RENAL STONE

RENAL STONE

Solid concentrations or crystal aggregations formed in the kidney from dissolved

urinary minerals

Peak incidence 35-45 years old

Male:Female ratio of 1:3

Risk factors:
◦ Urine stasis
◦ Chronic urinary infection
◦ Excess urinary excretion of stone-forming substances
◦ Decrease urinary citrate
◦ Hyperparathyroidism
◦ Idiopathic
PATHOPHYSIOLO
GY
SIGNS & • Colicky unilateral flank/upper quadrant pain
SYMPTOMS • Pain radiates to groin, testicle or labia
• Dysuria
• Hematuria
• Cloudy urine
• Nausea & vomiting
• Urgency
• frequency

INVESTIGATI • Urine dipstick, culture and

ON sensitivity, urine pH, 24h urine.
Renal function test: renal failure
due to stone
• KUB x-ray: detect and locate
stones
• Intravenous urography (IVU)
• Renal ultrasonography:
hydronephrosis and stone
COMPLICATION • Obstruction lead to hydronephrosis or hydroureter
• Urinary tract infection
• Renal failure due to renal scarring

ACUTE MANAGEMENT • Hydration

• Pain management: NSAIDS
• Antibiotic if infection (cefuroxime) Conservative
treatment for small ureteric stones by drink of more water

DEFINITIVE MANAGEMENT • Kidney: ESWL, PCNL, pyelolithiotomy, nephrolithotomy

Indication: • Ureter: Uteroscopy, endoscopic removal (dormia basket),
• Stone >7mm ureterolithotomy
• Obstruction of urinary flow • Bladder: cystolitholapexy
• Bilateral obstruction
• Persistent, recurrent or severe pain
• Infection
Extracorporeal Shock Wave
Lithotripsy (ESWL)
• Use external shock wave to crush
the stone. Fragment pass down
thru ureter causing ureteric colic
and need of NSAIDS (diclofenac)
• Location: kidney, upper & middle
ureter
• Contraindication: distal urinary
tract obstruction
Pyelolithotomy
• Indication: Stone in renal pelvis
Percutaneous Nephrolithotomy
(PCNL)
• Placement of hollow needle direct
to percutaneous access to renal
vein and parenchyma
• Small stone grasped and extract
under vision
• Large stone fragmented
• Indication:
• >2cm stone in upper ureter
• Contraindicated to ESWL
Nephrolithotomy
• to remove complex calculus
branching into the most peripheral
calyces, thus incision into renal
parenchyma is necessary to make
to clear the kidney
Interstitial
Cystitis
Introduction  An infection within the bladder.
 Predisposing factors :
• incomplete emptying of the bladder
• abnormalities within the bladder
• bacteria migrating up the urethra
• sexual activity in female

Epidemiology Effects more women, but can effect either sex

and all age groups.

Symptoms  Mild suprapubic pain

 Strong persistent urge to urinate
 Burning sensation during urination
 Hematuria

PE  Physical signs are rare

 Abdominal examination
• Mild suprapubic tenderness

IX  Laboratory
• FBC
• Urinalysis
• Urine culture & sensitivity (clean catch
specimen/catheterized urine specimen)
 Cystoscopy
 Imaging (not necessary but helpful TRO other potential causes)
• X-Ray
• Ultrasound
Complications  Chronic or recurrent utrinary tract infection
 Pyelonephritis
 Acute renal failure
Managements
TESTICULAR  TORSION
ASYIKIN
 TESTIS IS ROTATED ON IT

EMERGENCY
VASCULAR PEDICLE -->
ISCHAEMIA

>24H --> IRREVERSIBLE

!!!
APPROACH  TO SCROTAL SWELLING

1. CAN YOU GET 2. CAN YOU IDENTIFY 3. IS THE SWELLING 4. IS THE SWELLING
ABOVE THE THE TESTIS AND TRANSLUMINABLE? TENDER?
SWELLING? EPIDIDYMIS?
 Consist of testicular vessel
and vas deferens

Scrotal
anatomy
Potential space that
encompasses the anterior
2/3 of testis
Positioned posterol
to the testis
CLINICAL FEATURES
Peripubertal (12-18y/o)

Clinical diagnosis 
 Acute abdomen (T10 innervation)
 Acute onset of testicular pain and swelling
 Nausea and vomiting

Previous attack of self-limiting pain

 Precipitated by trauma, cycling, straining, coitus

No history of voiding complaints, dysuria, fever, exposure to STDs

 Risk factors
Cryptochirdism

Mal-descended testis hanging

like a bell clapper within the
tunical vaginalis
 Physical examination
Swollen and tender scrotum

High riding in scrotum with transverse lie

Absent cremestric effect (stroking inner thigh)

Negative Phren sign – no pain relief with lifting the affected testis
 Ddx
Epididymitis

Torsion of testicular appendage (pea coloured lump through scrotum)

Strangulated inguinal scrotal hernia

Investigation 
Colour doppler ultrasound 

- help confirm or exclude diagnosis

with 95% accuracy (useful when a
low suspicion of testicular torsion
exists)
Treatment 
o Emergency exploration if Doppler US –ve for flow or high index of clinical suspicion

       Untwisting (lateral) of affected testis and bilateral orchidopexy

       Warm up with warm pad to see reperfusion or check with doppler after untwisting

          [4 hours before ischemia]

       If dead, excise and replace with prosthesis