Dr. Abdellatif Zayed Dr. Abdellatif Zayed [email protected] [email protected] UROLITHIASIS UROLITHIASIS
Dr. Abdellatif Zayed [email protected] UROLITHIASIS.
Jan 15, 2016
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Dr Abdellatif ZayedDr Abdellatif ZayedAmzayed_1919yahoocomAmzayed_1919yahoocom
UROLITHIASISUROLITHIASIS
Urinary Stones are the third most Urinary Stones are the third most common affliction of the urinary common affliction of the urinary tract exceeded only by UTI and tract exceeded only by UTI and pathologic conditions of the pathologic conditions of the prostateprostate
2-4 of general population2-4 of general population
Age peak age 20-40 yearsAge peak age 20-40 years
Sex male female = 3-1Sex male female = 3-1
Genetic family history is +ve in Genetic family history is +ve in 25 of recurrent stone cases25 of recurrent stone cases
Climate and TempClimate and Temp
High temp results in concentrated High temp results in concentrated urine and more tendency to urine and more tendency to crystallization crystallization
The highest incidence is 1-2 months The highest incidence is 1-2 months after the maximal mean annual tempafter the maximal mean annual temp
If urinary constituents are similar in If urinary constituents are similar in each kidney and if there is no each kidney and if there is no evidence of obstruction why do most evidence of obstruction why do most stones present in a unilateral stones present in a unilateral fashionfashion
stone recurrence rates can be as high stone recurrence rates can be as high as 50 within 5 yearsas 50 within 5 years
PathogenesisPathogenesis
11Supersaturation theorySupersaturation theory The concentration at which saturation is The concentration at which saturation is reached and crystallization begins is called reached and crystallization begins is called solubility product (Ksp) solubility product (Ksp)
It is affected by temp pH and presence of It is affected by temp pH and presence of other substances in solution other substances in solution
Any conditions that makes the urine more Any conditions that makes the urine more concentrated may lead to stone formationconcentrated may lead to stone formation
2 Inhibitors lack 2 Inhibitors lack disturbed colloid-crystalloid ratio such as disturbed colloid-crystalloid ratio such as mucin and nucleic acid and Citrate Mgmucin and nucleic acid and Citrate Mg
3 Matrix Theory3 Matrix TheoryUnlike stones on the road In each little Unlike stones on the road In each little stone there is an organic scaffold stone there is an organic scaffold supporting the fill of crystalline supporting the fill of crystalline precipitateprecipitate
The amount of the noncrystalline The amount of the noncrystalline matrix component of urinary stones matrix component of urinary stones ranges from 2 to 10 by weight ranges from 2 to 10 by weight
A matrix stone can be associated with A matrix stone can be associated with chronic UTI and has a gelatinous chronic UTI and has a gelatinous texturetexture
Matrix stones are usually radiolucent Matrix stones are usually radiolucent (DD clots tumors and fungal balls) (DD clots tumors and fungal balls)
Types of the Types of the StoneStone
Most of stones are mixedMost of stones are mixed11 Calcium Oxalate stoneCalcium Oxalate stone22 Calcium phosphate stoneCalcium phosphate stone33 Uric acid stone (5 of cases Uric acid stone (5 of cases
Radiolucent)Radiolucent)44 Struvite or infection stone (MAP)Struvite or infection stone (MAP)55 Cystine stone (1 of all cases Familial Cystine stone (1 of all cases Familial
Radio-opaque because it contain Radio-opaque because it contain sulphur)sulphur)
Risk FactorsRisk Factors
11 Excess Calcium in urineExcess Calcium in urine Idiopathic hypercalcuriaIdiopathic hypercalcuria HyperparathyroidismHyperparathyroidism Losing Calcium because of inactivity Losing Calcium because of inactivity
22 Excess Oxalate in urineExcess Oxalate in urine Congenital Hyperoxaluria (rare Congenital Hyperoxaluria (rare
disease) disease) Surgical removal or illness of last Surgical removal or illness of last
feets of ileum feets of ileum
33 Hyperuricosuria (uric acid stone)Hyperuricosuria (uric acid stone)
Congenital error of tubular functionCongenital error of tubular function
Gout (Hyperuricemia)Gout (Hyperuricemia)
Breaking down of large volume of Breaking down of large volume of protein eg Bulky tumors and protein eg Bulky tumors and Chemotherapy Chemotherapy
33 UTIs due to urease producing organisms such UTIs due to urease producing organisms such as Proteus or Klebseilla (Struvite or infection as Proteus or Klebseilla (Struvite or infection stone)stone)
The high ammonium results in an alkaline The high ammonium results in an alkaline urineurine
Magnesium-Ammonium- Phosphate (MAP) is Magnesium-Ammonium- Phosphate (MAP) is insoluble in alkaline urine insoluble in alkaline urine
It grows at high rate (Stag-Horn stone)It grows at high rate (Stag-Horn stone)
Clinical featuresClinical features
2 discovered 2 discovered accidentallyaccidentally
Renal painRenal pain HematuriaHematuria GIT symptoms (nausea GIT symptoms (nausea
vomiting) due to vomiting) due to common innervations common innervations by celiac trunkby celiac trunk
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Urinary Stones are the third most Urinary Stones are the third most common affliction of the urinary common affliction of the urinary tract exceeded only by UTI and tract exceeded only by UTI and pathologic conditions of the pathologic conditions of the prostateprostate
2-4 of general population2-4 of general population
Age peak age 20-40 yearsAge peak age 20-40 years
Sex male female = 3-1Sex male female = 3-1
