Transcript Urinary Calculus Disease

Renal Tract Stones
Angelika Na
Renal tract stones
 10% of Caucasian men by age 70
 Recurrence
 10% in 1 year, 50% in 10 year
 Risk factors
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Age 20-50
Male, genetics (RTA, cystinuria)
Summer
Water intake
Diet
Occupation
Renal tract stones
 Composition
 Calcium oxalate (85% of all renal calculi)
 HyperCa eg. hyperPTH, Paget’s dx
 Uric acid (5-10%)
 Gout, myeloproliferative disorder
 Calcium phosphate + calcium oxalate (10%)
 RTA
 Calcium phosphate (rare)
 Struvite (infection stones - 2-20%)
 Cystine (1%)
 Cystinuria
Renal tract stones
 XR
 Radio-opaque
 Calcium phosphate, calcium oxalate
 Radiolucent
 Relative - cystine (sulphur), struvite
 Complete - uric acid, triamterene, xanthine,
indinavir
 Size & shape
 Staghorn calculi
Kidney stones
 Pain, haematuria
 UTIs (staghorn, struvite)
 Pyonephrosis, perinephric abscess,
septic, pyelonephritis
 Flank pain
Kidney stones - Mx
 Watchful waiting
 <5 mm (20%), 5-10mm (25%), 11-15 mm (40%),
>15 mm (30%) will require intervention
 ESWL
 <1 cm (80%), 1-2 cm (60%), >2 cm (50%) stone
free rates.
 Flexible ureteroscopy + laser
 <2 cm (80%), >2 cm (50%); 10% pt require >2tx
 PCNL + lithotripsy
 80-90% stone free rates.
 Open surgery (nephrolithotomy)
 Medical mx
Ureteric stones - Clinical
 Renal colic - loin to groin
 Uncomfortable, doubled-up with pain,
n&v
 Fever - BC, IV fluids + Abx,
nephrostomy
 Pregnancy test
 Dipstick + MSU
 FBE, UEC, Ca, Uric acid
Differential Diagnosis
 AAA
 Pyelonephritis
 Appendicitis
 Ovarian pathology
 Biliary pathology
Ureteric stones - Radiology
 CT KUB
 XR KUB -? radioopaque
 (IVP)
 MR KUB
XR KUB
CT KUB
Ureteric stones - Mx acute
 Analgesia - NSAID, opiate
 Fluid
 Watchful waiting - stone size
 <4 mm - 90% pass spontaneously
 4-6 mm - 50%
 >6 mm - 20%
 Medical mx - tamsulosin
Ureteric stones - Surgical mx
 Indications
 Pain, bacteriuria, fever, impaired Cr,
prolonged unrelieved obstruction, social
 Solitary kidney, bilateral stones
 Temporary relief of the obstruction
 Percutaneous nephrostomy
 JJ stent - SE: bladder irritation
Ureteric stones - Surgical mx
 Definitive mx
 (position of stones)
 Ureteroscopy
 ESWL ( JJ stent)
 PCNL
 Ureterolithotomy (open, lap)
 Percutaneous antegrade ureteroscopy
Bladder stones
 Composition
 Struvite (infection), uric acid
 Age
 Men > 50yo, BPH
 Long term IDC / SPC
 Children - low phosphate diet
 Clinical
 Asymptomatic (sc patients) - XR, US
 Haematuria, urgency, UTIs, LUTS
 Mx
 Cystolitholapaxy (endoscopic, open)
Renal tract stones
 Treat underlying cause
- Hyperparathyroidism - parathyroidectomy
- Hyperuricosuria - allopurinol + urine
alkalinisation
- Homocysteinuria - D-penicillamine
 Prevention
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Fluid intake
Calcium
Proteins
Wine
Oxalate