7/27/2019 Urinary Tract Stones

1/15

URINARY TRACT STONES

Mars Dwi Tjahjo

7/27/2019 Urinary Tract Stones

2/15

URINARY TRACT STONES

Urolithiasis : presence of urinary calculi at any

point along the collecting system.

The most common type of calculus contains

calcium and oxalate.

7/27/2019 Urinary Tract Stones

3/15

Kidney stone composition

Crystal composition Percentage of stone analyzed

Calsium oxalat 60

Calsium phosphate 20

Uric acid 10cystine 3

struvit 7

total 100

7/27/2019 Urinary Tract Stones

4/15

Epidemiology

Stone disease effect 1-5% of the population.

10-20% of cases will require surgical

intervention.

Attention to pathofisiology identifies etiology

in over 90% of cases.

The recurrence rate of urolithiasis is 50%within 5 years.

7/27/2019 Urinary Tract Stones

5/15

Pathofisiology

Low urinary volume is the most important

factor.

Hypercalciuria : excretion of urinary calcium

more than 200 mg/ 24 hours.

Absorptive hypercalciuria : increased intestinal

absorption of calcium.

7/27/2019 Urinary Tract Stones

6/15

Pathofisiology

Renal (leak) hypercalciuria : impairment in

renal tubular reabsorption of calcium.

Reabsorptive hypercalciuria (primary

hyperparathyroidism) : exsessive bone

resorption increase serum calcium level.

Calcium restriction is recommend for patient

with absorptive hypercalciuria.

7/27/2019 Urinary Tract Stones

7/15

Pathofisiology

Hyperoxaluria : urinary oxalat excretion > 45

mg/day.

Hyperuricosuria : urinary uric acid excretion >

600 mg/day.

Hypercystinuria : urinary cystine excretion >

250 mg/day.

7/27/2019 Urinary Tract Stones

8/15

Pathofisiology

Struvite stone : stone commpossed purely of

struvite were produced by urea splitting

organism.

Low urine volume : urine output < 1 L/day.

The typical etiology of this condition is low

fluid intake. Low urine output contributes to

the development of all types of urinarystones.

7/27/2019 Urinary Tract Stones

9/15

Principles of management

History :

risk factor

underlying predisposing condition

Dietary excesses

Inadequate fluid intake

7/27/2019 Urinary Tract Stones

10/15

Principles of management

Sign and symptom :

Asymptomatic.

colicky flank pain.

Hematuria.

frequency, urgency and dysuria.

Nausea and vomiting.

Fever or sepsis.

7/27/2019 Urinary Tract Stones

11/15

Principles of management

Blood screen :

complete blood count

Blood chemistry : uric acid, sodium, calcium, PTH.

Renal function : ureum, creatinine.

Urine : urinalysis and urine culture.

Radiologic evaluation : x-ray ( BNO-IVP), CT-

scan, USG.

Stone analisys.

7/27/2019 Urinary Tract Stones

12/15

Medical management

Conservative management (patient clinically

stable and no evidence of systemic infection)

Increase fluid intake to at least 3 L/day

Pain management

Diet

7/27/2019 Urinary Tract Stones

13/15

Surgical management

ESWL (extracorporeal shock wave litotripsy)

PNL (percutaneous nephrolithotomy)

URS (ureterorenoscopy) Open surgical procedure.

7/27/2019 Urinary Tract Stones

14/15

Summary

Management of urinary tract stone has

changed dramatically. With non invasive

technique (ESWL), and minimal invasive

technique (PNL and URS), stone retrieval issuccsesful in more than 90 % of casses, with

minimal complication.

Selective medical therapy is highly effective inpreventing new stone formation.

7/27/2019 Urinary Tract Stones

15/15