• Stones in urinary tract is a common disorder.
• Type of stones:
1- Calcium Oxalate & Calcium phosphate :
– Most common type.
– Radio-opaque stone.
– Due to either:
– Increase Ca absorption or decrease Ca renal reabsorption ÞÝ Calcium in urine.
2- Uric acid:
-Defect in uric acid metabolism e.g.
Gout & After cancer chemotherapy.
– Infection stone.
– Composed of Amm. Mg. Ph. and Ca .
Cystinuria is a congenital defect.
Symptoms of Urolithiasis
• Loin pain.
• Nausea & Vomiting.
Investigations of Urolithiasis
• Urinalysis: for Increase RBCs & WBCs.
• Intravenous Urogram (IVU).
• Helical CT.
Management of Urolithiasis
1- Conservative Treatment of Stones:
• Pain killers.
• Hydration (IV fluids)
• Hospital admission
• If < 5mm allow to pass spontaneously.
2- Extra-corporeal Shock-Wave Lithotripsy:
(ESWL ) shock waves travel through water & directed at stone site to break it.
Double – J ureteric stent:
Introduced through cystoscope to help ureter
dilate & pass stone fragments after ESWL.
3- Percutaneous nephrolithotomy: (PCNL)
with X-ray or US guidance needle is passed to renal pelvis then nephroscope is passed to break stone.
5- Open surgery: to remove large or difficult stones.
6- Ureteroscope: to break & remove ureteric stones using Dormia basket.
• Ultrasound lithotripter.
• Electrohydraulic lithotripter (EHL).