kidney stones

Question 1

types of stone

Answer 1

calcium oxalate (40%)
calcium oxalate and phosphate 25%
triple phosphate (infective) struvite 20%
uric acid

Question 2

symptoms and signs

Answer 2

renal pain, severe intermittent loin pain that radiates to groin
ureteric colic
dysuria
haematuria (microscopic or macroscopic)
nausea and vomiting
urinary infection
pyrexia

Question 3

investigations

Answer 3

FBC, U+E, creatinine
KUB scan (CT)- first line

calcium, albumin, urate
parathyoridhormone
urine analysis and culture
24hr urine
US
IVU

Question 4

when surgery for stones

Answer 4

recurrent haematuria
recurrent pain and infection
obstruction
occupation
progressive loss of kidney function

Question 5

treatment

Answer 5

Extracorporal shock wave lithotripsy- ESWL first line. try twice then try something else, makes stones smaller, only works for stones smaller than 2 cm, not cystine (resistant)

percutaneous nephrolithotomy- PCNL guided by US or XR

open surgery if cant do anything else

Question 6

ureteric stones

Answer 6

ureteroscopy- uteroscope, lithoclast, holmium laser
open surgery if not suitable

haematuria, fever, ureteric perforation, reflux, ureteric necrosis

Question 7

bladder stones signs, symptoms, treatment, cause

Answer 7

suprapubic groin penile pain
dysuria frequency and haematuria
UTI persistent

endoscopically treated or open excision if large
usually secondary to blkadder outflow obstruction