urinary tract stone 2

7/25/2019 Urinary Tract Stone 2

1/23

URINARY TRACT STONEPART TWO

AKHADA MAULANASUB BAGIAN UROLOGI BAGIAN /

SMF BEDAH FK UNRAM / RSU MATARAM NTB


2/23

Patient Histor

F!an" #ain $%&!!' (o!i(" or )i*ratin*+,

Sra #&-i( #ain

Fe.er

He)at&ria

Passin* stone

Irritate% s)#to)s $%s&ria' re0&en(+

Urinar retention an% (1an*e in #osition21en .oi%in*,

Na&sea' .o)itin*,


3/23

Patient Histor

D&ration o (o)#!aint,

3&a!it o (o)#!aint $)i!% or -ot1er+,

Sa)e (o)#!aint on #ast 1istor, W1ere 1e/s1e !i.es,

O((ation,

Dai! a(ti.ities, Dai! 4&i% inta"e,

Fa)i! %isease 1istor,


4/23

Patient Histor

Re!ations1i# o Stone Lo(ation to S)#to)s

Stone !o(ation Co))on s)#to)s

Ki%ne 5a*&e 4an" #ain' 1e)at&ria

Pro6i)a! &reter Rena! (o!i(' 4an" #ain' #era-%o)ina! #ain

Mi%%!e se(tion o &reter Rena! (o!i(' anterior

a-%o)ina! #ain' 4an" #ain

Dista! &reter Rena! (o!i(' %s&ria' &rinarre0&en(' anterior a-%o)ina!#ain' 4an" #ain


5/23


6/23

P1si(a! E6a)ination

Genera! (on%ition' (ons(io&sness' .ita! si*n$-!oo% #ress&re' 1eart rate' res#irator rate'te)#erat&re+,

Genera! stat&s $1ea%' (on7&n(ti.a' s(!era' ne("'t1roi% stat&s' (1est' a-%o)en' e6tre)ities+,

Uro!o* stat&s 8 Costo.erte-ra! an*!e $in4a))ation si*n' )ass'

-a!!ote)ent' ten%erness' ten%erness on #er(&ssion+, Sra #&-i( $-!a%%er stat&s' ten%erness+,

E6terna! *enita!ia $e6terna! )eat&s' in%&rations+

Di*ita! re(ta! e6a)ination $i ne(essar+


7/23

La-orator E6a)ination

B!oo% ro&tine test $H-' Ht' WBC'P!ate!et (o&nt+,

Ser&) &re&)' (reatinine,

E!e(tro!te $so%i&)' #otassi&)+ ine(essar,

B!oo% s&*ar

Urina!sis $#H' s#e(i9( *ra.it'se%i)ent :!e&"o(te an% ert1ro(te;'-a(ter+,

Urinar (&!t&re i -a(ter < ,


8/23

Ra%io*ra#1 E6a)ination

Go!% stan%ar% 8 KUB=I5U,

S(reenin* 8 "i%ne an% -!a%%er&!traso&n%,

I ser&) (reatinine > ? )*/%L orser&) &re&) > @ )*/%L KUB'&ro!o*i( &!traso&n%' an% reno*ra)$GFR+,

C1est 6=ra $or s&r*i(a! #re#aration+i ne(essar,


9/23

U!traso&n% E6a)ination


10/23

KUB


11/23

I5U


12/23

Consi%er Cons&!t

A(&te rena! ai!&re,

O-str&(ti.e &ro#at1

Se#sis Hi*1 e.er

S&**esti.e #one#1rosis


13/23

S#e(ia! Ra%io*ra#1 E6a)ination

APG $ante*ra%e #e!o*ra#1+

RPG $retro*ra%e #e!o*ra#1+


14/23

RPG $ Retro*ra% Pe!o*ra#1 +


15/23

E)er*en( Treat)ent

Ana!*esi(

Ne#1rosto)

Ureter (at1eter or D stent insertion He)o%ia!sis


16/23

Treat)ent

Conser.ati.e treat)ent 2it1)e%i(ation,

ESWL

S&r*i(a! treat)ent 8 PNL

URS

D stent insertion < ESWL

Lit1otri#s

O#en s&r*er


17/23

Treat)ent Goa!

Re!ie.in* #ain,

E.a(&atin* or %estroin* t1e stone,

Treatin* t1e (o)#!i(ation, Pre.ents stone re(&rren(e


18/23

ESWL


19/23

PNL


20/23

PNL


21/23

Lit1otri#s


22/23

URS


23/23

Fo!!o2 U#

)ont1s ater treat)ent' an%(ontin&e% t2i(e = o&r ti)esann&a!!,

Non in.asi.e 8 &ro!o*i( &!traso&n%,

urinary tract stone 2

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