This document provides information about renal calculi (kidney stones). It begins with an overview of kidney anatomy and blood supply. It then discusses the causes, risk factors, types, and clinical presentation of renal calculi. The main types of stones are calcium oxalate, phosphate, uric acid, cysteine, and xanthine. Clinical features include flank pain, hematuria, and pyuria. Investigation involves urine analysis, blood tests, ultrasound, CT scan, IV pyelogram, and retrograde pyelogram. The document outlines the most common and sensitive imaging modalities for detecting and characterizing renal calculi.
This document summarizes a presentation on renal stone disease. It discusses the anatomy of the kidneys and nephrons, stages of stone formation, types of stones including calcium oxalate and uric acid stones, investigations for stones, and medical and surgical management options. It notes that calcium oxalate is the most common stone type, occurring in over 75% of cases. Dietary and metabolic factors that can promote stone formation like hypercalciuria and hyperoxaluria are also outlined.
Metabolic evaluation and medical management of urolithiasis aims to prevent recurrent stone formation and complications. It should be simple, economically viable, and provide targeted treatment. Patients at high risk for recurrence include those with family history, intestinal diseases, or anatomical abnormalities. Evaluation includes history, blood tests, urine tests, imaging and stone analysis to identify metabolic derangements. Treatment is tailored based on stone composition and includes increased fluid intake, dietary modifications, and medications to correct underlying causes and reduce stone risk factors.
Urolithiasis pathophysiology , medical management Banda Gopal
This document discusses the pathophysiology and medical management of urolithiasis. It covers calcium metabolism and factors affecting calcium absorption. It then discusses the different types of stones including calcium, struvite, uric acid, and cystine stones. For each type, it outlines the underlying causes and medical management strategies. Conservative measures include diet modifications and increasing fluid/citrate intake, while medications used include thiazides, citrate supplements, allopurinol, and others to treat specific metabolic abnormalities causing stone formation. Imaging techniques for evaluating stones and indications for metabolic stone evaluation are also reviewed.
Metabolic evaluation of urinary lithiasis 2Praveen Ganji
This document discusses the metabolic evaluation of urinary lithiasis (kidney stones). It outlines the diagnostic evaluation process, including use of stone analysis and imaging to determine stone composition. An abbreviated protocol is described for low-risk first-time stone formers, while a more extensive evaluation is recommended for recurrent stone formers and those at high risk of recurrence. The economics of metabolic evaluation are discussed, noting the high costs of stone treatment but also the costs of testing. Finally, different classifications of nephrolithiasis based on underlying metabolic abnormalities are presented along with diagnostic criteria.
This document discusses the evaluation and management of urinary stones. Key points include:
- Clinical history is important to determine type of pain, risk factors, and if it is a first-time or recurrent stone.
- NCCT is the preferred initial imaging test for evaluation of suspected renal or ureteral stones.
- Conservative management involves increased fluid intake of at least 3 liters per day, a low-sodium diet moderate in animal protein and high in fruits/vegetables, and weight loss if overweight.
- For recurrent stone formers, a metabolic evaluation can identify underlying causes and guide targeted medical therapy like potassium citrate for calcium stones.
- Small distal ureteral stones
Benign prostatic hyperplasia (BPH) is a common condition in aging men that involves enlargement of the prostate gland. It often causes bothersome lower urinary tract symptoms (LUTS) such as frequent urination and weak urine flow. BPH-LUTS refers to these urinary symptoms linked to an enlarged prostate. Treatment involves medications like alpha-blockers and 5-alpha-reductase inhibitors to shrink the prostate and relieve symptoms. For men with larger prostates or those where medications fail, surgery such as transurethral resection of the prostate (TURP) may be considered, though it carries risks like incontinence or sexual side effects.
Kidney Stone By Dr ANIL KUMAR, Associate Professor( AIIMS-Patna)Anil Kumar
The document discusses renal calculi (kidney stones). It provides details on the anatomy of the kidney, causes of renal stones including risk factors, types of stones, clinical presentation, investigations and management. The main types of stones are calcium oxalate, phosphate, uric acid, cystine, and xanthine stones. Investigations include urine analysis, imaging like ultrasound, CT and IVU. Management depends on stone size and includes conservative measures, extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and open surgery.
Chyluria is a condition characterized by the presence of chyle or fatty lymph in the urine, causing it to appear milky white. It is most commonly caused by filarial infections in parts of Africa and India. The condition results from obstruction or insufficiency of the lymphatic system, causing retrograde flow of lymph into the urinary tract. Diagnosis involves urine tests to detect triglycerides and lymph. Treatment options include medication to treat underlying causes, sclerotherapy to scar lymphatic vessels, and surgery such as lymphatic disconnection or lymph node-vein anastomosis if more conservative treatments fail.
This document summarizes a presentation on renal stone disease. It discusses the anatomy of the kidneys and nephrons, stages of stone formation, types of stones including calcium oxalate and uric acid stones, investigations for stones, and medical and surgical management options. It notes that calcium oxalate is the most common stone type, occurring in over 75% of cases. Dietary and metabolic factors that can promote stone formation like hypercalciuria and hyperoxaluria are also outlined.
Metabolic evaluation and medical management of urolithiasis aims to prevent recurrent stone formation and complications. It should be simple, economically viable, and provide targeted treatment. Patients at high risk for recurrence include those with family history, intestinal diseases, or anatomical abnormalities. Evaluation includes history, blood tests, urine tests, imaging and stone analysis to identify metabolic derangements. Treatment is tailored based on stone composition and includes increased fluid intake, dietary modifications, and medications to correct underlying causes and reduce stone risk factors.
Urolithiasis pathophysiology , medical management Banda Gopal
This document discusses the pathophysiology and medical management of urolithiasis. It covers calcium metabolism and factors affecting calcium absorption. It then discusses the different types of stones including calcium, struvite, uric acid, and cystine stones. For each type, it outlines the underlying causes and medical management strategies. Conservative measures include diet modifications and increasing fluid/citrate intake, while medications used include thiazides, citrate supplements, allopurinol, and others to treat specific metabolic abnormalities causing stone formation. Imaging techniques for evaluating stones and indications for metabolic stone evaluation are also reviewed.
Metabolic evaluation of urinary lithiasis 2Praveen Ganji
This document discusses the metabolic evaluation of urinary lithiasis (kidney stones). It outlines the diagnostic evaluation process, including use of stone analysis and imaging to determine stone composition. An abbreviated protocol is described for low-risk first-time stone formers, while a more extensive evaluation is recommended for recurrent stone formers and those at high risk of recurrence. The economics of metabolic evaluation are discussed, noting the high costs of stone treatment but also the costs of testing. Finally, different classifications of nephrolithiasis based on underlying metabolic abnormalities are presented along with diagnostic criteria.
This document discusses the evaluation and management of urinary stones. Key points include:
- Clinical history is important to determine type of pain, risk factors, and if it is a first-time or recurrent stone.
- NCCT is the preferred initial imaging test for evaluation of suspected renal or ureteral stones.
- Conservative management involves increased fluid intake of at least 3 liters per day, a low-sodium diet moderate in animal protein and high in fruits/vegetables, and weight loss if overweight.
