Upper urinary tract calculi are more common in adults
than children and are seen more often in men than in women.
Bladder stones are rare in women and children, but are
common in men due to the greater incidence of lower urinary
tract obstruction, e.g., prostate enlargement.
The most common type of urinary stones are calcium, struvite
(magnesium-ammonia phosphate), uric acid, xanthine, and
cystine. Calcium stones are the most common.
KIDNEY STONES
Kidney stones (calculi) are solid or semi-solid mineral-like
substances occurring in the urinary tract.The main problem
occurs when the stones block the drainage of the kidney,
resulting in urinary obstruction. Urinary calculi are responsible
for 10% of urological hospital admissions per year. They
also account for a significant number of visits to the
hospital emergency departments and absenteeism from work
each year
Caucasians are affected more commonly than other racial
groups.
Kidney stones are more common in developed .
Clinical features Symptoms of kidney stones may vary from
non as in the case of "silent stones" which are
those that do not cause any significant urinary obstruction.
, to those causing obstruction with excruciating pain.
Most obstructing stones, depending upon cause, size, shape,
and location, cause the following symptoms:
acute severe pain in the affected side (flank)
nausea and vomiting
hematuria (blood in the urine)
infection
fever
urinary stone medical evaluation?
The medical evaluation will consist of the following:
detailed medical history
physical examination
urine and blood test
kidney x-ray/ultrasound
metabolic stone risk profile
Laboratory X-ray is the chief method used to diagnose
kidney stones. Ultrasound can also be used to detect stones
and urinary obstruction.
Treatment Treatment centers around medical and surgical;
however, the size, location, degree of symptoms, and presence
or absence of urinary infection and obstruction influence
the treatment decision. Hospitalization is usually necessary
for kidney obstruction and infection. A large number of
kidney stones are small enough to pass spontaneously. Medical
treatment is more successful in prevention of stones than
in dissolving them after they have formed.
Medical Treatment:
expectant (observation)
medications
adequate fluid intake
maintaining proper urine pH
diet
Surgical Treatment:
Extracorporeal shock wave lithotripsy (ESWL)
PCN (percutaneous nephrolithotomy-lithotripsy)
Endourology (endoscopic removal or manipulation)
Open surgery
Most stones can be removed without an incision employing the first three surgical
treatment procedures. ESWL is one of the most popular techniques today. It
works by using shock waves to fragment your stone into small pieces (sand-like)
that pass freely through the urinary tract.
Bladder stones
Stones form in the bladder due to outflow obstruction
( urethral strictures, prostatic obstruction) and the presence
of foreign body e.g. in-dwelling catheter. Some stones
found in the bladder may have been formed in the upper
UGT
Clinical Features
Most people with stones are usually without symptoms,
however, pain is the most common symptom which may be sharp,
dull, intermittent or colicky. Increase in fluid intake
or exercise causes an increase in the pain both via causing
increase movement of the stone.
Ureteric stones cause severe colicky abdominal pain that
radiates towards the groin. Haematuria often occurs. The
presence of infection may present with frequency, dysuria
or haematuria. Rarely, a stone at the bladder neck may
cause outflow obstruction resulting in urinary retention.
Investigation
Plain abdominal X-ray and IVU
Unehanced helical CT.
All above, in combination, will help in elucidation of
the stone be it radiolucent or opaque. Stones may appear
as filling defects. Obstruction will be observed as failure
of flow of contrast material.
Treatment
Analgeics.
Stones less than 5mm usually pass out spontaneously, those
greater than 1cm usually require intervention. Intervention
is also required if a stone is not moving and causing partial
obstruction in the absence of infection.
Extracorporeal Short Wave Lithotripsy
Nephrolithotomy
Open surgery.
Ureteral stones
A ureteral stone is actually a kidney stone that has moved into the ureter
and can be an extremely painful condition. However if small enough, the stone
will pass through the urine with some or no pain. As the stone grows, it
can obstruct urine flow and become lodged in a narrow part of the ureter.
The most common symptom is a sharp pain in the back or side, or possibly
the lower abdomen. Symptoms may also include nausea, vomiting, or blood in
the urine. Typically, initial management involves drinking lots of fluids
to cause the stones to exit the body with the urine. In more severe cases,
where the stones have become too large, or other treatment has not worked,
surgery to remove the stones may be necessary.
Investigations are as above.
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