Urinary Calculi

Ricky Agave Ompusunggu

 Books to read
• Smith & Tanagho’s General Urology 18th Ed.
• Campbell Walsh Urology 11th Ed.
• Handbook of Urology 3rd Ed.
 Epidemiolgy
• 3rd most common disease in Urology
• Age:
Prevalence 1%20-50
- 15%y.o (depends on risk factors)

• Geographical
Peak prevalence 20-50location
y.o  3:1
Sex: Male > Female
Climate
• Risk factors:
Water intake
Genetic: Caucasian and Asians, family
• IntrinsicDiet
history
Occupation
• Extrinsic
 Inheritan
Sex Age Nutrition Climate Race
ce

Abnormal
renal Pathophysiology
Disturbed
urine flow
UTI
Metabolic
abnormaliti
Genetic
factors
anatomy es
Increased of :
Decreased of:
• stone forming
• Crystallization
constituents
inhibitors
• Crystallization
• Urinary volume
promoters
• pH
• pH

Supersaturation

Abnormal Crystal
Crystal growth
crystalluria aggregation

Urinary
stone
 Stone Composition
Calcium: Hypercalcemia, hypercalciuria,
Oxalate
Uric acid
Citrate
• MultifactorialSodium
Magnesium
Phospate
• GAG
Crystal formation
Cystine
Pyrophospate
• Promotors Uropontin
• Inhibitors
History Taking
 Presentation & Diagnosis
• Presentation:
• Pain (colicky pain)
• Haematuria (microscopic or macroscopic occasionally)
• Febris
• Malaise, weakness, loss of appetite (complicated cases)
• Pyuria
• Diagnostic test
• Lab: CBC, Urinalysis, RFT, Electrolyte serum (Ca, P)
• Imaging:
• KUB ( easy, less expensive, can find everywhere)
• USG (non invasive, wide range of sensitivity to detect stone- “man behind the gun”)
• NCCT (expensive, high sensitivity & specifity, gold standard for plain imaging)
• IVU (virtually a historical investigation, replace by CT IVU)
• CT – IVU (very accurate method of diagnosing urinary calculi with its complications)
• MRU: can’t visualize stones, but able to demonstrate HN)
 Treatment
• If colick present treat first!
• Observational
• Ureteral stone
 Treatment
• Kidney stone
 Treatment
• MET (Medical expulsive therapy): Drugs that expel stones
might act by relaxing ureteral smooth muscle through
inhibition of calcium channel pumps, α-1 receptor
blockage or PDE 5 Inhibitor (new)
 Treatment
• Chemolysis
• Percutan chemolysis (Struvite stone, brushite stone, cystine, uric
acid)
• THAM solution
• Hemiacidrin 10%
• Oral Chemolysis : for Uric Acid Stone only
 Treatment
• Active Stone Removal
 Treatment
• Active Stone Removal
• ESWL
• URS/ f-URS (RIRS)
• PCNL (small stone  large stone can be taken out, sometimes
multi-puncture or multi-session)
• ECIRS (Endoscopic Combined Intrarenal Surgery) RIRS + PCNL
(WE WILL DO IT!!!!!!!!)
• Open Surgery (Historical, only for high stone burden or very
complicated case)