- For recurrent stone formers, a metabolic evaluation can identify underlying causes and guide targeted medical therapy like potassium citrate for calcium stones.
- Small distal ureteral stones
Benign prostatic hyperplasia (BPH) is a common condition in aging men that involves enlargement of the prostate gland. It often causes bothersome lower urinary tract symptoms (LUTS) such as frequent urination and weak urine flow. BPH-LUTS refers to these urinary symptoms linked to an enlarged prostate. Treatment involves medications like alpha-blockers and 5-alpha-reductase inhibitors to shrink the prostate and relieve symptoms. For men with larger prostates or those where medications fail, surgery such as transurethral resection of the prostate (TURP) may be considered, though it carries risks like incontinence or sexual side effects.
Kidney Stone By Dr ANIL KUMAR, Associate Professor( AIIMS-Patna)Anil Kumar
The document discusses renal calculi (kidney stones). It provides details on the anatomy of the kidney, causes of renal stones including risk factors, types of stones, clinical presentation, investigations and management. The main types of stones are calcium oxalate, phosphate, uric acid, cystine, and xanthine stones. Investigations include urine analysis, imaging like ultrasound, CT and IVU. Management depends on stone size and includes conservative measures, extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and open surgery.
Chyluria is a condition characterized by the presence of chyle or fatty lymph in the urine, causing it to appear milky white. It is most commonly caused by filarial infections in parts of Africa and India. The condition results from obstruction or insufficiency of the lymphatic system, causing retrograde flow of lymph into the urinary tract. Diagnosis involves urine tests to detect triglycerides and lymph. Treatment options include medication to treat underlying causes, sclerotherapy to scar lymphatic vessels, and surgery such as lymphatic disconnection or lymph node-vein anastomosis if more conservative treatments fail.
This document provides an overview of urinary lithiasis (kidney stone disease) including its epidemiology, etiology, pathogenesis, and classification. Some key points:
- Kidney stone disease prevalence has been increasing globally due to westernization and is most common in middle-aged adults.
- Stones form when urine becomes supersaturated, allowing crystals to nucleate and grow. Inhibitors normally prevent this but may be insufficient in stone formers.
- Calcium stones are most common and result from hypercalciuria in many cases. Other stone types include uric acid, struvite, and cystine stones.
- Multiple dietary, medical, and genetic factors influence stone risk by affecting urine
This document discusses urethral strictures, which are narrowings of the urethra caused by scarring. It covers the anatomy and epidemiology of urethral strictures and their various causes including iatrogenic, traumatic, inflammatory, and idiopathic factors. Diagnostic tests like retrograde urethrography and treatments options are outlined, including dilation, direct vision internal urethrotomy, and urethroplasty surgery. Urethroplasty is considered the gold standard treatment but has the highest success rate for short, simple strictures.
This document defines interstitial cystitis (IC) and bladder pain syndrome (BPS) as chronic bladder pain and discomfort perceived to be related to the urinary bladder. It discusses the epidemiology, etiology, signs and symptoms, diagnosis, and treatment of IC/BPS. Regarding treatment, it emphasizes conservative therapies like behavioral modification, physical therapy, and oral medications first before more invasive options like intravesical therapies, cystoscopy, neuromodulation, or in rare cases, surgery. The goal is to avoid surgery if possible and use multiple simultaneous treatments for best outcomes.
Priapism is a prolonged, unwanted erection that continues hours beyond sexual stimulation. There are two main types: ischemic (low-flow) priapism which is painful and involves little blood flow out of the penis, and non-ischemic (high-flow) priapism which is painless and involves an abnormal connection allowing high arterial inflow. Ischemic priapism is a medical emergency requiring aspiration of blood from the penis and injection of medications to induce detumescence within 4-6 hours to prevent permanent erectile dysfunction. Treatment options depend on duration and include aspiration, intracavernosal injections of medications, or surgical shunting if conservative measures fail.
Priapism is a prolonged, often painful erection unrelated to sexual stimulation. The document defines and discusses the types, causes, pathophysiology, epidemiology, and treatment challenges of priapism. Specifically, it distinguishes between ischemic (low-flow) priapism caused by failure of venous outflow, and nonischemic (high-flow) priapism caused by unregulated arterial inflow. Sickle cell disease and medications are common causes and prolonged ischemia can lead to erectile dysfunction due to corporal fibrosis.
1. Injury to the ureter is a serious complication that can result in high morbidity and potential loss of renal function.
2. The ureter is most commonly injured during gynecological or abdominal surgeries, though trauma from blunt force or penetrating injuries can also cause damage.
3. Diagnosis of ureteral injury relies on imaging like CT scans and retrograde ureterography to identify signs of extravasation or deviation, though hematuria alone is a poor indicator.
This document provides an overview of the evaluation and management of ureteric stones. It discusses the typical signs and symptoms of ureteric stones including flank pain radiating to the groin. Imaging options like ultrasound, KUB, CT are outlined. Treatment depends on factors like stone size and location, and may include pain control, conservative management, medical expulsive therapy, or active stone removal procedures like ESWL, URS, or PCNL. Prevention emphasizes adequate hydration and dietary modifications.
The document provides information on the surgical anatomy of the kidney and ureter. It discusses the embryology, gross anatomy including orientation and position of the kidneys. It describes the microscopic anatomy including the nephron. It details the coverings of the kidney including the fibrous capsule, perinephric fat, Gerota's fascia and paranephric fat. It outlines the relations of the kidney to surrounding structures like ribs, diaphragm and pleura. It also discusses the blood supply, lymphatic drainage and nerve supply of the kidneys.
Metabolic workup and medical management of urolithiasis aims to prevent recurrent stone formation through identifying underlying causes. The goals are to prevent further stone growth and extrarenal complications. Evaluation involves medical history, blood and urine tests, imaging, and stone analysis to guide targeted therapy. First-line management includes increased fluid intake, dietary modifications like reduced sodium and animal protein, and medications depending on the metabolic abnormality identified, such as thiazides for hypercalciuria. Selective long-term medical management can normalize urinary risk factors and prevent further stone episodes in many patients.
This document provides guidelines for the evaluation and management of hematuria from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It discusses the classification, timing, differential diagnosis, and evaluation of hematuria. The evaluation includes history, physical exam, urinalysis, urine culture if indicated, renal function testing, cystoscopy, and imaging such as CT urogram. The goal of evaluation is to identify any underlying causes of hematuria such as infection or malignancy. Close follow up is recommended depending on the diagnosis and persistence of microscopic hematuria.
The document discusses the management of haematuria in the emergency department. It covers the common causes of haematuria, appropriate investigations in the ED including imaging and labs, goals of treatment focusing on resuscitation, ensuring free urine drainage, safe discharge, and prompt follow up. It provides guidance on managing macroscopic haematuria including bladder washouts and irrigation. Indications for admission or safe discharge are outlined along with special circumstances. Three case examples are presented and management steps discussed.
