Surgical Management of Stones

Question 1

Imaging prior to stone treatment

Answer 1

CT prior to PCNL or to choose between SWL and URS
Mag3 if indicated
Contrasted imaging if necessary
Re-image after MET if stone pass suspected

Question 2

Lab testing prior to stone treatment

Answer 2

UA, UCx if indicated
CBC and platelets prior to PCNL or concern
BMP

Question 3

Ureteral stone treatment

Answer 3

<10mm - MET and treat if no passage in 4 weeks
URS has highest SFR, ESWL an option
URS recommended for cystine or uric acid
Have a flexible ureteroscope available

Question 4

Should stents be placed routinely for SWL

Answer 4

no

Question 5

When can stent be omitted for URS

Answer 5

no ureteral injury, no stricture, no residual fragments, normal contralateral kidney

Question 6

Renal stone treatment

Answer 6

Observe non-obstructing stones
<10mm lower pole = SWL or URS
>10mm lower pole = PCNL or URS
Non-lower pole <20mm = SWL or URS
>20mm = PCNL (NOT SWL)
Nx if crap kidney

Question 7

PCNL nuances

Answer 7

flexible nephroscopy
NT optional
Saline irrigation
Counsel re: bleeding risk
Alternative is staged URS

Question 8

Pediatric stone treatments

Answer 8

<10mm ureteral = observation/MET
URS or SWL for ureteral stones if needed
>20mm = PCNL or SWL (stented)