Renal Stones

Question 1

What are renal stones also called

Answer 1

Urolithiasis

Question 2

Lifetime risk for males renal stones

Answer 2

1:8

Question 3

Stones more common in

Answer 3

Men over 30

Question 4

Women peak for renal stones

Answer 4

35

Question 5

Chance of stone recurrence is what within 10 years

Answer 5

50%

Question 6

Most common type of renal stone

Answer 6

Calcium Oxalate 45%

Question 7

Symptoms and Signs of Renal Stone

Answer 7

Renal Pain
Ureteric Colic (Radiate to groin)
Dysuria
Haematuria
Testicular or Vulval Pain
Urinary Infection
Loin Tender
pyrexia

Question 8

Tests for Renal Stone

Answer 8

Bloods: FBC, U+E, Creatinine
Calcium, Albumin, Urate
Parathormone
Urine Analysis
24 hr Urine Collection
KUB Scan
Ultrasound
IVU
CT KUB
CT KUB Urogram

Question 9

indications for surgery in renal stones

Answer 9

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

Question 10

Techniques for Surgery for renal stones

Answer 10

Endoscopic
ESWL
PCNL
Open

Question 11

Open surgery in renal stones recurrence rate

Answer 11

Least recurrence rate out of all procedures

Question 12

Indications for open surgery for renal stones

Answer 12

Non functioning infected kidney with large stones necessitating nephrectomy.

Cases which for technical reasons cannot be managed by PCNL or ESWL.

Question 13

Indications for Simple Partial or Total Nephrectomy in Renal Stones

Answer 13

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

Question 14

Indications for PCNL in Renal Stones

Answer 14

Large stone burden (risk of Steinstrasse)

Associated PUJ stenosis.

Infundibular stricture.

Calyceal diverticulum.

Morbid obesity or skeletal deformity.

ESWL resistant stones e.g. Cystine.

Lack of availability of ESWL.

Question 15

What type of renal stones is resistant to ESWL

Answer 15

Cystine

Question 16

PCNL does it need contrast

Answer 16

yes and ultrasound or x-ray

Question 17

Contraindications for PCNL for renal stones

Answer 17

Uncorrected coagulopathy.

Active Urinary Tract Infection.

Obesity or unusual body habitus unsuitable for X-ray tables.

Relative contraindications include small kidneys and severe perirenal fibrosis.

Question 18

Complications of PCNL in renal stones

Answer 18

Pelvic Tear most common
Ureteral Tear
Stricture of PUJ
Pseudoaneurysm or AV Fistula

Question 19

What treatment is common first line treatment for renal and ureteric stones

Answer 19

ESWL

Question 20

When is ESWL not first line treatment for renal or ureteric stones

Answer 20

> 2cm
Lower Pole Stones
Cystine Stones

Question 21

When is open surgery suitable for ureteric stones

Answer 21

Failed ESLW or Ureteroscopy

Question 22

Indications for Rigid Ureteroscopy for Ureteric Stones

Answer 22

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

Question 23

Complications of Ureteroscopy minor

Answer 23

Haematuria, fever, small ureteric perforation, minor vesico-ureteric reflux.

Question 24

How do Bladder Stones present

Answer 24

Suprapubic/Groin/Penile Pain
Dysuria
Frequency
Haematuria
Persistent UTI
Sudden interruption of Stream

Question 25

Bladder stones are usually secondary to

Answer 25

outflow obstruction