Genetic family history is +ve in Genetic family history is +ve in 25 of recurrent stone cases25 of recurrent stone cases
Climate and TempClimate and Temp
High temp results in concentrated High temp results in concentrated urine and more tendency to urine and more tendency to crystallization crystallization
The highest incidence is 1-2 months The highest incidence is 1-2 months after the maximal mean annual tempafter the maximal mean annual temp
If urinary constituents are similar in If urinary constituents are similar in each kidney and if there is no each kidney and if there is no evidence of obstruction why do most evidence of obstruction why do most stones present in a unilateral stones present in a unilateral fashionfashion
stone recurrence rates can be as high stone recurrence rates can be as high as 50 within 5 yearsas 50 within 5 years
PathogenesisPathogenesis
11Supersaturation theorySupersaturation theory The concentration at which saturation is The concentration at which saturation is reached and crystallization begins is called reached and crystallization begins is called solubility product (Ksp) solubility product (Ksp)
It is affected by temp pH and presence of It is affected by temp pH and presence of other substances in solution other substances in solution
Any conditions that makes the urine more Any conditions that makes the urine more concentrated may lead to stone formationconcentrated may lead to stone formation
2 Inhibitors lack 2 Inhibitors lack disturbed colloid-crystalloid ratio such as disturbed colloid-crystalloid ratio such as mucin and nucleic acid and Citrate Mgmucin and nucleic acid and Citrate Mg
3 Matrix Theory3 Matrix TheoryUnlike stones on the road In each little Unlike stones on the road In each little stone there is an organic scaffold stone there is an organic scaffold supporting the fill of crystalline supporting the fill of crystalline precipitateprecipitate
The amount of the noncrystalline The amount of the noncrystalline matrix component of urinary stones matrix component of urinary stones ranges from 2 to 10 by weight ranges from 2 to 10 by weight
A matrix stone can be associated with A matrix stone can be associated with chronic UTI and has a gelatinous chronic UTI and has a gelatinous texturetexture
Matrix stones are usually radiolucent Matrix stones are usually radiolucent (DD clots tumors and fungal balls) (DD clots tumors and fungal balls)
Types of the Types of the StoneStone
Most of stones are mixedMost of stones are mixed11 Calcium Oxalate stoneCalcium Oxalate stone22 Calcium phosphate stoneCalcium phosphate stone33 Uric acid stone (5 of cases Uric acid stone (5 of cases
Radiolucent)Radiolucent)44 Struvite or infection stone (MAP)Struvite or infection stone (MAP)55 Cystine stone (1 of all cases Familial Cystine stone (1 of all cases Familial
Radio-opaque because it contain Radio-opaque because it contain sulphur)sulphur)
Risk FactorsRisk Factors
11 Excess Calcium in urineExcess Calcium in urine Idiopathic hypercalcuriaIdiopathic hypercalcuria HyperparathyroidismHyperparathyroidism Losing Calcium because of inactivity Losing Calcium because of inactivity
22 Excess Oxalate in urineExcess Oxalate in urine Congenital Hyperoxaluria (rare Congenital Hyperoxaluria (rare
disease) disease) Surgical removal or illness of last Surgical removal or illness of last
feets of ileum feets of ileum
33 Hyperuricosuria (uric acid stone)Hyperuricosuria (uric acid stone)
Congenital error of tubular functionCongenital error of tubular function
Gout (Hyperuricemia)Gout (Hyperuricemia)
Breaking down of large volume of Breaking down of large volume of protein eg Bulky tumors and protein eg Bulky tumors and Chemotherapy Chemotherapy
33 UTIs due to urease producing organisms such UTIs due to urease producing organisms such as Proteus or Klebseilla (Struvite or infection as Proteus or Klebseilla (Struvite or infection stone)stone)
The high ammonium results in an alkaline The high ammonium results in an alkaline urineurine
Magnesium-Ammonium- Phosphate (MAP) is Magnesium-Ammonium- Phosphate (MAP) is insoluble in alkaline urine insoluble in alkaline urine
It grows at high rate (Stag-Horn stone)It grows at high rate (Stag-Horn stone)
Clinical featuresClinical features
2 discovered 2 discovered accidentallyaccidentally
Renal painRenal pain HematuriaHematuria GIT symptoms (nausea GIT symptoms (nausea
vomiting) due to vomiting) due to common innervations common innervations by celiac trunkby celiac trunk
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Age peak age 20-40 yearsAge peak age 20-40 years
Sex male female = 3-1Sex male female = 3-1
Genetic family history is +ve in Genetic family history is +ve in 25 of recurrent stone cases25 of recurrent stone cases
Climate and TempClimate and Temp
High temp results in concentrated High temp results in concentrated urine and more tendency to urine and more tendency to crystallization crystallization
The highest incidence is 1-2 months The highest incidence is 1-2 months after the maximal mean annual tempafter the maximal mean annual temp
If urinary constituents are similar in If urinary constituents are similar in each kidney and if there is no each kidney and if there is no evidence of obstruction why do most evidence of obstruction why do most stones present in a unilateral stones present in a unilateral fashionfashion
stone recurrence rates can be as high stone recurrence rates can be as high as 50 within 5 yearsas 50 within 5 years
PathogenesisPathogenesis
11Supersaturation theorySupersaturation theory The concentration at which saturation is The concentration at which saturation is reached and crystallization begins is called reached and crystallization begins is called solubility product (Ksp) solubility product (Ksp)