This document discusses flexible ureterorenoscopy (RIRS) for treating conditions of the kidney and urinary tract. RIRS uses flexible instruments introduced through the ureter to access the kidney in a minimally invasive manner. It has advantages over rigid ureteroscopy like shorter hospital stays and recovery time. The document outlines the history, indications, instrumentation, technique and complications of RIRS. Emerging technologies discussed include digital flexible ureteroscopy, flexible robotic assistance and virtual reconstruction of ureteroscopic views.
1. The document discusses different types of hernias, including inguinal, femoral, umbilical, incisional, and rare types.
2. It provides details on examining patients for hernias, such as observing for visible lumps, checking for cough impulse, and performing reducibility tests.
3. Key factors are described for differentiating between direct and indirect inguinal hernias, as well as differentiating inguinal from femoral hernias based on location and examination findings.
This document discusses nephrolithiasis (kidney stones). It begins with a case of a 78-year-old man who presented with gross hematuria and was found to have a kidney stone. The stone was removed, and analysis showed it was calcium oxalate. The document then reviews epidemiology, natural history, stone formation process, clinical presentation, evaluation, etiologies including calcium, uric acid, struvite and cystine stones, and treatment options including medical management and urological interventions.
This document provides an overview of overactive bladder (OAB). It defines OAB and its main symptoms of urgency, frequency, and nocturia. It discusses the prevalence of OAB increasing with age and being similar between genders. The document outlines the bladder anatomy and physiology, as well as theories around the etiology and pathophysiology of OAB. It describes the diagnosis and clinical evaluation of OAB through medical history, physical exam, urinalysis, and other tests. Finally, it covers treatment approaches for OAB including behavioral modifications, medications, injections, and surgeries.
This document discusses the management of ureteral strictures. It provides details on various endourologic and surgical options for treating ureteral strictures, including balloon dilation, ureteroscopic endoureterotomy, ureteral stenting, ureteroureterostomy, and ureteroneocystostomy. The success rates and approaches for different procedures are described. Postoperative care is also outlined.
Urinary calculi are composed of substances normally found in urine that precipitate out of solution to form stones. The most common types of stones found are calcium oxalate, calcium phosphate, uric acid, and cystine. Risk factors for stone formation include dehydration, diet, medical conditions, and anatomical abnormalities. Management involves dietary changes to reduce stone-forming substances in urine, increased fluid intake, and surgical procedures like ESWL or ureteroscopy for stone removal.
This document discusses the evaluation of urolithiasis (urinary stones). It provides an overview of diagnostic evaluation including history, blood tests, urine analysis, imaging, and stone analysis. It describes the goals and characteristics of metabolic evaluation to prevent recurrent stone formation. Both abbreviated and extensive protocols for metabolic evaluation are outlined, including details on 24-hour urine collection and components analyzed. The roles of various imaging modalities like KUB, ultrasound, and intravenous pyelography are also summarized.
This document discusses renal calculi (kidney stones). It defines renal calculi and reviews the anatomy and physiology of the renal system. It examines the etiology, risk factors, and pathogenesis of renal calculi. It also describes the clinical manifestations, diagnostic studies, medical and surgical management, nursing management including nursing diagnoses, and prevention of renal calculi.
Kidney stones form when dietary minerals in urine become concentrated enough to crystallize. They are typically classified by location and chemical composition, with calcium salts and uric acid being most common. Risk factors include diet, medical conditions, and family history. Stones form through supersaturation when urine is too concentrated for minerals to remain in solution. Symptoms include flank pain, nausea, and blood in urine. Diagnosis involves history, physical exam, and imaging tests like ultrasound or CT. Treatment focuses on resolving underlying causes and preventing stone recurrence.
This document provides an overview of urinary lithiasis (kidney stone disease) including its epidemiology, etiology, pathogenesis, and classification. Some key points:
- Kidney stone disease prevalence has been increasing globally due to westernization and is most common in middle-aged adults.
- Stones form when urine becomes supersaturated, allowing crystals to nucleate and grow. Inhibitors normally prevent this but may be insufficient in stone formers.
- Calcium stones are most common and result from hypercalciuria in many cases. Other stone types include uric acid, struvite, and cystine stones.
- Multiple dietary, medical, and genetic factors influence stone risk by affecting urine
This document discusses urethral strictures, which are narrowings of the urethra caused by scarring. It covers the anatomy and epidemiology of urethral strictures and their various causes including iatrogenic, traumatic, inflammatory, and idiopathic factors. Diagnostic tests like retrograde urethrography and treatments options are outlined, including dilation, direct vision internal urethrotomy, and urethroplasty surgery. Urethroplasty is considered the gold standard treatment but has the highest success rate for short, simple strictures.
This document defines interstitial cystitis (IC) and bladder pain syndrome (BPS) as chronic bladder pain and discomfort perceived to be related to the urinary bladder. It discusses the epidemiology, etiology, signs and symptoms, diagnosis, and treatment of IC/BPS. Regarding treatment, it emphasizes conservative therapies like behavioral modification, physical therapy, and oral medications first before more invasive options like intravesical therapies, cystoscopy, neuromodulation, or in rare cases, surgery. The goal is to avoid surgery if possible and use multiple simultaneous treatments for best outcomes.
Priapism is a prolonged, unwanted erection that continues hours beyond sexual stimulation. There are two main types: ischemic (low-flow) priapism which is painful and involves little blood flow out of the penis, and non-ischemic (high-flow) priapism which is painless and involves an abnormal connection allowing high arterial inflow. Ischemic priapism is a medical emergency requiring aspiration of blood from the penis and injection of medications to induce detumescence within 4-6 hours to prevent permanent erectile dysfunction. Treatment options depend on duration and include aspiration, intracavernosal injections of medications, or surgical shunting if conservative measures fail.
Priapism is a prolonged, often painful erection unrelated to sexual stimulation. The document defines and discusses the types, causes, pathophysiology, epidemiology, and treatment challenges of priapism. Specifically, it distinguishes between ischemic (low-flow) priapism caused by failure of venous outflow, and nonischemic (high-flow) priapism caused by unregulated arterial inflow. Sickle cell disease and medications are common causes and prolonged ischemia can lead to erectile dysfunction due to corporal fibrosis.
1. Injury to the ureter is a serious complication that can result in high morbidity and potential loss of renal function.
2. The ureter is most commonly injured during gynecological or abdominal surgeries, though trauma from blunt force or penetrating injuries can also cause damage.
3. Diagnosis of ureteral injury relies on imaging like CT scans and retrograde ureterography to identify signs of extravasation or deviation, though hematuria alone is a poor indicator.
This document provides an overview of the evaluation and management of ureteric stones. It discusses the typical signs and symptoms of ureteric stones including flank pain radiating to the groin. Imaging options like ultrasound, KUB, CT are outlined. Treatment depends on factors like stone size and location, and may include pain control, conservative management, medical expulsive therapy, or active stone removal procedures like ESWL, URS, or PCNL. Prevention emphasizes adequate hydration and dietary modifications.
The document provides information on the surgical anatomy of the kidney and ureter. It discusses the embryology, gross anatomy including orientation and position of the kidneys. It describes the microscopic anatomy including the nephron. It details the coverings of the kidney including the fibrous capsule, perinephric fat, Gerota's fascia and paranephric fat. It outlines the relations of the kidney to surrounding structures like ribs, diaphragm and pleura. It also discusses the blood supply, lymphatic drainage and nerve supply of the kidneys.
