06/02/2012

An introduction to Urinary
Stone disease/Urolithiasis

Epidemiology
Prevalence increased in 20 th century

120-140/100,000 per year

M>F (x2-3)

50% recurrence at 5yrs

Type and frequency of urinary stones

%
Calcium oxalate 73
Calcium phosphate
Struvite 15

Uric acid 8

Cystine 3

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Aetiology

Inhibitors Promoters

Citrates Stasis
Complex mucopolysaccharides Nucleation
Urine pH

Crystal formation

Dietary excess of:

Low fluid intake
Sodium
Low dietary citrus fruit intake
Oxalate
Calcium
Purines
Refined carbohydrates

Clinical presentation
Typically renal colic

Constitutional symptoms

Sepsis

Incidental

Haematuria

History and examination

Urinalysis

Imaging

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Imaging
KUB

IVU

US-KUB

CT

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Management

Analgesia e.g. NSAIDS, Narcotics

Intervention e.g. ureteric stent, nephrostomy

Prevention e.g. Stone screen, dietary

modification, medical therapy

Management
Expectant

ESWL

Ureteroscopy

PCNL

Open/Laparoscopic surgery

Expectant

90% of ureteric stones 4mm or less will

pass spontaneously given time

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Extracorporeal Shock Wave

Lithotripsy -ESWL
Classification of
Lithotriptors

a) Shock-wave Source

b) Localization System

c) Price

Electrohydraulic shock waves

Piezoelectric Shock wave

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Electomagnetic Shock wave

Complications of ESWL

Pain
Bleeding
Infection
Ureteric Obstruction
Ureteric Steinstrasse

Ureteroscopy
Rigid or flexible

Ureteric and intrarenal stones

Mechanical lithotripsy
EHL lithotripsy
Ultrasound lithotripsy
Laser lithotripsy

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PCNL / percutaneous nephrolithotomy

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General guidelines
Large kidney stones PCNL/open
< 2cm ESWL

Ureteric stones ESWL / URS

Small ureteric stones Expectant

Bladder stones treat stone

& cause of

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