It is affected by temp pH and presence of It is affected by temp pH and presence of other substances in solution other substances in solution
Any conditions that makes the urine more Any conditions that makes the urine more concentrated may lead to stone formationconcentrated may lead to stone formation
2 Inhibitors lack 2 Inhibitors lack disturbed colloid-crystalloid ratio such as disturbed colloid-crystalloid ratio such as mucin and nucleic acid and Citrate Mgmucin and nucleic acid and Citrate Mg
3 Matrix Theory3 Matrix TheoryUnlike stones on the road In each little Unlike stones on the road In each little stone there is an organic scaffold stone there is an organic scaffold supporting the fill of crystalline supporting the fill of crystalline precipitateprecipitate
The amount of the noncrystalline The amount of the noncrystalline matrix component of urinary stones matrix component of urinary stones ranges from 2 to 10 by weight ranges from 2 to 10 by weight
A matrix stone can be associated with A matrix stone can be associated with chronic UTI and has a gelatinous chronic UTI and has a gelatinous texturetexture
Matrix stones are usually radiolucent Matrix stones are usually radiolucent (DD clots tumors and fungal balls) (DD clots tumors and fungal balls)
Types of the Types of the StoneStone
Most of stones are mixedMost of stones are mixed11 Calcium Oxalate stoneCalcium Oxalate stone22 Calcium phosphate stoneCalcium phosphate stone33 Uric acid stone (5 of cases Uric acid stone (5 of cases
Radiolucent)Radiolucent)44 Struvite or infection stone (MAP)Struvite or infection stone (MAP)55 Cystine stone (1 of all cases Familial Cystine stone (1 of all cases Familial
Radio-opaque because it contain Radio-opaque because it contain sulphur)sulphur)
Risk FactorsRisk Factors
11 Excess Calcium in urineExcess Calcium in urine Idiopathic hypercalcuriaIdiopathic hypercalcuria HyperparathyroidismHyperparathyroidism Losing Calcium because of inactivity Losing Calcium because of inactivity
22 Excess Oxalate in urineExcess Oxalate in urine Congenital Hyperoxaluria (rare Congenital Hyperoxaluria (rare
disease) disease) Surgical removal or illness of last Surgical removal or illness of last
feets of ileum feets of ileum
33 Hyperuricosuria (uric acid stone)Hyperuricosuria (uric acid stone)
Congenital error of tubular functionCongenital error of tubular function
Gout (Hyperuricemia)Gout (Hyperuricemia)
Breaking down of large volume of Breaking down of large volume of protein eg Bulky tumors and protein eg Bulky tumors and Chemotherapy Chemotherapy
33 UTIs due to urease producing organisms such UTIs due to urease producing organisms such as Proteus or Klebseilla (Struvite or infection as Proteus or Klebseilla (Struvite or infection stone)stone)
The high ammonium results in an alkaline The high ammonium results in an alkaline urineurine
Magnesium-Ammonium- Phosphate (MAP) is Magnesium-Ammonium- Phosphate (MAP) is insoluble in alkaline urine insoluble in alkaline urine
It grows at high rate (Stag-Horn stone)It grows at high rate (Stag-Horn stone)
Clinical featuresClinical features
2 discovered 2 discovered accidentallyaccidentally
Renal painRenal pain HematuriaHematuria GIT symptoms (nausea GIT symptoms (nausea
vomiting) due to vomiting) due to common innervations common innervations by celiac trunkby celiac trunk
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Climate and TempClimate and Temp
High temp results in concentrated High temp results in concentrated urine and more tendency to urine and more tendency to crystallization crystallization
The highest incidence is 1-2 months The highest incidence is 1-2 months after the maximal mean annual tempafter the maximal mean annual temp
If urinary constituents are similar in If urinary constituents are similar in each kidney and if there is no each kidney and if there is no evidence of obstruction why do most evidence of obstruction why do most stones present in a unilateral stones present in a unilateral fashionfashion
stone recurrence rates can be as high stone recurrence rates can be as high as 50 within 5 yearsas 50 within 5 years
PathogenesisPathogenesis
11Supersaturation theorySupersaturation theory The concentration at which saturation is The concentration at which saturation is reached and crystallization begins is called reached and crystallization begins is called solubility product (Ksp) solubility product (Ksp)
It is affected by temp pH and presence of It is affected by temp pH and presence of other substances in solution other substances in solution
Any conditions that makes the urine more Any conditions that makes the urine more concentrated may lead to stone formationconcentrated may lead to stone formation
2 Inhibitors lack 2 Inhibitors lack disturbed colloid-crystalloid ratio such as disturbed colloid-crystalloid ratio such as mucin and nucleic acid and Citrate Mgmucin and nucleic acid and Citrate Mg
3 Matrix Theory3 Matrix TheoryUnlike stones on the road In each little Unlike stones on the road In each little stone there is an organic scaffold stone there is an organic scaffold supporting the fill of crystalline supporting the fill of crystalline precipitateprecipitate
The amount of the noncrystalline The amount of the noncrystalline matrix component of urinary stones matrix component of urinary stones ranges from 2 to 10 by weight ranges from 2 to 10 by weight
A matrix stone can be associated with A matrix stone can be associated with chronic UTI and has a gelatinous chronic UTI and has a gelatinous texturetexture
Matrix stones are usually radiolucent Matrix stones are usually radiolucent (DD clots tumors and fungal balls) (DD clots tumors and fungal balls)