Metabolic workup and medical management of urolithiasis aims to prevent recurrent stone formation through identifying underlying causes. The goals are to prevent further stone growth and extrarenal complications. Evaluation involves medical history, blood and urine tests, imaging, and stone analysis to guide targeted therapy. First-line management includes increased fluid intake, dietary modifications like reduced sodium and animal protein, and medications depending on the metabolic abnormality identified, such as thiazides for hypercalciuria. Selective long-term medical management can normalize urinary risk factors and prevent further stone episodes in many patients.
This document provides guidelines for the evaluation and management of hematuria from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It discusses the classification, timing, differential diagnosis, and evaluation of hematuria. The evaluation includes history, physical exam, urinalysis, urine culture if indicated, renal function testing, cystoscopy, and imaging such as CT urogram. The goal of evaluation is to identify any underlying causes of hematuria such as infection or malignancy. Close follow up is recommended depending on the diagnosis and persistence of microscopic hematuria.
The document discusses the management of haematuria in the emergency department. It covers the common causes of haematuria, appropriate investigations in the ED including imaging and labs, goals of treatment focusing on resuscitation, ensuring free urine drainage, safe discharge, and prompt follow up. It provides guidance on managing macroscopic haematuria including bladder washouts and irrigation. Indications for admission or safe discharge are outlined along with special circumstances. Three case examples are presented and management steps discussed.
This document discusses flexible ureterorenoscopy (RIRS) for treating conditions of the kidney and urinary tract. RIRS uses flexible instruments introduced through the ureter to access the kidney in a minimally invasive manner. It has advantages over rigid ureteroscopy like shorter hospital stays and recovery time. The document outlines the history, indications, instrumentation, technique and complications of RIRS. Emerging technologies discussed include digital flexible ureteroscopy, flexible robotic assistance and virtual reconstruction of ureteroscopic views.
1. The document discusses different types of hernias, including inguinal, femoral, umbilical, incisional, and rare types.
2. It provides details on examining patients for hernias, such as observing for visible lumps, checking for cough impulse, and performing reducibility tests.
3. Key factors are described for differentiating between direct and indirect inguinal hernias, as well as differentiating inguinal from femoral hernias based on location and examination findings.
This document discusses nephrolithiasis (kidney stones). It begins with a case of a 78-year-old man who presented with gross hematuria and was found to have a kidney stone. The stone was removed, and analysis showed it was calcium oxalate. The document then reviews epidemiology, natural history, stone formation process, clinical presentation, evaluation, etiologies including calcium, uric acid, struvite and cystine stones, and treatment options including medical management and urological interventions.
This document provides an overview of overactive bladder (OAB). It defines OAB and its main symptoms of urgency, frequency, and nocturia. It discusses the prevalence of OAB increasing with age and being similar between genders. The document outlines the bladder anatomy and physiology, as well as theories around the etiology and pathophysiology of OAB. It describes the diagnosis and clinical evaluation of OAB through medical history, physical exam, urinalysis, and other tests. Finally, it covers treatment approaches for OAB including behavioral modifications, medications, injections, and surgeries.
This document discusses the management of ureteral strictures. It provides details on various endourologic and surgical options for treating ureteral strictures, including balloon dilation, ureteroscopic endoureterotomy, ureteral stenting, ureteroureterostomy, and ureteroneocystostomy. The success rates and approaches for different procedures are described. Postoperative care is also outlined.
Urinary calculi are composed of substances normally found in urine that precipitate out of solution to form stones. The most common types of stones found are calcium oxalate, calcium phosphate, uric acid, and cystine. Risk factors for stone formation include dehydration, diet, medical conditions, and anatomical abnormalities. Management involves dietary changes to reduce stone-forming substances in urine, increased fluid intake, and surgical procedures like ESWL or ureteroscopy for stone removal.
This document discusses the evaluation of urolithiasis (urinary stones). It provides an overview of diagnostic evaluation including history, blood tests, urine analysis, imaging, and stone analysis. It describes the goals and characteristics of metabolic evaluation to prevent recurrent stone formation. Both abbreviated and extensive protocols for metabolic evaluation are outlined, including details on 24-hour urine collection and components analyzed. The roles of various imaging modalities like KUB, ultrasound, and intravenous pyelography are also summarized.
This document discusses renal calculi (kidney stones). It defines renal calculi and reviews the anatomy and physiology of the renal system. It examines the etiology, risk factors, and pathogenesis of renal calculi. It also describes the clinical manifestations, diagnostic studies, medical and surgical management, nursing management including nursing diagnoses, and prevention of renal calculi.
Kidney stones form when dietary minerals in urine become concentrated enough to crystallize. They are typically classified by location and chemical composition, with calcium salts and uric acid being most common. Risk factors include diet, medical conditions, and family history. Stones form through supersaturation when urine is too concentrated for minerals to remain in solution. Symptoms include flank pain, nausea, and blood in urine. Diagnosis involves history, physical exam, and imaging tests like ultrasound or CT. Treatment focuses on resolving underlying causes and preventing stone recurrence.
This presentation provides an overview of kidney stones, including their incidence, types, causes, symptoms, diagnosis, and treatment. Kidney stones, also called renal calculi, form when substances in urine crystallize and harden. The most common types are calcium and uric acid stones. Risk factors include dehydration and family history. Symptoms include flank pain and blood in the urine. Diagnosis involves tests of urine and imaging of the kidneys. Treatment focuses on pain relief, increasing fluid intake, and sometimes surgical procedures to break up or remove stones.
This document discusses renal calculi (kidney stones). It begins by stating that renal stones are a frequent disorder that occur more commonly in males and can run in families. The main causes of stone formation include increased concentrations of stone constituents in urine, decreased urine flow, and absence of substances that inhibit stone formation. The most common types of stones are calcium oxalate, calcium phosphate, magnesium ammonium phosphate, uric acid, and cystine. Risk factors for different stone types and the clinical presentation, diagnosis, and complications of kidney stones are also summarized.
Appendicitis PPT By Dr Anil Kumar,Assist Prof( Gen Surgery) AIIMS, PatnaAnil Kumar
This document provides an overview of the anatomy, pathology, clinical presentation, diagnosis, and treatment of acute appendicitis. It discusses the typical location and size of the appendix. It describes the causes, signs, and symptoms of appendicitis, as well as diagnostic tools like the Alvarado score. Treatment involves antibiotics, analgesia, and an appendectomy within 24 hours if indicated. Complications of appendicitis and appendectomy are also reviewed.
The document describes the anatomy and physiology of the urinary tract and kidney, risk factors and types of kidney stones, and methods for diagnosing and treating stones, including increasing fluid intake, altering diet, using medications to change urine composition, and surgically removing stones with procedures like ureteroscopy and lithotripsy. Kidney stones form when substances like calcium, oxalate, and uric acid become supersaturated in the urine and crystallize into solid masses.
