Urolithiasis

SKDI 3A
calyceal stone
Medullary stone Staghorn calculi

Stone formation
Pelvic
in calyceal cup stone
Upper ureteral stone

Stone in
infundibulum

Middle ureteral stone

Bladder stone
Lower ureteral stone

Prostatic calculi
 Cause of Stone Disease
Supersaturation of urine is the key to stone formation

Intermittent supersaturation - Dehydration

Crystal aggregation

Anatomic Abnormalities PUJ

Bacterial Infection

Defects in transport of Calcium and Oxalate by Renal

epithelia
E.Coli infection increases matrix content in urine . Proteus makes
urine alkaline
Diagnosis

History
Asymptomatic (check up)
Pain
Abnormal urination
Hematuria
UTI/Pyuria
Passing stones
 Diagnosis

Investigation
Urinalysis, urine culture
CBC, BUN, Creatinine,
Electrolyte
Ultrasound, KUB
IVP
Scout film KUB
 Diagnosis

Investigation
CT
Stones analysis
Metabolic evaluation
IVP
CT scan
 Metabolic Screening

Bilateral kidney stones

Recurrent kidney stones

Familial history of kidney stones

Children with urolithiasis

Stones in a solitary kidney

Concurrent medical conditions

predisposing to stones
 Metabolic
Evaluation

Blood
Calcium, ionized calcium
Electrolyte
BUN, Creatinine
Uric acid
 Metabolic Evaluation

Urine
Analysis
Culture

24 hours Urine
volume, creatinine, calcium,
sodium, oxalate, uric acid,
citrate
Stone analysis
 Management

1. Medical treatment
2. Conservative treatment
3. Surgical intervention
 Indications for Active Stone
removal

Stone removal is usually indicated for stones with a diameter

exceeding 6-7 mm. Active stone removal is strongly
recommended in patients fulfilling the following criteria:
Persistent pain despite adequate medication
Persistent obstruction with risk of impaired renal function
Stone with urinary tract infection
Risk of pyonephrosis or urosepsis
Bilateral obstruction.
Obstructing calculus in a solitary functioning kidney
 Surgical intervention

Lithotripsy
Intracorporeal (PCNL, URS,
Vesicolithotripsy)
Extracorporeal (ESWL)

Lithotomy(Opened surgery)
Nephro-
Pyelo-
Uretero-

 Open Surgical Procedures

Nephrectomy Nephrolithotomy
Cystolithotomy
Recurrence prevention