Types of the Types of the StoneStone
Most of stones are mixedMost of stones are mixed11 Calcium Oxalate stoneCalcium Oxalate stone22 Calcium phosphate stoneCalcium phosphate stone33 Uric acid stone (5 of cases Uric acid stone (5 of cases
Radiolucent)Radiolucent)44 Struvite or infection stone (MAP)Struvite or infection stone (MAP)55 Cystine stone (1 of all cases Familial Cystine stone (1 of all cases Familial
Radio-opaque because it contain Radio-opaque because it contain sulphur)sulphur)
Risk FactorsRisk Factors
11 Excess Calcium in urineExcess Calcium in urine Idiopathic hypercalcuriaIdiopathic hypercalcuria HyperparathyroidismHyperparathyroidism Losing Calcium because of inactivity Losing Calcium because of inactivity
22 Excess Oxalate in urineExcess Oxalate in urine Congenital Hyperoxaluria (rare Congenital Hyperoxaluria (rare
disease) disease) Surgical removal or illness of last Surgical removal or illness of last
feets of ileum feets of ileum
33 Hyperuricosuria (uric acid stone)Hyperuricosuria (uric acid stone)
Congenital error of tubular functionCongenital error of tubular function
Gout (Hyperuricemia)Gout (Hyperuricemia)
Breaking down of large volume of Breaking down of large volume of protein eg Bulky tumors and protein eg Bulky tumors and Chemotherapy Chemotherapy
33 UTIs due to urease producing organisms such UTIs due to urease producing organisms such as Proteus or Klebseilla (Struvite or infection as Proteus or Klebseilla (Struvite or infection stone)stone)
The high ammonium results in an alkaline The high ammonium results in an alkaline urineurine
Magnesium-Ammonium- Phosphate (MAP) is Magnesium-Ammonium- Phosphate (MAP) is insoluble in alkaline urine insoluble in alkaline urine
It grows at high rate (Stag-Horn stone)It grows at high rate (Stag-Horn stone)
Clinical featuresClinical features
2 discovered 2 discovered accidentallyaccidentally
Renal painRenal pain HematuriaHematuria GIT symptoms (nausea GIT symptoms (nausea
vomiting) due to vomiting) due to common innervations common innervations by celiac trunkby celiac trunk
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
If urinary constituents are similar in If urinary constituents are similar in each kidney and if there is no each kidney and if there is no evidence of obstruction why do most evidence of obstruction why do most stones present in a unilateral stones present in a unilateral fashionfashion
stone recurrence rates can be as high stone recurrence rates can be as high as 50 within 5 yearsas 50 within 5 years
PathogenesisPathogenesis
11Supersaturation theorySupersaturation theory The concentration at which saturation is The concentration at which saturation is reached and crystallization begins is called reached and crystallization begins is called solubility product (Ksp) solubility product (Ksp)
It is affected by temp pH and presence of It is affected by temp pH and presence of other substances in solution other substances in solution
Any conditions that makes the urine more Any conditions that makes the urine more concentrated may lead to stone formationconcentrated may lead to stone formation
2 Inhibitors lack 2 Inhibitors lack disturbed colloid-crystalloid ratio such as disturbed colloid-crystalloid ratio such as mucin and nucleic acid and Citrate Mgmucin and nucleic acid and Citrate Mg
3 Matrix Theory3 Matrix TheoryUnlike stones on the road In each little Unlike stones on the road In each little stone there is an organic scaffold stone there is an organic scaffold supporting the fill of crystalline supporting the fill of crystalline precipitateprecipitate
The amount of the noncrystalline The amount of the noncrystalline matrix component of urinary stones matrix component of urinary stones ranges from 2 to 10 by weight ranges from 2 to 10 by weight
A matrix stone can be associated with A matrix stone can be associated with chronic UTI and has a gelatinous chronic UTI and has a gelatinous texturetexture
Matrix stones are usually radiolucent Matrix stones are usually radiolucent (DD clots tumors and fungal balls) (DD clots tumors and fungal balls)
Types of the Types of the StoneStone
Most of stones are mixedMost of stones are mixed11 Calcium Oxalate stoneCalcium Oxalate stone22 Calcium phosphate stoneCalcium phosphate stone33 Uric acid stone (5 of cases Uric acid stone (5 of cases
Radiolucent)Radiolucent)44 Struvite or infection stone (MAP)Struvite or infection stone (MAP)55 Cystine stone (1 of all cases Familial Cystine stone (1 of all cases Familial
Radio-opaque because it contain Radio-opaque because it contain sulphur)sulphur)
Risk FactorsRisk Factors
11 Excess Calcium in urineExcess Calcium in urine Idiopathic hypercalcuriaIdiopathic hypercalcuria HyperparathyroidismHyperparathyroidism Losing Calcium because of inactivity Losing Calcium because of inactivity
22 Excess Oxalate in urineExcess Oxalate in urine Congenital Hyperoxaluria (rare Congenital Hyperoxaluria (rare
disease) disease) Surgical removal or illness of last Surgical removal or illness of last
feets of ileum feets of ileum
33 Hyperuricosuria (uric acid stone)Hyperuricosuria (uric acid stone)
Congenital error of tubular functionCongenital error of tubular function
Gout (Hyperuricemia)Gout (Hyperuricemia)
Breaking down of large volume of Breaking down of large volume of protein eg Bulky tumors and protein eg Bulky tumors and Chemotherapy Chemotherapy
33 UTIs due to urease producing organisms such UTIs due to urease producing organisms such as Proteus or Klebseilla (Struvite or infection as Proteus or Klebseilla (Struvite or infection stone)stone)
The high ammonium results in an alkaline The high ammonium results in an alkaline urineurine
