Urology - Urolithiasis: Ix And Mx Flashcards Preview

Year 3- Surgery > Urology - Urolithiasis: Ix And Mx > Flashcards

Flashcards in Urology - Urolithiasis: Ix And Mx Deck (11)
Loading flashcards...
1
Q

Ix: Urine and blood

A
  • Urine: dip for haematuria and MC+S, may need a 24h collection to try and assess how to avoid recurrence
  • Blood: FBC, U+E, Ca, PO4, urate
2
Q

Ix: imaging (not including IVU)

A
  • KUB XR: 90% of stones are radio opaque (urate radiolucent and cysteine faint)
  • USS: look for hydronephrosis
  • Spiral non contract CT KUB: gold standard, 99% of stones visible
3
Q

Ix: imaging - IVU (and contra indications)

A
  • Intravenous urogram: IV contrast injected and immediate serial films taken until contrast reaches level of obstruction (much more radiation than KUB XR)
  • CIs: contrast allergy, renal failure, severe asthma, metforming, pregnancy
4
Q

Urolithiasis: initial Rx

A
  • Analgesia (NSAIDs allowed): diclofenac or opioids (pethidine)
  • Fluids: IV if unable to tolerate PO
  • ABX if infection: contact micro/local trust policy
5
Q

Urolithiasis: Rx - conservative (<5mm in lower 1/3 of ureter)

A
  • 90-95% pass spontaneously
  • can discharge pt with analgesia
  • sieve urine to collect stone for OPD analysis
6
Q

Urolithiasis: Rx - Medical expulsion therapy (MET)

A
  • Indications: stone 5-10mm and expected to pass

- Drugs: Nifedipine or tamsulosin +/- prednisolone

7
Q

Rx: active stone removal - indications

A
  • Low likelihood of spontaneous passage (>10mm)
  • Persistent obstruction
  • Renal insufficiency
  • infection
8
Q

Rx: active stone removal - Extracorporeal shockwave lithotripsy (SWL)

A
  • Stones <20mm in kidney or proximal ureter
  • SE: may cause renal injury and raise BP
  • CI: pregnancy, AAA, bleeding diathermy
9
Q

Rx: active stone removal - other options

A
  • Ureterorenoscopy
  • Percutaenous nephrolithotomy (PNL)
  • lap or open surgery: rare
10
Q

Rx: active stone removal - surgical emergency

A
  • When pt is febrile with renal obstruction
  • needs percutaneous nephrostomy or stent
  • IV ABX
11
Q

Rx: active stone removal - summary

A
  • Conservative if stone <5mm in distal ureter
  • MET if stone 5-10mm and expected to pass
  • Active if stones >10mm, persistent pain and renal insufficiency

Decks in Year 3- Surgery Class (54):