Urolithiasis

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• 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:

-Radiolucent stone.

-Defect in uric acid metabolism e.g.

Gout & After cancer chemotherapy.

3- Struvite:

– Infection stone.

– Composed of Amm. Mg. Ph. and Ca .

4- Cystine:

Cystinuria is a congenital defect.

Stone Formation

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Symptoms of Urolithiasis

• Loin pain.

• Nausea & Vomiting.

• Dysuria.

• Frequency.

• Haematuria.

• Fever.

Investigations of Urolithiasis

• Urinalysis: for Increase RBCs & WBCs.

• KUB.

• Ultra-sound.

• Intravenous Urogram (IVU).

• Helical CT.

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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.

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Double – J ureteric stent:

Introduced through cystoscope to help ureter

dilate & pass stone fragments after ESWL.

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3- Percutaneous nephrolithotomy: (PCNL)

with X-ray or US guidance needle is passed to renal pelvis then nephroscope is passed to break stone.

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5- Open surgery: to remove large or difficult stones.

− Nephrolithotomy.

− Pyelolithotomy.

− Ureterolithotomy.

− Cystolithotomy.

6- Ureteroscope: to break & remove ureteric stones using Dormia basket.

• Ultrasound lithotripter.

• Electrohydraulic lithotripter (EHL).

• Lithoclast.

• Laser.

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