Magnesium-Ammonium- Phosphate (MAP) is Magnesium-Ammonium- Phosphate (MAP) is insoluble in alkaline urine insoluble in alkaline urine
It grows at high rate (Stag-Horn stone)It grows at high rate (Stag-Horn stone)
Clinical featuresClinical features
2 discovered 2 discovered accidentallyaccidentally
Renal painRenal pain HematuriaHematuria GIT symptoms (nausea GIT symptoms (nausea
vomiting) due to vomiting) due to common innervations common innervations by celiac trunkby celiac trunk
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
PathogenesisPathogenesis
11Supersaturation theorySupersaturation theory The concentration at which saturation is The concentration at which saturation is reached and crystallization begins is called reached and crystallization begins is called solubility product (Ksp) solubility product (Ksp)
It is affected by temp pH and presence of It is affected by temp pH and presence of other substances in solution other substances in solution
Any conditions that makes the urine more Any conditions that makes the urine more concentrated may lead to stone formationconcentrated may lead to stone formation
2 Inhibitors lack 2 Inhibitors lack disturbed colloid-crystalloid ratio such as disturbed colloid-crystalloid ratio such as mucin and nucleic acid and Citrate Mgmucin and nucleic acid and Citrate Mg
3 Matrix Theory3 Matrix TheoryUnlike stones on the road In each little Unlike stones on the road In each little stone there is an organic scaffold stone there is an organic scaffold supporting the fill of crystalline supporting the fill of crystalline precipitateprecipitate
The amount of the noncrystalline The amount of the noncrystalline matrix component of urinary stones matrix component of urinary stones ranges from 2 to 10 by weight ranges from 2 to 10 by weight
A matrix stone can be associated with A matrix stone can be associated with chronic UTI and has a gelatinous chronic UTI and has a gelatinous texturetexture
Matrix stones are usually radiolucent Matrix stones are usually radiolucent (DD clots tumors and fungal balls) (DD clots tumors and fungal balls)
Types of the Types of the StoneStone
Most of stones are mixedMost of stones are mixed11 Calcium Oxalate stoneCalcium Oxalate stone22 Calcium phosphate stoneCalcium phosphate stone33 Uric acid stone (5 of cases Uric acid stone (5 of cases
Radiolucent)Radiolucent)44 Struvite or infection stone (MAP)Struvite or infection stone (MAP)55 Cystine stone (1 of all cases Familial Cystine stone (1 of all cases Familial
Radio-opaque because it contain Radio-opaque because it contain sulphur)sulphur)
Risk FactorsRisk Factors
11 Excess Calcium in urineExcess Calcium in urine Idiopathic hypercalcuriaIdiopathic hypercalcuria HyperparathyroidismHyperparathyroidism Losing Calcium because of inactivity Losing Calcium because of inactivity
22 Excess Oxalate in urineExcess Oxalate in urine Congenital Hyperoxaluria (rare Congenital Hyperoxaluria (rare
disease) disease) Surgical removal or illness of last Surgical removal or illness of last
feets of ileum feets of ileum
33 Hyperuricosuria (uric acid stone)Hyperuricosuria (uric acid stone)
Congenital error of tubular functionCongenital error of tubular function
Gout (Hyperuricemia)Gout (Hyperuricemia)
Breaking down of large volume of Breaking down of large volume of protein eg Bulky tumors and protein eg Bulky tumors and Chemotherapy Chemotherapy
33 UTIs due to urease producing organisms such UTIs due to urease producing organisms such as Proteus or Klebseilla (Struvite or infection as Proteus or Klebseilla (Struvite or infection stone)stone)
The high ammonium results in an alkaline The high ammonium results in an alkaline urineurine
Magnesium-Ammonium- Phosphate (MAP) is Magnesium-Ammonium- Phosphate (MAP) is insoluble in alkaline urine insoluble in alkaline urine
It grows at high rate (Stag-Horn stone)It grows at high rate (Stag-Horn stone)
Clinical featuresClinical features
2 discovered 2 discovered accidentallyaccidentally
Renal painRenal pain HematuriaHematuria GIT symptoms (nausea GIT symptoms (nausea
vomiting) due to vomiting) due to common innervations common innervations by celiac trunkby celiac trunk
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
2 Inhibitors lack 2 Inhibitors lack disturbed colloid-crystalloid ratio such as disturbed colloid-crystalloid ratio such as mucin and nucleic acid and Citrate Mgmucin and nucleic acid and Citrate Mg
3 Matrix Theory3 Matrix TheoryUnlike stones on the road In each little Unlike stones on the road In each little stone there is an organic scaffold stone there is an organic scaffold supporting the fill of crystalline supporting the fill of crystalline precipitateprecipitate
The amount of the noncrystalline The amount of the noncrystalline matrix component of urinary stones matrix component of urinary stones ranges from 2 to 10 by weight ranges from 2 to 10 by weight
A matrix stone can be associated with A matrix stone can be associated with chronic UTI and has a gelatinous chronic UTI and has a gelatinous texturetexture
Matrix stones are usually radiolucent Matrix stones are usually radiolucent (DD clots tumors and fungal balls) (DD clots tumors and fungal balls)
Types of the Types of the StoneStone
Most of stones are mixedMost of stones are mixed11 Calcium Oxalate stoneCalcium Oxalate stone22 Calcium phosphate stoneCalcium phosphate stone33 Uric acid stone (5 of cases Uric acid stone (5 of cases
Radiolucent)Radiolucent)44 Struvite or infection stone (MAP)Struvite or infection stone (MAP)55 Cystine stone (1 of all cases Familial Cystine stone (1 of all cases Familial
Radio-opaque because it contain Radio-opaque because it contain sulphur)sulphur)
Risk FactorsRisk Factors