This document discusses urolithiasis (kidney stones). It begins by defining urolithiasis and noting its prevalence and cost. It then covers the epidemiology, types, symptoms, diagnosis, and management of kidney stones. The main points are that kidney stones can form anywhere in the urinary tract, have a lifetime risk of 2-20% depending on location, and are most commonly treated through active medical expulsion or minimally invasive surgeries like ESWL or ureteroscopy. Surgical intervention is indicated for large or obstructing stones, infection, or if conservative measures fail.
PPT by Dr Anil Kumar, Assitant Professor, AIIMS,Patna on Anal Fissure & Fistu...Anil Kumar
This document provides information on the anatomy, physiology, examination, and common conditions of the anal canal. It begins with an overview of the gross anatomy of the anal canal, including the three zones, anal sphincter muscles, blood supply and development. Common conditions like anal fissure and fistula-in-ano are then discussed in detail, outlining their causes, types, clinical features and management options. Both conservative and surgical treatment approaches are covered for anal fissure and various surgical procedures for fistula-in-ano such as fistulotomy and seton placement.
Urinary Stone Management [Dr. Edmond Wong]Edmond Wong
This document discusses the evaluation and treatment of kidney stones. It begins by outlining the typical workup, which includes imaging tests like CT scans, renal function tests, and metabolic workups of blood and urine. Various treatment options for kidney stones are then reviewed, including extracorporeal shockwave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL), and various surgical procedures. Risk factors, epidemiology, specific stone types and underlying factors are also discussed.
Dokumen tersebut membahas tentang urolithiasis atau batu ginjal dan saluran kemih. Secara ringkas, dokumen menjelaskan definisi, klasifikasi, etiologi, insidensi, faktor risiko, epidemiologi, gejala klinik, komplikasi, dasar diagnosis, pemeriksaan penunjang, dan diagnosis banding dari kondisi tersebut.
This document discusses renal calculi (kidney stones) and bladder calculi. It defines both conditions and explains their pathophysiology, types, causes, clinical manifestations, investigations, medical and surgical management, nursing process, and preventive strategies. The main points are that kidney and bladder stones form when minerals crystallize in the urine, calcium oxalate is the most common type of kidney stone, symptoms include pain and hematuria, and treatment involves increasing fluid intake, analgesics, surgery if needed, and addressing underlying causes.
The Lumenis Pulse 120H laser platform provides 120W of power for holmium laser procedures including prostate vaporization, kidney stone treatment, and flexible ureteroscopy. It features improved energy delivery to tissue with the new Xpeeda side-firing fiber, pulse shaping technology for better hemostasis, and integrated suction capabilities. Users report minimal bleeding, fast procedure times, and good post-operative outcomes with the Lumenis system across various urology applications.
Kidney Hospitals in India – Laparoscopic Surgery, Lithotripsy Centre, Dialysi...Dinesh Patel
Devasya Kidney Hospital provides information on kidney disease, protection, and treatment. Chronic kidney disease means the kidneys are less able to filter wastes from the blood and may lead to failure requiring dialysis or transplant. Type 2 diabetes and high blood pressure are the most common causes. The hospital has advanced laparoscopic and lithotripsy centers, a dialysis center, and other facilities for kidney care. It is located in Ahmedabad and was the first in India to use advanced laser technology for prostate procedures.
This document discusses different anaesthetic options for lithotripsy procedures to break up kidney stones. It begins by providing background on kidney stone prevalence and treatments such as lithotripsy. It then describes various lithotripsy techniques and considerations for the procedure. The main anaesthetic choices for lithotripsy are discussed in detail, including benefits and drawbacks of options like conscious sedation, monitored anaesthesia care, general anaesthesia, regional techniques like spinal or epidural anaesthesia, and intravenous analgesia with sedation. Patient factors and the lithotripsy device used help determine the most appropriate anaesthetic approach.
This document discusses urinary calculi (kidney stones) and nephrolithiasis (renal stones). It defines these terms and discusses their etiology, pathophysiology, clinical manifestations, diagnosis, and management. Common causes include hyperparathyroidism, increased calcium levels, uric acid, and diet or fluid intake issues. Symptoms include abdominal or back pain, hematuria, and dysuria. Diagnosis involves history, imaging like x-rays, and urine/blood tests. Treatment depends on stone size and location but may include increased fluid intake, pain management, dietary changes, shockwave lithotripsy, or surgery. Nursing care focuses on pain relief, urinary elimination, health education,
- Extracorporeal shockwave lithotripsy (ESWL) uses shockwaves to fragment kidney stones noninvasively. It was discovered in the 1980s during military research.
- ESWL uses different generators (electrohydraulic, electromagnetic, piezoelectric) to focus shockwaves on stones. Ultrasound and fluoroscopy are used for imaging. Stone fragmentation occurs through mechanisms like spall fracture and squeezing.
- While usually low risk, ESWL can potentially cause acute extrarenal or renal injuries. Chronic risks include higher blood pressure and stone recurrence. Techniques like adequate anesthesia and coupling aim to optimize outcomes.
This document discusses staghorn calculi, which are large infection stones that fill the renal pelvis and calyces. It covers the etiology, pathogenesis, epidemiology, clinical presentation, evaluation, and various treatment modalities for staghorn calculi. The primary treatment is percutaneous nephrolithotomy (PCNL), which has stone-free rates of around 80% but risks include injury to adjacent organs and sepsis. Other options include extracorporeal shockwave lithotripsy, ureteroscopy, open surgery, dissolution therapy, antibiotics, urease inhibitors, urinary acidification, and dietary modification, but PCNL generally provides the best chance of complete stone clearance.
This document summarizes the medical management of renal calculi (kidney stones). It discusses risk factors, diagnostic evaluation including imaging and urine tests, conservative and pharmacological approaches, and surgical management options. The conservative approach involves increased fluid intake while pharmacological agents include thiazide diuretics, citrate, and allopurinol depending on the identified metabolic abnormality. Surgical interventions for stones include shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy.
The document discusses the diagnosis and treatment of kidney stones in the emergency department, noting that kidney stones are a common cause of flank pain that can be diagnosed using computed tomography imaging. It explores the risk factors, types, and pathophysiology of kidney stone formation as well as the appropriate management of pain and potential complications of obstruction. Differential diagnoses that can mimic kidney stones are also reviewed to guide emergency physicians in properly evaluating patients presenting with acute flank pain.
Lithotripsy uses externally generated shock waves to disintegrate kidney stones into smaller granules that can pass through urine. It is a common alternative to surgery for treating kidney stones, offering advantages like no incisions or lengthy hospital stays, though some discomfort may occur. The document outlines how lithotripsy works, who should not receive it, and what patients experience during the procedure.
This document discusses renal calculi (kidney stones). It begins with an overview of kidney anatomy and blood supply. It then discusses the causes, risk factors, and types of kidney stones. The main types are calcium oxalate, phosphate, uric acid, cysteine, and xanthine stones. The document outlines the clinical presentation of kidney stone symptoms like flank pain, hematuria, and infection. It provides details on diagnostic tests for stones including urine analysis, radiography, ultrasound, CT, IV pyelogram, and nuclear medicine scans. Treatment options like ESWL, PCNL, and surgery are also briefly mentioned.
