UROLITHIASIS

Hatim alnosayan

INTRODUCTION

• Prevalence 2% to 3%.

• Peak age group 20 – 40 yrs

• Life time risk: M > F.

• Recurrence rate 50% at 10 yrs.

• 90% of the stones are radio opaque.

RISK FACTORS

• Genetics.

• Age.

• Sex

• Geography.

• Diet

• occupation

WHY DO STONES FORM ?

• Chronic fluid deprivation

• Increased excretion of salt

• Change in PH.

• Reduction of inhibitors of stone formation ( citrate as complexing calcium ).

• Stasis.

• Foreingn bodies.

• idiopathic

TYPE OF STONES

•Calcium stone.• Ca oxalate.

• Ca phosphate.

• Non – calcium stones

• Uric acid.

• Cystine.

• Struvite.

• Mesclanous.

• Calcium oxalate:

• Most common ( 75%).

• Hypercalciuria.

• Dark brown.

• Sharp projection.

• Radio opaque.

• Struvite stone:

• Triple phosphate.

• Infectious.

• Alkaline urine.

• Radio opaque

• Asymptomatic.

• Uric acid stone:

• 5 – 10% of stones.

• Low ph.

• Cystine stone:

• Only 1 – 2 %.

• Caused by genetic defect in renal reabsorption of amine acids.

CLINICAL FEATURES

• Flank pain.

• Hematuria.

• Urinary urgency and frequency.

• Nausea and vomiting.

• Fever & chills.

• Asymptomatic.

DIFFERENTIAL DIAGNOSIS

• Urological :

• Pyelonephritis.

• Stricture, tumour, renal infarction.

• Non – urological :

• Appendicitis.

• Diverticulitis.

• Ectopic pregnancy.

• Ruptured AAA.

• Biliary colic.

INVESTIGATIONS

• To confirm the diagnosis:

• Urine analysis.

• X ray KUB.

• Uss/ IVU/ CT.

• To find the aetiology:

• Analysis the stone.

• S. ca, s. uric acid.

• To look for complications

• S. crea, CBC

MANAGEMENT

• Treatment options:

• Conservative.

• ESWL.

• Ureteroscopy.

• PCNL.

• Open surgery.

MANAGEMENT

how you are goning to take deceision to treat stone patients?

• Stone burden . Most important

• Stone location.

• The anatomy of urinary tract.

• Availability of Rx.

• Pt wish.

CONSERVATIVE MANAGEMENT

• Small stones < 5 mm.

• Pain controlled.

• Absence of renal failure or sepsis.

• Analgesia.

• Alpha blocker.

• Review and ensure stone has passed.

EXTRA CORPOREAL SHOCK WAVE LITHOTRIPSY

• Renal pelvis and upper ureter stone.

• Non invasive & no need for anaesthesia.

• Need multiple sessions.

• Stone size < 1.5 cm.

PCNL

• Larg stone > 2cm or staghorn

• Ureteric stenosis ( PUJ obstruction ).

OPEN SURGERY

ADVICE TO PATIENT WITH RECURRENT STONE

• Treat the cause.

• Plenty of water.

• Limit red meat.

• Avoid calcium supplement.

• Avoid excess salt, milk product.

• Optemize co morbidities.

THANK YOU