11 Excess Calcium in urineExcess Calcium in urine Idiopathic hypercalcuriaIdiopathic hypercalcuria HyperparathyroidismHyperparathyroidism Losing Calcium because of inactivity Losing Calcium because of inactivity
22 Excess Oxalate in urineExcess Oxalate in urine Congenital Hyperoxaluria (rare Congenital Hyperoxaluria (rare
disease) disease) Surgical removal or illness of last Surgical removal or illness of last
feets of ileum feets of ileum
33 Hyperuricosuria (uric acid stone)Hyperuricosuria (uric acid stone)
Congenital error of tubular functionCongenital error of tubular function
Gout (Hyperuricemia)Gout (Hyperuricemia)
Breaking down of large volume of Breaking down of large volume of protein eg Bulky tumors and protein eg Bulky tumors and Chemotherapy Chemotherapy
33 UTIs due to urease producing organisms such UTIs due to urease producing organisms such as Proteus or Klebseilla (Struvite or infection as Proteus or Klebseilla (Struvite or infection stone)stone)
The high ammonium results in an alkaline The high ammonium results in an alkaline urineurine
Magnesium-Ammonium- Phosphate (MAP) is Magnesium-Ammonium- Phosphate (MAP) is insoluble in alkaline urine insoluble in alkaline urine
It grows at high rate (Stag-Horn stone)It grows at high rate (Stag-Horn stone)
Clinical featuresClinical features
2 discovered 2 discovered accidentallyaccidentally
Renal painRenal pain HematuriaHematuria GIT symptoms (nausea GIT symptoms (nausea
vomiting) due to vomiting) due to common innervations common innervations by celiac trunkby celiac trunk
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
The amount of the noncrystalline The amount of the noncrystalline matrix component of urinary stones matrix component of urinary stones ranges from 2 to 10 by weight ranges from 2 to 10 by weight
A matrix stone can be associated with A matrix stone can be associated with chronic UTI and has a gelatinous chronic UTI and has a gelatinous texturetexture
Matrix stones are usually radiolucent Matrix stones are usually radiolucent (DD clots tumors and fungal balls) (DD clots tumors and fungal balls)
Types of the Types of the StoneStone
Most of stones are mixedMost of stones are mixed11 Calcium Oxalate stoneCalcium Oxalate stone22 Calcium phosphate stoneCalcium phosphate stone33 Uric acid stone (5 of cases Uric acid stone (5 of cases
Radiolucent)Radiolucent)44 Struvite or infection stone (MAP)Struvite or infection stone (MAP)55 Cystine stone (1 of all cases Familial Cystine stone (1 of all cases Familial
Radio-opaque because it contain Radio-opaque because it contain sulphur)sulphur)
Risk FactorsRisk Factors
11 Excess Calcium in urineExcess Calcium in urine Idiopathic hypercalcuriaIdiopathic hypercalcuria HyperparathyroidismHyperparathyroidism Losing Calcium because of inactivity Losing Calcium because of inactivity
22 Excess Oxalate in urineExcess Oxalate in urine Congenital Hyperoxaluria (rare Congenital Hyperoxaluria (rare
disease) disease) Surgical removal or illness of last Surgical removal or illness of last
feets of ileum feets of ileum
33 Hyperuricosuria (uric acid stone)Hyperuricosuria (uric acid stone)
Congenital error of tubular functionCongenital error of tubular function
Gout (Hyperuricemia)Gout (Hyperuricemia)
Breaking down of large volume of Breaking down of large volume of protein eg Bulky tumors and protein eg Bulky tumors and Chemotherapy Chemotherapy
33 UTIs due to urease producing organisms such UTIs due to urease producing organisms such as Proteus or Klebseilla (Struvite or infection as Proteus or Klebseilla (Struvite or infection stone)stone)
The high ammonium results in an alkaline The high ammonium results in an alkaline urineurine
Magnesium-Ammonium- Phosphate (MAP) is Magnesium-Ammonium- Phosphate (MAP) is insoluble in alkaline urine insoluble in alkaline urine
It grows at high rate (Stag-Horn stone)It grows at high rate (Stag-Horn stone)
Clinical featuresClinical features
2 discovered 2 discovered accidentallyaccidentally
Renal painRenal pain HematuriaHematuria GIT symptoms (nausea GIT symptoms (nausea
vomiting) due to vomiting) due to common innervations common innervations by celiac trunkby celiac trunk
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Types of the Types of the StoneStone
Most of stones are mixedMost of stones are mixed11 Calcium Oxalate stoneCalcium Oxalate stone22 Calcium phosphate stoneCalcium phosphate stone33 Uric acid stone (5 of cases Uric acid stone (5 of cases
Radiolucent)Radiolucent)44 Struvite or infection stone (MAP)Struvite or infection stone (MAP)55 Cystine stone (1 of all cases Familial Cystine stone (1 of all cases Familial
Radio-opaque because it contain Radio-opaque because it contain sulphur)sulphur)
Risk FactorsRisk Factors
11 Excess Calcium in urineExcess Calcium in urine Idiopathic hypercalcuriaIdiopathic hypercalcuria HyperparathyroidismHyperparathyroidism Losing Calcium because of inactivity Losing Calcium because of inactivity
22 Excess Oxalate in urineExcess Oxalate in urine Congenital Hyperoxaluria (rare Congenital Hyperoxaluria (rare
disease) disease) Surgical removal or illness of last Surgical removal or illness of last
feets of ileum feets of ileum
33 Hyperuricosuria (uric acid stone)Hyperuricosuria (uric acid stone)
Congenital error of tubular functionCongenital error of tubular function
Gout (Hyperuricemia)Gout (Hyperuricemia)
Breaking down of large volume of Breaking down of large volume of protein eg Bulky tumors and protein eg Bulky tumors and Chemotherapy Chemotherapy
33 UTIs due to urease producing organisms such UTIs due to urease producing organisms such as Proteus or Klebseilla (Struvite or infection as Proteus or Klebseilla (Struvite or infection stone)stone)
The high ammonium results in an alkaline The high ammonium results in an alkaline urineurine