This document provides an overview of urolithiasis (kidney stones). It discusses the epidemiology, classification, pathogenesis, clinical features, investigations, treatment modalities, complications, and prevention of kidney stones. Treatment depends on the location and size of the stone and includes extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, ureteroscopy, and open surgery. The goal is to remove stones while minimizing complications such as infection, obstruction, and loss of renal function. Prevention focuses on adequate fluid intake, dietary modifications, and medical management for certain stone types.
The document discusses urinary tract stones (calculi) including their formation, types, symptoms, diagnosis, and treatment. Key points:
- Stones form when urinary concentrations of minerals like calcium, oxalate, and uric acid increase.
- Symptoms include sharp pain (renal colic) radiating from the back to the groin as stones pass through the urinary tract.
- Diagnosis involves imaging tests like CT scans, X-rays, and ultrasounds to detect radiopaque stones.
- Treatment depends on stone size but may include shock wave lithotripsy, ureteroscopy, or open surgery to remove stones. Recurrence rates after treatment remain high.
The document discusses urinary tract problems including kidney and bladder diseases. It outlines various urinary symptoms and disorders such as oliguria, polyuria, nocturia, dysuria, enuresis, urinary incontinence, hematuria, and kidney stones. Diagnosis involves physical examination, urine analysis, imaging tests like ultrasound, IVU, CT, and 24-hour urine collection. Treatment depends on the underlying cause but may include pain medication, increased fluid intake, and surgical removal of stones or tumors.
This document provides information on urinary tract stones (urolithiasis), including:
- The types and locations of stones including nephrolithiasis, ureterolithiasis, and cystolithiasis.
- Common causes or risk factors for stone formation including diet, dehydration, infection, and genetic factors.
- Clinical features associated with stones in the kidneys, ureters, and bladder.
- Imaging techniques used to detect stones such as radiography, intravenous urography, CT, and ultrasound.
- Treatment approaches including medical expulsive therapy, shockwave lithotripsy, ureteroscopy, and open surgery.
This document provides an overview of renal stones (nephrolithiasis). It discusses the anatomy of the kidneys, types of stones, risk factors and pathophysiology. Symptoms include flank pain and hematuria. Diagnosis is typically made using non-contrast CT. Treatment depends on stone size and location, and may include conservative management, extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), or ureteroscopic stone removal (URS). Surgical procedures aim to break up or remove stones to allow passage. Complications can include bleeding, infection, and injury to surrounding structures.
continuation on the urinary tract disorders. congenital and acquired disorders well covered. pyelonephritis also forms part of the text. thanks for reading. remeber to like and follow
The document discusses various disorders of the genitourinary system including urological obstructions, disorders of the kidney, and disorders of the ureters, urinary bladder and urethra. It covers the etiology, risk factors, clinical presentation, diagnostic evaluation, and management of various conditions like urethral strictures, renal calculi, nephrotic syndrome, acute glomerulonephritis and more. Nursing management is also described which involves monitoring vitals, intake/output, administering medications as ordered, and educating patients.
This document provides information about renal calculi (kidney stones). It begins with objectives for understanding renal calculi and applying nursing care. It then covers anatomy and physiology of the kidney, risk factors for kidney stones, types of stones, clinical manifestations, diagnostic tests, medical and surgical management, nursing diagnoses, and patient education topics like diet. The overall goal is to equip nurses with knowledge of renal calculi to properly assess, diagnose, and care for patients experiencing this condition.
urolithasis.pptx for medical purposes...GokulnathMbbs
This document discusses urinary tract stones (urolithiasis). It defines different types of stones including nephrolithiasis, ureterolithiasis, and cystolithiasis. It covers the etiology of stone formation including dietary factors, dehydration, infection, and genetic conditions. Types of stones like calcium oxalate, struvite, cystine and uric acid are described. Clinical features, investigations, and management options for kidney stones, ureteric stones and bladder stones are summarized. Treatment includes conservative measures, shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and open surgery.
Heyria Hussien's document discusses various non-traumatic urologic emergencies including hematuria, renal colic, urinary retention, acute scrotum, Fournier's gangrene, and priapism. It provides details on the presentation, diagnosis, and management of each condition. Hematuria is discussed in depth including causes, evaluation, and treatment depending on severity and origin. Renal colic caused by kidney stones is described as a common urologic emergency presenting with severe flank pain. Urinary retention can be acute or chronic, with acute retention requiring immediate catheterization. Acute scrotum requires prompt evaluation to differentiate potentially life-threatening testicular torsion from other conditions like epid
This document discusses urolithiasis, or kidney stones. It begins by introducing kidney stones as the third most common pathology after UTIs and prostate issues. It then covers the pathogenesis, risk factors, classifications, varieties, clinical features, evaluations, and treatments of kidney stones. Key points include that calcium stones make up 70-80% of cases, struvite and cystine stones are also common, risk factors include diet, fluid intake, family history, and medical conditions. Evaluations involve urinalysis, imaging like ultrasound or CT, and stone analysis. Treatments depend on stone location and size, with drainage for infected or obstructed cases.
Urolithiasis refers to the formation of stones in the urinary tract. Kidney stones are the most common type and risk factors include male sex, age 30-50 years old, genetic predisposition, diet high in purines/oxalates/calcium, and low water intake. Stones form when urine becomes supersaturated with minerals that precipitate into crystals. The majority are calcium-based, while others contain uric acid, struvite, or cystine. Clinical features range from asymptomatic to severe flank pain. Diagnosis involves urinalysis, radiography, and sometimes urine culture. Treatment depends on stone size but may include increased fluid intake, medications, extracorporeal shockwave lithot
Urolithiasis is a common disease that is estimated to
produce medical costs of $2.1 billion per year in the United States alone.
Renal colic affects approximately 1.2 million people
each year in USA and accounts for approximately 1% of
all hospital admissions.
Most active emergency departments (EDs) manage
patients with acute renal colic every day.
1. Urolithiasis refers to the formation of stones in the urinary tract, which can occur anywhere from the kidneys to the urethra. The document discusses the clinical approach to urolithiasis with a focus on etiology, pathogenesis, clinical features, investigations, medical and surgical management based on Ayurveda and modern medicine.
2. Evaluation involves history, physical exam, lab tests of urine and blood, and imaging modalities like ultrasound, CT, IVU. Management depends on stone size, location and includes conservative measures, medical expulsive therapy, extracorporeal shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, and
This presentation provides an overview of kidney stones, including their incidence, types, causes, symptoms, diagnosis, and treatment. It discusses how stones form when urine becomes supersaturated, outlines the most common types (calcium, uric acid, struvite), and associated risk factors like dehydration. Symptoms include flank pain and painful urination. Diagnostic tests include urine tests and imaging. Treatment involves pain relief, increased fluid intake, and sometimes surgical procedures like lithotripsy to break up stones.
This document provides information about the urinary system organs and kidneys. It discusses the kidneys' location and internal structures, including the renal cortex and medulla. It describes how urine flows from the kidneys to the ureters and bladder. Imaging modalities for visualizing the urinary system are also mentioned, as well as common anatomical variations, abnormalities, and pathologies seen in the kidneys.
Brief description of genitourinary system-related disorders with their nursing management. This presentation involves glomerulonephritis, nephrotic syndrome, acute renal failure, and renal calculi.
