms for bladder stones?

A

Suprapubic, groin or penile pain, dysuria, frequency, haematuria, UTI persistent, sudden interruption of urine stream and strangury

25
Q

How are most bladder stones treated?

A

Endoscopically
Larger can be treated by open excision