The physical characteristics of urinary calculi (1) Calcium phosphate stones (2) Magnesium ammonium phosphate stones (3)Calcium oxalate stones (4) Cystine stones (5) Uric acid stones: they can not be seen on plain X-ray films
Pathology The size, number and position of the stone goven the development of secondary pathologic changes in the urinary tract. The major cause of progressive renal damage is the renal infection
The ureter is narrow at 3 points A. at the ureteropelvic junction B. at the point where the ureter crosses over the iliac vessels 4mm C. in the ureterovesical zone 1-5 mm
Renal calculi Clinical findings A. symptoms: pain flank pain colic hematuria
Nausea and vomiting Abdominal distention from paralytic ileus Chills, high fever and vesical irritability are due to infection
The history should include a survey of fluid intake, diet,drugs,periods of immobilization, pervious passage of stones and the presence of gout.
If the stones is still submucosal or adherent to the pareachyma, there are no symptoms. Staghorn calculus maybe asymptomatic.
B. Signs: Tenderness in the costovertebral angle or over the kidney may or may not be present. If marked hydronephrotic atrophy has occurred, a mass in the flank may be seen, felt or percussed.
C. Laboratory Findings: 1. Blood count 2. Urinalysis 3. Renal function tests: –Determination of the tubular reabsorption of phosphate (TRP) may prove helpful in the diagnosis of hyperparathyroidism when minimal hypercalcemia and normal blood phosphate levels are obtained.
D. X-rays Findings: At least 90% of renal stonesare radiopaque. KUB+IVP (excretory urograms) are necessary because they accurately localize the calcific shadow. If renal function is poor, retrograde urograms may be needed.
E. Ultrasonography: were able to distinguish between opaque and nonopaque stones.
F. CT.
G. Instrumental Examination: Cystoscopy for diagnostic purposes is seldom necessary.
H. Examination of stones:
Treatment: A. Conservative measures 1. No surgery is necessary in the following cases. 2. Combating infection 3. Attempts at dissolution
B. Surgical Measures: Removal of the stone is indicated if it is obstructive and causes undue pain or progressive renal damage or if the infection complicating a stone cannot be eradicated.
URETERAL STONE Ureteral stones originate in the kidney. Ureteral stones are seldom completely obstructive. A stone always be arrested at the narrowed points in the ureter.
Symptoms: Pain : (1) radiating, colicky, agonizing pain (2) The rather constant ache in the costovertebral area and flank. Gastrointestinal symptoms (Nausea, Vomiting, abdominal distention) Gross hematuria Chronic infection
Signs The patient is usually in agony. There is marked tenderness in the costovertebral angle and flank. The testis may be hypersensitive
Laboratory Findings: There are the same as far as renal stone
X-ray Findings A plain film IVP: dilatation of the ureter above the stone the degree of obstruction. CT scan: make the differentiation from ureteral tumor or blood clot.
Treatment A. specific measures B. ESWL C. Surgical treatment D. management of acute symptoms
VESICAL STONE Relatively painless. Terminal haematuria, dysuria and interruption of urine flow are due to impaction of the stone in the internal urinary meatus during micturition.
Signs DRE: BPH NEUROGENIC BLADDER
Lab Findings Blood cells are commonly found in the urine.
X-ray film Stones Vesicoureteral reflux, particularly in children
Cystoscopy
Ultrasonography
Treatnment Cystoscopy and surgical removal (transurethral route, suprapubic route) General Measures. Analgesics for pain Antibiotics Chemical dissolution
Urethral Calculi Symptoms: 1. Sudden stoppage of urination 2. Dribbling of the urine 3. Reffered pain may be radiated to the head of the penis
Diagnosis 1. Palpation of the penis, the perineum or the rectum 2. Panendoscopic examination or roentegenography 3. Grating may be felt upon attepmts to pass a sound
Treatment Treatment is influenced by the size, shape and position of the calculus and by the status of the urethra