UROLITHIASIS Hatim alnosayan

INTRODUCTION Prevalence 2% to 3%. Prevalence 2% to 3%. Peak age group 20 – 40 yrs Peak age group 20 – 40 yrs Life time risk: M > F. Life time risk: M > F. Recurrence rate 50% at 10 yrs. Recurrence rate 50% at 10 yrs. 90% of the stones are radio opaque. 90% of the stones are radio opaque.

RISK FACTORS Genetics. Genetics. Age. Age. Sex Sex Geography. Geography. Diet Diet occupation occupation

WHY DO STONES FORM ? Chronic fluid deprivation Chronic fluid deprivation Increased excretion of salt Increased excretion of salt Change in PH. Change in PH. Reduction of inhibitors of stone formation ( citrate as complexing calcium ). Reduction of inhibitors of stone formation ( citrate as complexing calcium ). Stasis. Stasis. Foreingn bodies. Foreingn bodies. idiopathic idiopathic

TYPE OF STONES Calcium stone. Calcium stone. Ca oxalate. Ca oxalate. Ca phosphate. Ca phosphate. Non – calcium stones Non – calcium stones Uric acid. Uric acid. Cystine. Cystine. Struvite. Struvite. Mesclanous. Mesclanous.

Calcium oxalate: Calcium oxalate: Most common ( 75%). Most common ( 75%). Hypercalciuria. Hypercalciuria. Dark brown. Dark brown. Sharp projection. Sharp projection. Radio opaque. Radio opaque.

Struvite stone: Struvite stone: Triple phosphate. Triple phosphate. Infectious. Infectious. Alkaline urine. Alkaline urine. Radio opaque Radio opaque Asymptomatic. Asymptomatic.

Uric acid stone: Uric acid stone: 5 – 10% of stones. 5 – 10% of stones. Low ph. Low ph. Cystine stone: Cystine stone: Only 1 – 2 %. Only 1 – 2 %. Caused by genetic defect in renal reabsorption of amine acids. Caused by genetic defect in renal reabsorption of amine acids.

CLINICAL FEATURES Flank pain. Flank pain. Hematuria. Hematuria. Urinary urgency and frequency. Urinary urgency and frequency. Nausea and vomiting. Nausea and vomiting. Fever & chills. Fever & chills. Asymptomatic. Asymptomatic.

DIFFERENTIAL DIAGNOSIS Urological : Urological : Pyelonephritis. Pyelonephritis. Stricture, tumour, renal infarction. Stricture, tumour, renal infarction. Non – urological : Non – urological : Appendicitis. Appendicitis. Diverticulitis. Diverticulitis. Ectopic pregnancy. Ectopic pregnancy. Ruptured AAA. Ruptured AAA. Biliary colic. Biliary colic.

INVESTIGATIONS To confirm the diagnosis: To confirm the diagnosis: Urine analysis. Urine analysis. X ray KUB. X ray KUB. Uss/ IVU/ CT. Uss/ IVU/ CT. To find the aetiology: To find the aetiology: Analysis the stone. Analysis the stone. S. ca, s. uric acid. S. ca, s. uric acid. To look for complications To look for complications S. crea, CBC S. crea, CBC

MANAGEMENT Treatment options: Treatment options: Conservative. Conservative. ESWL. ESWL. Ureteroscopy. Ureteroscopy. PCNL. PCNL. Open surgery. Open surgery.

MANAGEMENT how you are goning to take deceision to treat stone patients? Stone burden. Most important Stone burden. Most important Stone location. Stone location. The anatomy of urinary tract. The anatomy of urinary tract. Availability of Rx. Availability of Rx. Pt wish. Pt wish.

CONSERVATIVE MANAGEMENT Small stones < 5 mm. Small stones < 5 mm. Pain controlled. Pain controlled. Absence of renal failure or sepsis. Absence of renal failure or sepsis. Analgesia. Analgesia. Alpha blocker. Alpha blocker. Review and ensure stone has passed. Review and ensure stone has passed.

EXTRA CORPOREAL SHOCK WAVE LITHOTRIPSY Renal pelvis and upper ureter stone. Renal pelvis and upper ureter stone. Non invasive & no need for anaesthesia. Non invasive & no need for anaesthesia. Need multiple sessions. Need multiple sessions. Stone size < 1.5 cm. 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. Treat the cause. Plenty of water. Plenty of water. Limit red meat. Limit red meat. Avoid calcium supplement. Avoid calcium supplement. Avoid excess salt, milk product. Avoid excess salt, milk product. Optemize co morbidities. Optemize co morbidities.

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