Magnesium-Ammonium- Phosphate (MAP) is Magnesium-Ammonium- Phosphate (MAP) is insoluble in alkaline urine insoluble in alkaline urine
It grows at high rate (Stag-Horn stone)It grows at high rate (Stag-Horn stone)
Clinical featuresClinical features
2 discovered 2 discovered accidentallyaccidentally
Renal painRenal pain HematuriaHematuria GIT symptoms (nausea GIT symptoms (nausea
vomiting) due to vomiting) due to common innervations common innervations by celiac trunkby celiac trunk
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Risk FactorsRisk Factors
11 Excess Calcium in urineExcess Calcium in urine Idiopathic hypercalcuriaIdiopathic hypercalcuria HyperparathyroidismHyperparathyroidism Losing Calcium because of inactivity Losing Calcium because of inactivity
22 Excess Oxalate in urineExcess Oxalate in urine Congenital Hyperoxaluria (rare Congenital Hyperoxaluria (rare
disease) disease) Surgical removal or illness of last Surgical removal or illness of last
feets of ileum feets of ileum
33 Hyperuricosuria (uric acid stone)Hyperuricosuria (uric acid stone)
Congenital error of tubular functionCongenital error of tubular function
Gout (Hyperuricemia)Gout (Hyperuricemia)
Breaking down of large volume of Breaking down of large volume of protein eg Bulky tumors and protein eg Bulky tumors and Chemotherapy Chemotherapy
33 UTIs due to urease producing organisms such UTIs due to urease producing organisms such as Proteus or Klebseilla (Struvite or infection as Proteus or Klebseilla (Struvite or infection stone)stone)
The high ammonium results in an alkaline The high ammonium results in an alkaline urineurine
Magnesium-Ammonium- Phosphate (MAP) is Magnesium-Ammonium- Phosphate (MAP) is insoluble in alkaline urine insoluble in alkaline urine
It grows at high rate (Stag-Horn stone)It grows at high rate (Stag-Horn stone)
Clinical featuresClinical features
2 discovered 2 discovered accidentallyaccidentally
Renal painRenal pain HematuriaHematuria GIT symptoms (nausea GIT symptoms (nausea
vomiting) due to vomiting) due to common innervations common innervations by celiac trunkby celiac trunk
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
33 Hyperuricosuria (uric acid stone)Hyperuricosuria (uric acid stone)
Congenital error of tubular functionCongenital error of tubular function
Gout (Hyperuricemia)Gout (Hyperuricemia)
Breaking down of large volume of Breaking down of large volume of protein eg Bulky tumors and protein eg Bulky tumors and Chemotherapy Chemotherapy
33 UTIs due to urease producing organisms such UTIs due to urease producing organisms such as Proteus or Klebseilla (Struvite or infection as Proteus or Klebseilla (Struvite or infection stone)stone)
The high ammonium results in an alkaline The high ammonium results in an alkaline urineurine
Magnesium-Ammonium- Phosphate (MAP) is Magnesium-Ammonium- Phosphate (MAP) is insoluble in alkaline urine insoluble in alkaline urine
It grows at high rate (Stag-Horn stone)It grows at high rate (Stag-Horn stone)
Clinical featuresClinical features
2 discovered 2 discovered accidentallyaccidentally
Renal painRenal pain HematuriaHematuria GIT symptoms (nausea GIT symptoms (nausea
vomiting) due to vomiting) due to common innervations common innervations by celiac trunkby celiac trunk
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
33 UTIs due to urease producing organisms such UTIs due to urease producing organisms such as Proteus or Klebseilla (Struvite or infection as Proteus or Klebseilla (Struvite or infection stone)stone)
The high ammonium results in an alkaline The high ammonium results in an alkaline urineurine
Magnesium-Ammonium- Phosphate (MAP) is Magnesium-Ammonium- Phosphate (MAP) is insoluble in alkaline urine insoluble in alkaline urine
It grows at high rate (Stag-Horn stone)It grows at high rate (Stag-Horn stone)
Clinical featuresClinical features
2 discovered 2 discovered accidentallyaccidentally
Renal painRenal pain HematuriaHematuria GIT symptoms (nausea GIT symptoms (nausea
vomiting) due to vomiting) due to common innervations common innervations by celiac trunkby celiac trunk
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Clinical featuresClinical features
2 discovered 2 discovered accidentallyaccidentally
Renal painRenal pain HematuriaHematuria GIT symptoms (nausea GIT symptoms (nausea
vomiting) due to vomiting) due to common innervations common innervations by celiac trunkby celiac trunk
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Lab investigationsLab investigations
11 Blood tests routine chemistries + serum Ca + uric Blood tests routine chemistries + serum Ca + uric acidacid
22 UrinalysisUrinalysis 1048715 1048715 Ph gt 7 + phosphate crystals suggests calcium Ph gt 7 + phosphate crystals suggests calcium
phosphate or struvite calculiphosphate or struvite calculi
Hexagonal cystine crystals is diagnostic for Hexagonal cystine crystals is diagnostic for cystinuriacystinuria
Uric acid crystals and calcium oxalate crystals are Uric acid crystals and calcium oxalate crystals are
often normaloften normal
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Radiology InvestigationsRadiology Investigations
11 KUB will identify radiopaque stones KUB will identify radiopaque stones but will miss radiolucent stones and but will miss radiolucent stones and will not detect obstructionwill not detect obstruction
22 US can detect radiolucent stones US can detect radiolucent stones but may miss small stones and but may miss small stones and uretral stonesuretral stones
Combination US amp KUB Combination US amp KUB comparable to non contrast spiral comparable to non contrast spiral CTCT
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
