UROLITHIASIS Hatim alnosayan. INTRODUCTION Prevalence 2% to 3%. Prevalence 2% to 3%. Peak age group...
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Transcript of UROLITHIASIS Hatim alnosayan. INTRODUCTION Prevalence 2% to 3%. Prevalence 2% to 3%. Peak age group...
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