1. Urinary calculus disease

2. Basics
 Urinary calculi are aggregates of
crystalloids around tiny organic matrix
 Males > Females (3:1)
 Common in 2nd
-3rd
decades
 Common in hot & humid areas
 Commonly cause colicky pain radiating
towards groin & hematuria, urgency,
frequency

3. Types
 Calcium stones- radiopaque
 Oxalate- commonest
 Phosphate (hydroxyapatite)
 Uric acid stones- radiolucent
 Struvite stones- MgNH4PO4
 Common in females
 Due to UTI with urea splitting bacteria, mostly P.mirabilis
 Can form ‘staghorn’ calculi
 Cystine stones- due to a genetic (AR) defect,
causing cystinuria

4. Causes
 Calcium stones
 Hypercalciuria-
idiopathic, hyperparathyroidism,
immobilization, sarcoidosis,
Calcium/vitamin D excess
 Hyperuricosuria-
non-vegetarians
 Hyperoxaluria- ileal
disease or resection/bypass,
vitamin C excess,
primary hyperoxaluria
 Uric acid stones
 Gout
 Acidic pH
 Colonic disease/resection
 Lesch-Nyhan syndrome
 Struvite stones
 Alkaline pH, due to urea splitting
bacteria
 Cystine stones
 Cystinuria- hereditary
 Drugs
 Indinavir, Sulfadiazine

5. Majority <6 mm will pass spontaneously
Why treat?

6. Complications
Colic
Hydronephrosis
Post-renal azotemia

7. Evaluation
 History- of colicky pain
 Radiology- to confirm/localize stone
 X-ray- proper preparation, radiopaque stones
 IVP- anatomical & functional
 US- localization & hydroureter/nephrosis
 CT-scan- gold standard for detection, cost & radiation
 Other-
 Urine- routine analysis & culture
 24-hour urine analysis
 CBC, Creatinine, calcium, uric acid

8. Treatment
NSAID/opioids
Double water intake
Urological procedures

9. Prevention
 Plenty of water- habitually
 Adequate calcium- ?
 Moderate protein intake
 Fruit juices-
 Orange- oxalate stones
 Black currant- uric acid stones
 Cranberry- struvite stones
 Drugs-
 Calcium stones- thiazides with Na restriction
 Uric acid stones- alkalinise urine & allopurinol

10. Prevention
 Plenty of water- habitually
 Adequate calcium- ?
 Moderate protein intake
 Fruit juices-
 Orange- oxalate stones
 Black currant- uric acid stones
 Cranberry- struvite stones
 Drugs-
 Calcium stones- thiazides with Na restriction
 Uric acid stones- alkalinise urine & allopurinol