Renal calculi, or kidney stones, form when minerals and salts crystallize and stick together in the kidneys. Kidney stones affect 1 in 11 people in the United States and can cause sharp, severe pain as they move through the urinary tract. Treatment depends on the size and location of the stone and may involve increased fluid intake to pass small stones, medications to treat infections or alter urine chemistry, or surgical procedures like lithotripsy to break up larger stones. Nursing care focuses on pain management, monitoring urine output, educating patients on preventative measures like fluid intake and diet changes, and checking for complications.
The kidney develops from the metanephros and the ureter sprouts from the mesonephric duct. The kidneys are retroperitoneal organs located on either side of the vertebral column. Due to the presence of the liver, the right kidney is slightly lower. Kidney stones are commonly calcium oxalate and cause pain radiating to the groin or testes. Symptoms include renal colic, hematuria, and recurrent urinary tract infections. Complications can include hydronephrosis, pyonephrosis, and renal failure if stones are large and bilateral.
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Renal stone by Dr Anil Kumar, Assistant Professor, AIIMS-Patna
1. RENAL CALCULI
Dr Anil Kumar
Assistant Professor
Department of Surgical Disciplines
All India Institute of Medical Sciences, Patna
2. OBJECTIVE
• Anatomy of Kidney
• Causes of Renal Stones
• Types of Renal Stones
• Management of Renal Stones.
• ESWL, PCNL & Operative concept in Brief.
3. ANATOMY
• Length – 10 to 13 cm
• Width- 5 to 7.5 cm
• Thickness- 2 to 2.5 cm
• Weight – 150 to 175 gram
• Left kidney( larger ) > Right kidney
4. ANATOMY:
• Right Kidney: Lower than Left
• From anterior to Posterior: VAU.
• Right Renal Artery crosses posterior to
the IVC.
• Left Renal Vein is longer than Right.
17. RANDALL’S PLAQUE
Soft tissue calcification found
in the deep renal medulla-
skirting the surface of the
epithelium of the Papilla,
where they act as nucleating
elements for renal stones
18. PATHOPHYSIOLOGY
•Slow urine flow, resulting in supersaturation of
the urine with the particular element that first
become crystallized and later become stone
21. STONES:
Primary Stones
In healthy urinary tract without
any antecedent inflammation.
Formed in acid urine.
Usually consist of calcium
oxalate, uric acid, urates,
Cystine, xanthine or calcium
carbonate.
Secondary Stones
Are usually formed as the
result of inflammation.
Urine is usually alkaline as
urea splitting organism are
most often the causative
organisms.
e.g Triple phosphates
stones
22. TYPES OF RENAL STONES
• Calcium oxalate – Mc Type
• Phosphate stone
• Uric acid
• Xanthine
• Cysteine
23. TYPES OF RENAL CALCULUS:
• Calcium Oxalate: MC type of Kidney stone(85%)
• Also called as Mulberry stone
• Shape: Irregular, Hard surface with
sharp projection
• Colour: Brown
• Risk Factors: Hypercalciuria , Hypercalcemia
& Hyperoxaluria.
• Radio dense stone
24. PHOSPHATE CALCULUS:
• Also k/as : Struvite stone .
• Composition: Calcium, Ammonium & Magnesium Phosphate
( Triple Phosphate stone)
• Risk factors: Alkaline urine with Proteus Infection (Infectious stone)
• Surface: Smooth and Dirty white in colour.
• Calculus may enlarge – Fill whole of the collecting system- Staghorn Calculi.
25. PHOSPHATE CALCULUS
• Staghorn Calculi: Usually silent and
may cause progressive destruction
of renal parenchyma.
• Predisposing Factors:
-Women ( More incidence of UTI)
-Foreign Body in the Urinary tract
(Foley’s Catheter)
-Neurogenic Bladder
-BOO.
• Over 10 years of follow up: Incidence of recurrence & UTI is up to 50%
26. URIC ACID STONE
• MC Radiolucent urinary calculi
• Formed in Acidic Urine.
• Hard in consistency, Smooth surface
• Appearance: Multifaceted, Irregular or Rosettes
• Colour: Yellow to reddish brown.
• Diagnosis: Filling defect on excretory Urogram.
27. URIC ACID STONE
• Filling defect on X-Ray- Confirmed by CT Scan.
• Predisposing Factors for Uric Stones
-Gout
-Myeloproliferative disease
-Lesch- Nehan Syndrome.
• Treatment Approach: Low purine diet,
Hydration & Alkalization of urine
-Allopurinol
-Acetazolamide( If PH is < 6.5)
28. CYSTINE CALCULUS:
• Extremely Hard stone
• Found only in Acidic Urine
• Appearance: Hexagonal or Benzene ring
• Predisposing Factors: Cystinuria.
• Treatment Approach: Low methionine diet
-Alkalization of urine
-Cystine complex agent: D-Penicillamine, Alpha-mercaptopropionylglycine(MPG)
Radio-opaque
29. XANTHINE CALCULUS:
• Seen in Xanthinuria
• Extremely Rare stone
• Appearance : Smooth( surface) & Round
• Colour: Brick red
• Cross section: Lamellation.
• High fluid intake with Allopurinol:
(Treatment Approach)
Radiolucent Stone Like
Uric acid
30. CLINICAL FEATURES
• Age: 30-50 years
• Gender: More common in Male( M:F = 4:3)
• Infectious stone – More common in female.
• MC Symptom- Pain ( 75%)
• Haematuria ( calcium oxalate)- Very minimal
• Pyuria.
31. PAIN IN RENAL CALCULI
• Fixed renal pain ( Renal angle)/ Hypochondrium.
• Nature: Excruciating & Cramping Pain.
• Radiation: Along the course of Ureter.( Groin, Penis, Scrotum or labium)
• Severity of pain is not related to the size of stone.
• Pain may be worse on movement( climbing stairs)
• Pain last for less than 8 hours ( In the absence of infection)
32. PAIN IN RENAL CALCULI:
• Pain is almost invariably associated with Hematuria.
• Tachycardia ( Because of pain )
• Rigidity of the Lateral abdominal muscle.
• Tenderness on deep palpation.
• Percussion over kidney: Sudden, sharp & severe pain ( stab like)
33. CLINICAL FEATURES OF RENAL STONE
• Hematuria: minimal
• Pyuria: Renal Stone Infection pressure builds up in dilated
with obstruction collecting system
Septicemia Organism injected into the Circulation
34. DIETL’S CRISIS( INTERMITTENT HDN)
Acute
Renal
Pain
After some
hours
Large volume of
urine is Passed
Pain is
relieved
35. INVESTIGATION: RENAL STONE
• URINE: pH , Microscopic examination( RBC, PUS CELLS & CRYSTALLURIA) & Culture for urea
splitting organism
• Acidic Urine: CCU ( Calcium Oxalate, Cystine & Uric Acid)
• Alkaline Urine: Calcium Phosphate ( Brushite) & Struvite.
• Crystalluria: Calcium oxalate Monohydrate- Dumbbell or Hourglass Appearance
• Struvite – Coffin lid. Uric Acid- Multifaceted, irregular or rosettes
• Cystine- Hexagonal or benzene ring
36. INVESTIGATION: RENAL STONE
• Renal Function Test: Blood urea & Serum Creatinine.
