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urinary > Urolithiasis > Flashcards

Urolithiasis Flashcards

1
Q

Which gender is most likely to get urolithiasis

A

younger males

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2
Q

What is the most common cause of urological emergency admission

A

Renal colic

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3
Q

What is renal colic

A

Pain that may occur when a stone becomes lodged in your urinary tract

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4
Q

What are symptoms and signs of urolithiasis

A

Renal pain - back flank and groin
Ureteric colic
Dysuria
Haematuria
Testicular or vulval pain
UTI
tender loin
Pyrexia

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4
Q

What are the most common types of stone

A

Calcium oxalate is the most common type of mineral in the stones

calcium phosphate is also common

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5
Q

What is ureteric colic

A

Pain radiating to the groin

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6
Q

What are investigations done for urolithiasis

A

Blood tests - full blood count, U&E, creatinine, calcium, albumin, urate, parathormone

urine analysis

Radiological investigations - KUB, ultrasound

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7
Q

What cannot be seen in ultrasound for urinary system

A

Ureters as they are very retroperitoneal so have many structures in front of them

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8
Q

Why can stones be seen on
X-ray

A

Because they are made up of calcium usually

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9
Q

Why is removal of kidney stones such a delicate procedure

A

The kidney is well vascularised so the blood vessels have to be avoided

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10
Q

What are the indications for surgical treatment of urolithiasis

A

obstruction, recurrent gross haematuria , recurrent pain and infection , progressive decrease in GFR and what their occupation is

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11
Q

What surgery technique is most common for removal of stones

A

Endoscopic surgery

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12
Q

What are the advantages and disadvantages of open surgery for renal stone removal

A

advantage - single procedure with low recurrence rate

Disadvantage - large scar with long hospital stay and a long recovery

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13
Q

What are indications for open surgery

A

Non functioning infected kidney with large stones which needs a nephrectomy

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14
Q

What is a pyelolithotomy

A

Removal of a renal stone from the renal pelvis

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15
Q

What are staghorn stones

A

Formed by infection of the kidneys and forms in the shape of the collecting system

16
Q

What is PCNL

A

Percutaneous nephrolithotomy

17
Q

What are the indications for PCNL

A

Large stone burden
PUJ stenosis
Morbid obesity

18
Q

Describe Percutaneous nephrolithotomy

A

Catheter is passed up into the kidney collecting system
A contrast is used, and the collecting system is dilate enough to break up the stone

19
Q

What guides a percutaneous access

A

Ultrasound or xray

20
Q

What are the contraindications for PCNL

A

uncorrected coagulopathy
Active uti
Obesity or an unsuitable body for X-ray tables

21
Q

What are the complications of PCNL

A

pseudoaneurysm or AV fistula

Pelvic or ureteral tear
PUJ stricture

Injury to adjacent organs - bowel and lungs

Could cause infection like sepsis

22
Q

What does ESWL stand for

A

Extracorporeal shock wave lithotripsy

23
Q

What happens in ESWL

A

The stones are too large to pass through the renal pelvis
The ESWL shock waves the stones which crushes them allowing the smaller pieces to pass out into the urine

X-ray or ultrasound is used to guide where to place the shockwaves

24
Q

What is the first line of treatment for renal and ureteric calculi

A

ESWL - extracorporeal shockwave lithotripsy

25
Q

When is ESWL not indicated

A

If stones are bigger than 2cm

If there have already been 2 failed attempts

Stones are made up of cystine which is hard to break down

26
Q

What are the indications for open ureterolithotomy

A

The patient is not suitable for laparascopic approach

Patient has had a failed ESWL or ureteroscopy

27
Q

What are the indications for ureteroscopy

A

Severe obstruction, uncontrollable pain, persistent haematuria

28
Q

What ureteroscope is the standard instrument for treating lower ureteric stones

A

Rigid

urinary (24 decks)

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