33IVUIVU
bull Not useful if the kidney is not functioning Not useful if the kidney is not functioning or during pain or during pain
bull NephrotoxicNephrotoxic
bull Contraindicated if serum creatinine Contraindicated if serum creatinine gt25mgdl gt25mgdl
bull Allergic reactions to contrast is commonAllergic reactions to contrast is common
bull Takes longer time than CTTakes longer time than CT
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
44 Spiral CTSpiral CT The imaging of choice in The imaging of choice in
patients with renal colic patients with renal colic
No contrast complicationsNo contrast complications
bull No need to asses kidney No need to asses kidney function before use function before use
bull May show other causes of May show other causes of acute abdominal pain acute abdominal pain
bull It can predict stone fragility It can predict stone fragility
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
During the attack of renal colicDuring the attack of renal colic Parentral strong analgesicParentral strong analgesic Pain Killer eg Pethdine or morphinePain Killer eg Pethdine or morphine
In between the attackIn between the attack Plenty of oral fluidPlenty of oral fluid Alkalization of urine except in cases Alkalization of urine except in cases
of infection stoneof infection stone
TreatmentTreatment
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Spontaneous passage depends on Spontaneous passage depends on stone size shape location and stone size shape location and associated ureteral edemaassociated ureteral edema
Ureteral calculi 5 mm in size have a Ureteral calculi 5 mm in size have a 50 chance of spontaneous passage 50 chance of spontaneous passage In contrast calculi gt6 mm have a In contrast calculi gt6 mm have a lt5 chance of spontaneous passagelt5 chance of spontaneous passage
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Causes painCauses pain Causes obstructionCauses obstruction Associated with infectionAssociated with infection
Lines of treatmentLines of treatment11 ESWLESWL22 PCNLPCNL33 Open SurgeryOpen Surgery44 NephrectomyNephrectomy
Should the stone be removedShould the stone be removed
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
ESWLESWL
Such shock waves occur in naturemdashthe Such shock waves occur in naturemdashthe familiar thunderstorm with lightning familiar thunderstorm with lightning (an electrical discharge) followed by (an electrical discharge) followed by thunder (an acoustic sonic boom) is an thunder (an acoustic sonic boom) is an analogous situationanalogous situation
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
ESWLESWL
A shock wave created A shock wave created by electric explosion by electric explosion focused on the stone focused on the stone the stone broken into the stone broken into small fragments that small fragments that pass spontaneouslypass spontaneously
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Contraindications of ESWLContraindications of ESWL
11 Gross skeletal abnormalitiesGross skeletal abnormalities
22 excessive weightexcessive weight
33 Pregnant womenPregnant women
44 Large abdominal aortic Large abdominal aortic aneurysms oraneurysms or
55 uncorrectable bleeding disordersuncorrectable bleeding disorders
66 Unsuitable for large stoneUnsuitable for large stone
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Postoperative ComplicationsPostoperative Complications
SteinstrasseSteinstrasse (stone street) (stone street)
Perirenal HematomasPerirenal Hematomas (066) (066)
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Per Cutaneous Nephro Lithotomy Per Cutaneous Nephro Lithotomy (PCNL)(PCNL)
A tract is created A tract is created percutaneously percutaneously down to the down to the Kidney under X-Kidney under X-Ray screening Ray screening control control
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Pneumatic LithotritePneumatic Lithotrite
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
The stone can be The stone can be fragmented using fragmented using
11 Pneumatic lithotrite Pneumatic lithotrite
22 Laser lithotriteLaser lithotrite
33 Ultrasound lithotriteUltrasound lithotrite
44 Electrohydrolic lithotriteElectrohydrolic lithotrite
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Bilateral Renal StonesBilateral Renal StonesOperate on the better functioning Kidney Operate on the better functioning Kidney
first first
Two exceptionsTwo exceptions
11 Severe pain on the worse sideSevere pain on the worse side
22 Presence of infection in the worse sidePresence of infection in the worse side
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
PyelolithotomPyelolithotomyy
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Extended PyelolithoyomyExtended Pyelolithoyomy
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Anatrophic nephrolithotomyAnatrophic nephrolithotomy
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
ESWL
URSESWL
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Ureteroscopic stone Ureteroscopic stone extractionextraction
Ureteroscopic stone extraction is Ureteroscopic stone extraction is highly efficacious for lower ureteral highly efficacious for lower ureteral calculicalculi
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
UreterolithotomyUreterolithotomy
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Bladder StoneBladder Stone
11 Cystolitholapaxy the stones to be Cystolitholapaxy the stones to be broken and removed through a broken and removed through a cystoscope cystoscope
22 Open CystolithotomyOpen Cystolithotomy
Thank you
Amzayed_1919yahoocom
0101953318
Thank you
Amzayed_1919yahoocom
0101953318
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