• S . Uric acid level.
• Haemogram.
• Coagulation Profile
• Blood Sugar
37. X-RAY KUB: RENAL STONE
• Kidney stone – looked opposite to second lumbar vertebrae( L2)
• Lateral X-Ray of Abdomen: Gall stones – Anterior to Lumbar spine and renal and
ureteric calculus overlie the lumbar spine.
• 90 % of stones are Radiopaque.
• Radiolucent stones are TIXU: Triamterene ( Antihypertensive drug), Indinavir
(Protease inhibitors) , Xanthine & Uric acid stone.
38. OPACITIES ON PLAIN X-RAY :
CONFUSED WITH RENAL CALCULUS
Calcification of ATM-V
Adrenal Gland
Tuberculous lesion in the kidney
Mesenteric Lymph node
Walls of the Veins ( Pelvis)- Phlebolith
GOAT
Gall stones
Ossified tip of the 12th Rib
Concretion in the Appendix
Tab / Foreign bodies in the alimentary
canal(Cyclopenthiazide)/ Navidrex
41. IVP:INTRAVENOUS PYELOGRAM
• is an x-ray examination of the kidneys,
ureters and urinary bladder that uses
iodinated contrast material injected
into veins.
Immediately- Renal Blush of cortex area
At 3 minutes- Diminished renal blush with
Delineation of calyces and renal pelvis
At 9-15 minutes – Contrast emptied into
Ureter & bladder.
42. IVP: EARLY FILM ( 1 MIN & 5 MIN) & DELAYED
FILM
Non-
functioning left
kidney
45. RETROGRADE PYELOGRAM:
• Dye is injected directly into the ureter rather than into vein.
• Better delineation of anatomy of Kidney & Ureter.
• Very useful if distal ureter is not visualized.
• Exclude ureteric calculi and allow assessment of ureteric stricture.
• Cystoscopy with RP: Detect most of the pathology.
47. RADIONUCLIDE EVALUATION:
• DMSA ( Dimercaptosuccinic acid): Renal Morphology( Scarring )
First inject the DMSA into vein that enter- Kidney
second ( after 2-4 hours) Take image by
gamma camera
• DTPA( Diethylene Triamine Pentacetic Acid):
Assess Perfusion & Function
Less effective than MAG-3
• MAG-3 ( Mercapto-acetyl glycine ): Best for Renal
Perfusion.
DMSA
49. MAG-3: OBSTRUCTED LEFT KIDNEY
MAG3 -
demonstrated the
obstructed left
kidney at the level of
the ureteropelvic
junction with
28ml/min
renographic
clearance, which
represented 38% of
the total renal
function.
50. MANAGEMENT OF RENAL CALCULUS
• Conservative Treatment(4-6 weeks): Indication
• Single stone < 5 mm.
• Ureter is undilated.
• Stone in lower third of ureter.
• Evidence of downward movement.
• Fluid intake : Most important as well as first
step
51. MANAGEMENT OF RENAL CALCULUS:
CONSERVATIVE
• For Cystine, Calcium oxalate & Uric acid stone
• Increase fluid Intake
• Alkalization of Urine: Potassium citrate/ Sodium bicarbonate
• Urinary PH: 6.5-7.0
• For Uric Acid: Allopurinol 300 mg QID
• For Cystine: D-Penicillamine & Alpha – Mercaptopropionyleglycine
52. RENAL CALCULUS
• Avoid animal protein: Meat, chicken & Egg
• Take low salt diet.
• High Fibre diet
• Weight Reduction.
• Tamsulosin- alpha -1 blockers ( Flowmax) : 0.4 mg for 7-10 days:
• Nifedipine: CCB: May be beneficial.
53. SURGICAL INTERVENTION: RENAL
CALCULUS
• ESWL ( Extracorporeal Shock Wave Lithotripsy)
• PCNL ( Percutaneous Nephrolithotomy)
• URS ( Ureteroscopy)
• Lap Stone Removal
• OSS ( Open Stone Surgery)
OSS: Indication:
1.Anatomical abnormality(PUJO)
2. Non functioning kidney with stone
( Nephrectomy)
Types:
1. Pyelolithotomy
2.Extended Pyelolithotomy
3. Nephrolithotomy
4.Partial Nephrectomy
54. STONE & SURGERY OF CHOICE
• Stone < 2 cm: ESWL
• Stone > 2 cm : PCNL
• Staghorn Calculi: PCNL + ESWL
• Initial approach is PCNL , followed by ESWL.
• 80-85% of simple renal calculi : Treated satisfactorily with ESWL.
55. ESWL:
• Principle: Bombarding of stones with High energy shock waves to disintegrate the
stones into fragments- small fragments pass down to ureter.
• Localization of stone for bombarding – Fluoroscopy or USG
• Physics of ESWL: The change in density b/w the soft renal tissue & hard stone
causes release of energy at the stone surface which causes “ Compression induced
tensile cracking of stone“.
• Incoming Shock waves – causes fragmentation of stones- Erosion & Shattering
• Gold standard / strongest Lithotripter for ESWL- Dornier Unmodified HM-3
61. CONDITION WHERE ESWL MAY FAIL:
• Stone size > 2 cm, Multiple stone or Staghorn stone.
• Lower Calyceal location
• Marked hydronephrosis or scarring
• Calyceal diverticulum
• Horseshoe kidney
• Difficult stone : Brushite, Hydroxyapatite, Cystine & Calcium oxalate monohydrate (
BHC-2)
62. CONTRAINDICATION OF ESWL:
Absolute Relative Relative
Pregnancy UTI Obesity
Bleeding Disorder Unrelieved distal obstruction Severe Renal failure
Cardiac Pacemakers Aneurysm
Uncontrolled Hypertension
Severe orthopedic deformity
63. COMPLICATIONS OF ESWL:
• Infection – Main complication.
• Acute injury to the renal parenchyma: Hematuria & edema around the kidney.
• Chronic renal injury: Hypertension, Decrease renal function & Increase in rate of
stone recurrence.
• Lung Parenchymal Injury
• Steinstrasse ( street of stones gravel in ureter)
65. PCNL : STEPS
G/A or Regional Anesthesia
Cystoscopy & Ureteral catheterization
Instillation of radio-opaque dye to
opacify the renal pelvic-caliceal system .
Puncture site: few centimeter inferior &
medial to tip of the 12th ribs
66. PCNL :
Hollow Needle is
placed from skin to
opacity of renal
pelvic caliceal system
70. PCNL
• Small stones : may be grasped under vision & extracted whole
• Larger stones:
Fragmented by USG,
Laser or electrohydraulic
Probe and removed in
Pieces.
76. NEPHROLITHOTOMY:
• Indication: Complex calculus branching into the most peripheral calyces.
• Mobilized the kidney.
• Cross-clamp the renal pedicle to control the bleeding.
• Cool the kidney with ice pack( to increase the ischemic time)
• Incision given on Brodel’s Line: Posterior & parallel to the most convex part of the
kidney , where territories of the anterior and posterior branches of the renal artery
meet.