Stones In Urology

In urology, three types of stones are present

  1. Renal stones
  2. Ureteric stones
  3. Bladder stones
 
 
Types Of Stones
  • Oxalate stones
    • Composed of calcium oxalate
    • Hard, black / brown in colour (Due to RBC break down)
    • Irregular in shape
    • Covered with spiky projections which can cause bleeding
    • Radio-opaque
    • Symptoms are produced early 
    • Up to 5mm in diameter ; the stone will come out spontaneously
  • Phosphate stones (Staghorn calculi)
    • Composed of triple phosphate (Calcium and magnesium phosphate, ammonium) 
    • Smooth, dirty white 
    • Radio-opaque 
    • Formed in alkaline urine (Proteus)
    • Follows a silent course 
  • Uric acid and urate calculi
    • Hard, smooth and often multiple
    • Yellow to brown in colour
    • Radiolucent 
  • Cystine stones
    • Occurs in patients with cystinuria 
    • Radio-opaque
    • Appears in acidic urine
    • Pink or yellow colour ; After exposure to air become greenish in colour
  • Xanthine stones
    • Brick red in colour
    • Lamellated on cross section 

Causes Of Renal And Ureteric Stones
  1. Idiopathic
  2. Dietary
    • Low fluid intake
    • High protein 
    • High uric acid (Gout, chemotherapy)
  3. Urinary stasis
    • Due to obstruction or stricture
  4. Chronic infection 
    • By urease producing organisms – Proteus 
  5. Prolonged immobility
    • Spinal injury, paraplegia
  6. Metabolic
    • Hyperparathyroidism, idiopathic hypercalciuria 
  7. Dehydration 


Causes Of Bladder Stones

  1. Voiding dysfunction
    • BPH, urethral stricture
  2. Foreign body 
  3. Diverticula 



Presentation Of Stones

Renal Stones
Ureteric Stones
Bladder Stones
1. Can be asymptomatic
2. Renal colic
      Dull aching loin pain
      Anteriorly in the                          hypochondriac region
5. Haematuria
6. Nausea, vomiting

7. Renal angle tenderness

1. Can be asymptomatic
2. Ureteric colic
       Severe, agonizing, colicky,         stabbing pain passing from         loin to groin
        Radiation….
            Mid ureter : Groin
            Lower ureter : Scrotum
            VU junction : Tip of                  penis, labia majora
3. Haematuria
4. Nausea, vomiting

5. Iliac fossa tenderness (Calculus in the distal ureter)

1. Can be asymptomatic
2. Strangury
       Pain on micturation
       At the end of micturation
       Referred to the tip of the             penis
3. Suprapubic pain
4. Frequency of micturation
5. Incomplete emptying
6. Intermittent bladder out flow      obstruction

7. Haematuria



Conservative Management Of Stones

* If the stone is ≤ 6mm – Conservative measures can be done

* If the patient is having one kidney – Cannot go for conservative management

  1. Bed rest
  2. Plenty of oral fluids 
  3. If vomiting – IV fluids are given 
  4. Antiemetics
  5. Analgesics 
    • Declofenac 100mg 
    • Pethidine 70mg IM 
  6. If fever and suspicious of infection, antibiotics are given
 
 
Investigations Done For Stones
  1. Complete blood count
  2. Urine full report 
  3. Urine C/S
  4. X-Ray KUB region
    • 90% of renal stones are radio-opaque 
  5. Ultrasound of KUB region
  6. Non contrast CT scan (Gold standard)
  7. Intravenous urogram 
 
 
Treatment Of Stones
 
Renal Stones
Ureteric Stones
Bladder Stones
1. ESWL (Extra-coporeal              shockwave lithotripsy)
2. Ureteroscopy and intra-              corporeal lithotripsy
3. Surgery
      Ureterolithotomy
      Pyelolithotomy

      Nephrolithotomy

Upper 1/3rd
1. ESWL (Extra-coporeal              shockwave lithotripsy)
2. Ureteroscopy and intra-              corporeal lithotripsy
3. Surgery
      Ureterolithotomy
      Pyelolithotomy

      Nephrolithotomy

 
Middle 1/3rd
1. Ureteroscopy and intra-              corporeal lithotripsy
2. Surgery
Ureterolithotomy
 
Lower 1/3rd
1. Ureteroscopy and intra-              corporeal lithotripsy
2. Dormia basket extraction
3. Surgery

Ureterolithotomy

1. Litholapaxy

2. Cystolithotripsy

ESWL (Extra-coporeal shockwave lithotripsy)


It uses shock waves to break a kidney stone into small pieces that can more easily travel through the urinary tract and pass from the body

Non invasive
No anaaesthesia
May need multiple rounds of treatment


Contraindications 

  1. Stones of the lower ureter (Can fracture the pelvis)
  2. Urosepsis 
  3. Pregnancy
  4. Coagulopathy
  5. Renal artery aneurysm / Abdominal aortic aneurysm
 
Complications
  1. Infection 
  2. Renal hematoma
  3. Obstruction of ureter by fragments 
  4. Renal or adjacent organ damage




Double J Stent / Ureteric Stent / Pigtail Stent

It is a thin tube that is inserted into the ureter to prevent or treat obstruction of the urine flow from the kidney.

Inserted by the help of a cystoscope
One or both ends of the stent may be coiled to prevent it from moving out of place


Prevention Of Recurrence Of Stones

  1. Drink plenty of fluids (2500mL)
  2. Correct metabolic abnormalities
  3. Treatment of infection 
  4. Urine alkalization 
    • NaHCO3 : 5 – 10gm daily, orally
    • Cystine and uric acid stones 
  5. Thiazide diuretics 
    • For idiopathic hypercalciuria
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prometricmcqq
1 year ago

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