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Bedah Jadiii
Bedah Jadiii
http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20090113103910749131&linkID=71700&cook=no
FBC (full blood count), serum creatinine,
calcium, phosphate, urate, proteins and
alkaline phosphatase.
Biochemistry Investigations ph, hematuria,
leukosituria, Crystalluria
Urine culture: secondary infection.
BOF
IVP / IVU
USG
Retrograde or antegrade pyelography
Bartley G. Cilento, Jr., Gerald C. Mingin, and Hiep T. Nguyen 2006, Pediatric Surgery and Urology Long-term Outcomes,Second Edition, Cambridge University Press, PP 698
Extrinsic
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factor
Geografi
Matrix-nucleation
theory
Crystallization-
inhibition theory
• Organic
• anorganic
Crystal -
Presipitation Nucleation Agregation Big crystal
cristal
ion
Sitrat
Crystallization-
inhibition theory
1. Glikosaminoglikan
(GAG )
Protein & organic 2.Tamm Horsfall
subtantion Protein ( THP )
3. Nefrokalsin
4.Osteopontin
Oxalate Urate Cystine Silicate
urolithiasis urolithiasis urolithiasis urolithiasis
1. CONSERVATIVE OBSERVATION
2. DISSOLUTION AGENTS
3. RELIEF OF OBSTRUCTION
4. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
5. URETEROSCOPIC MANAGEMENT
6. PERCUTANEOUS NEPHROSTOLITHOTOMY
7. OPEN STONE SURGERY
• ESWL is indicated for treatment of most renal calculi <1.5 to 2 cm
in size.
• Insertion of a temporary internal stent is recommended for stones
>1.5 cm in size to prevent steinstrasse or ureteral obstruction
caused by passage of stone fragments.
• Although its primary use is in the fragmentation of renal calculi,
ESWL is also advantageous for ureteral stones, especially those <8
mm in diameter.
a) Access to the ureter for ureteroscopy is greatly facilitated
by use of the ureteral access sheath.
Under fluoroscopy, the sheath is passed over a guide wire
into the proximal ureter. Passage of the sheath causes
ureteral dilation, and the sheath itself provides a
continuous working channel for the introduction of
endoscopes and instruments during ureteroscopic
procedures.
b) Lithotripsy techniques include US, electrohydraulic,
pneumatic, or laser lithotripsy. For ureteroscopic stone
fragmentation
c) Stone extraction of small stones may be accomplished by
a stone basket. The advent of rigid and more recently
flexible ureteroscopy has eliminated the need for blind or
radiologically guided basket extraction.
• (PCNL) is indicated for large stones >2 cm in size or for staghorn
calculi.
• With use of rigid and flexible nephroscopes and a variety of
fragmenting tools, approximately 85% of patients can be
rendered stone-free at 3 months
• Results are comparable with those of open surgery, although
many large stones will require staged procedures. Even full
staghorn calculi can be successfully removed with PCNL.
Is virtually never required today, given the
advances in minimally invasive surgery and
ESWL.
In the past, ureterolithotomy and open
nephrolithotomy (anatrophic nephrolithotomy)
were common urologic procedures, but today
they are rarely performed
pierce a, grace. neil r, borley . 2002 surgery at a glance, second edition, blackwell science ,pp 158
In a patient with neurogenic bladder, kidney
stones generally are the result of infection
untreated the stones become the source
of persistent renal infection and eventual
renal loss