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.

2. Edited by:
Kamrul Islam Shipo

3.  The urinary tract includes the kidneys, ureters,
bladder and urethra. Within each kidney, urine
flows from the outer cortex to the inner
medulla.
 The renal pelvis is the funnel through which
urine exits the kidney and enters the ureter.

6.  The kidneys remove wastes, control the body's fluid
balance, and regulate the balance of electrolytes
 The medulla is composed of a series of conical
masses called the renal pyramids.
 The apex of these pyramids form a papilla which
projects into the lumen of the minor calyces.
 The cortex extends between these medullary
pyramids as the renal columns
 The minor calyces are cup shaped tubes which
surround the renal papilla. These converge to form
the major calyces, which in turn unite to form the
renal pelvis.

8.  The stones are solid concretions or calculi (crystal
aggregations) formed in the kidneys from
dissolved urinary minerals
 Stones are formed in the urinary tract when
urinary concentrations of substances such as
calcium oxalate, calcium phosphate, and uric acid
increase

9.  Urinary calculi are more common in men than in
women.
 Incidence of urinary calculi peaks between the 3rd
and 5th decades of life.

10.  There is seasonal variation with stone
occurring more often in the summer months
suspecting the role of dehydration in this
process

11. 1)Dietetic. (more calcium oxalate containing food)
2)Altered urinary solutes and colloids:(reduced water intake=increased
solid deposition >increased crystallization >stone formation.)
3)Reduced urinary citrate .
4)Renal infection.
5)Inadequate water drainage and urinary stasis.
6)Prolonged immobilization.
7)Hyperparathyroidism .(increased calcium deposition .)
8)Gout.

12.  Calcium oxalate
 Calcium phosphate
 Mixed-Oxalate+Phoaphate
 Struvite (Ca, Al, Mg, Phosphate)
 Cystine
 Xanthine
 Matrix

13.  sharp, severe pain

14.  most characteristic manifestation of renal or
ureteral calculi
 caused by movement of the calculus and
consequent irritation
 Renal colic originates deep in the lumbar region
and radiates around the side and down toward
the testicle in the male and the bladder in the
female
 Ureteral colic radiates toward the genitalia and
thigh

15.  When the pain is severe, the patient usually has
nausea, vomiting, pallor, grunting respirations,
elevated blood pressure and pulse, diaphoresis,
and anxiety

16.  Urinary tract infection
 Other manifestations of calculi include infection
with an elevated temperature and white blood
cell (WBC) count and urine obstruction that
causes hydroureter, hydronephrosis, or both
 Haematuria
 Pain resulting from the passage of a calculus
down the ureter is intense and collicky.

17.  1. Assessment

18.  Prior stone formation
 Renal or bladder colic type pain without
objective evidence of calculi formation
 Risk factors
 Location, character, and duration of current pain
 Current and previous radiation patterns
(indicates possible location and movement of
calculus through the urinary system)

19. #G/E:
 Anemia
 Oedema
 Dehydration
 Increased Pulse and BP.
 Raised Temperature.
#Urinary System:
Tenderness on palpation
Passage of stones.

20. 1.Plain x-Ray of KUB region( radio dense shadow)
2.Ultrasonography of KUB region(echogenic structure
with shadow)
3.Intravenous urography .
4.Intravenous pyelography .
5.Excretory urography .
6.Unenhanced computer tomography
7.Plain radiograph of the abdomen

21.  Nowadays Unenhanced computer tomography
Has been seen more sensitive and specific. It
can identify both radioluscent and radio opaque
shadow.
 90% of the urinary stone is radio opaque .
 10% gal bladder stone is radio opaque.
 Uric acid stone , Cystine,struvite stones are
radioluscent .

22. #Others :
-Urine RME and C/s
-Serum creatinine
#For Anaesthesia :
>CBC
> RBS
>CX-R
>ECG

23. # To indentify the cause:
 Serum calcium
 PTH
 Uric acid Urinary calcium Phosphate

24.  Obstructive uropathy compromises the
function of the affected kidney.
 Microscopic or gross hematuria is rarely
associated with significant hemorrhage.
 Urosepsis is infection that may cause shock
or death without prompt intervention.
 Ileus may occur

26.  Stones<5mm,90 percent spontaneous
passage.
 Hydration
 Diuretics
 Anti-emetics

28.  involves first visualizing the stone and then
destroying it.
 Access to the stone is accomplished by inserting
a ureteroscope into the ureter and then
inserting a laser, electrohydraulic lithotriptor, or
ultrasound device through the ureteroscope to
fragment and remove the stones.
 A stent may be inserted and left in place for 48
hours or more after the procedure to keep the
ureter patent.
 Hospital stays are generally brief, and some
patients can be treated as outpatients.

29.  LASER LITHOTRIPSY. A newer treatment
for calculi is laser lithotripsy. Lasers
are used together with a uretero-scope
to remove or loosen impacted
stones. Constant water irrigation of
the ureter is required to dissipate the
heat

30.  ESWL is a noninvasive procedure used to break up
stones in the calyx of the kidney.
 In ESWL, a high-energy amplitude of pressure, or
shock wave, is generated by the abrupt release of
energy and transmitted through water and soft
tissues. When the shock wave encounters a
substance of different intensity (a renal stone), a
compression wave causes the surface of the stone
to fragment. Repeated shock waves focused on
the stone eventually reduce it to many small
pieces.

31.  These small pieces are excreted inthe urine,
usually without difficulty.the fragments may be
passed upto 3 months after the procedure
 Stone size should be 1.5-2 cm

32.  Percutaneous lithotripsy involves the insertion of a
guide percutaneously (through the skin) under
fluoroscopy near the area of the stone. An
ultrasonic wave is aimed at the stone to break it
into fragments.
 stone size should be >2.5 cm

34.  IMMEDIATE
 Pain
 Urinary infection
 Obstructive uropathy
 Haematuria
 Urinoma-URINOMA HAPPENS AS A RESULT OF URETERAL
TEAR WHICH ALLOWS THE ENTRY OF FREE FLUID INTO THE
RETROPERITONEUM
 Renal and perirenal haematoma
 Surrounding organ injury

35. DELAYED
 Renal functional loss
 Hypertension
 Residual calculi
 Recurrent calculi

37.  If the stone is too large or lithotripsy procedures
fail to remove it, an open surgical procedure is
performed

38.  Cystolithotomy, removal of bladder calculi
through a suprapubic incision, is used only
when stones cannot be crushed and removed
transurethrally. Stricture (abnormal
narrowing) is the most common
postoperative complication.
 A stone is removed from the renal pelvis by
pyelo-lithotomy and from the renal calyx by a
nephrolithotomy

39.  Despite advances in the treatment of urinary calculi, it
is often impossible to remove all stone fragments
completely. From 5 to 30 percent of patients have
residual stone burden requiring ongoing treatment.
 Recurrence rate is approximately 30 percent within
years.
 Extracorporeal shock wave lithotripsy and endoscopic
stone removal techniques have significantly improved
long term prognosis of renal function after calculus
removal.