The physical characteristics of urinary calculi (1) Calcium phosphate stones (2) Magnesium ammonium phosphate stone

s (3)Calcium oxalate stones (4) Cystine stones (5) Uric acid stones: they can not be seen on

plain X-ray films

Pathology

The size, number and position of the stone goven the development of secondary pathologic changes in the urinary tract. The major cause of progressive renal damage is the renal infection

The ureter is narrow at 3 points

A . at the ureteropelvic junction B. at the point where the ureter crosses over

the iliac vessels 4mm C. in the ureterovesical zone 1-5 mm

Renal calculi

Clinical findings A. symptoms: pain flank pain colic hematuria

Nausea and vomiting Abdominal distention from paralytic ileus Chills, high fever and vesical irritability are

due to infection

The history should include a survey of fluid intake, diet ,drugs,periods of immobilization, pervious passage of stones and the presence of gout.

If the stones is still submucosal or adherent to the pareachyma, there are no symptoms.

Staghorn calculus maybe asymptomatic.

B. Signs: Tenderness in the costovertebral angle or over the kidney may or may not be present. If marked hydronephrotic atrophy has occurred, a mass in the flank may be seen , felt or percussed.

C. Laboratory Findings: 1. Blood count 2. Urinalysis 3. Renal function tests:

– Determination of the tubular reabsorption of phosphate (TRP) may prove helpful in the diagnosis of hyperparathyroidism when minimal hypercalcemia and normal blood phosphate levels are obtained.

D. X-rays Findings: At least 90% of renal stonesare radiopaque. KUB+IVP (excretory urograms) are necessary because they accurately localize the calcific shadow. If renal function is poor, retrograde urograms may be needed.

E. Ultrasonography: were able to distinguish between opaque and nonopaque stones.

F. CT.

G. Instrumental Examination: Cystoscopy for diagnostic purposes is seldom necessary.

H. Examination of stones:

Treatment: A. Conservative measures 1. No surgery is necessary in the following

cases. 2. Combating infection 3. Attempts at dissolution

B. Surgical Measures: Removal of the stone is indicated if it is obstructive and causes undue pain or progressive renal damage or if the infection complicating a stone cannot be eradicated.

URETERAL STONE

Ureteral stones originate in the kidney. Ureteral stones are seldom completely obstructive. A stone always be arrested at the narrowed points in the ureter.

Symptoms: Pain : (1) radiating, colicky, agonizing pain (2) The rather constant ache in the costovert

ebral area and flank. Gastrointestinal symptoms (Nausea, Vomiti

ng, abdominal distention) Gross hematuria Chronic infection

Signs

The patient is usually in agony. There is marked tenderness in the costovert

ebral angle and flank. The testis may be hypersensitive

Laboratory Findings: There are the same as far as renal stone

X-ray Findings

A plain film IVP: dilatation of the ureter above the stone

the degree of obstruction. CT scan: make the differentiation from uret

eral tumor or blood clot.

Treatment

A. specific measures B. ESWL C. Surgical treatment D. management of acute symptoms

VESICAL STONE

Relatively painless. Terminal haematuria, dysuria and interruption of urine flow are due to impaction of the stone in the internal urinary meatus during micturition.

Signs

DRE: BPH NEUROGENIC BLADDER

Lab Findings

Blood cells are commonly found in the urine.

X-ray film

Stones Vesicoureteral reflux, particularly in childre

n

Cystoscopy

Ultrasonography

Treatnment

Cystoscopy and surgical removal (transurethral route, suprapubic route)

General Measures. Analgesics for pain Antibiotics Chemical dissolution

Urethral Calculi

Symptoms: 1. Sudden stoppage of urination 2. Dribbling of the urine 3. Reffered pain may be radiate

d to the head of the penis

Diagnosis

1. Palpation of the penis, the perineum or the rectum

2. Panendoscopic examination or roentegenography

3. Grating may be felt upon attepmts to pass a sound

Treatment

Treatment is influenced by the size, shape and position of the calculus and by the status of the urethra