KIDNEY URETER stones methods ofremoval

Methods of Removal

Exteracorporeal  Shock  Wave  Lithotripsy  (E.S.W.L.)  is  a  new

technique that employs a focussed beam of ultrasonic shock  waves

to  pulverise  renal  and  some  ureteric  stones,  the  sandlike

material can then pass out with the urine. Fig.25.9

OPEN SURGERY

Surgical exposure of the kidney and pelvis is required through  a

lumbar incision for staghorn and multiple calculi.

Kidney and Ureters

Surgical removal of multiple renal calculi or staghorn calculi represents a difficult task for the unrologist. Actual bivalving of the kidney with cooling and vascular control may be required

Radiologic Procedures.

Obstruction can be relieved by percutaneous nephrostomy performed under x-ray or ultrasonographic monitor. Infection can be treated, pain relieved, and acute cases can be made elective. Uric acid stones may be dissolved, and other stones may be removed by the percutaneous method

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KIDNEY URETER stones investigations

On clinical examination, a tender palpable kidney may be present.

INVESTIGATIONS

A  plain X-ray abdomen, including the kidney, ureter and  bladder

areas (KUB) should be done.

A urine examination will reveal cyrstaliuria or haematuria.

An  IVP  will give additional information on renal  function  and

result of back pressure on pelvis and kidney (Hydronephrosis).

TREATMENT

Immediate treatment is with antispasmodics and antibiotics.

A  decision has to be taken as regards surgical  intervention.  A

stone less than 5 mm. can pass without help but if it gets  fixed

in  position  and causes hydronephrosis, it has  to  be  removed.

Large  stones causing pain and repeated infection  or  haematuria

also need to be removed.

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KIDNEY URETER stones presentation

Stones can present

Pain

-       Renal ache

-       Ureteric colic

Fever (Infection)

Frequency

Dysusia

Haematuria

Polpable kidny (hydronephrosis)

Anuria

-       One functioning Kidney

-       Bilateral Stones

In   a  Long  standing  case,  the  patient  can   present   with

hydronephrosis   (enlarged  distended  kidney)  or   pyonephrosis

(enlarged pufilled kidney).

7.1 Symptoms

1. The most prominent symptom of surgical disorder due to  stones

   of  the  kidney and ureter is pain. Pain  originating  in  the

   kidney,  occurs in the renal angles.

The pain can be a  dull ache. 

2. Haematuria can  be produced by lesions of the kidney  and  the

   ureter. Renal lesions can produce profound haematuria.

3. Severe pain (colic) can also cause vomiting.

4. Anuria (less than 150 cc or urine/24 hrs.) can be  produced in

   bilateral obstruction or one-sided renal agenesis.

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KIDNEY URETER renal calculus

URINARY CALCULUS

This  is a common surgical condition and at a hospital  in  Delhi

over  4,000  cases  were treated in  twenty  years,  constituting

nearly 14% of all surgical hospital admissions.

Urinary  calculus  consists  of a  crystalline  component  and  a

mixture   of   mucoprotein  and  mucopolysachride   holding   the

crystalline material together. The etiology is unknown,  however,

stones do occur in conditions, where the solute concentration  in

urine rises or there is change in pH. Other contributing  factors

are   stasis,   infection,   prolonged   immobilization,   hyper-

parathyroidism, cystinuria, oxaluria, etc.

Once  formed stones in kidney and ureter can manifest  with  pain

(dull  ache  or  ureteric colic) dysuria and  frequency  (due  to

infection) or haematuria.

Any questions be sent to drmmkapur@gmail.com
All older posts are stored in archives for access and review.
Visitors that follow may post contributions to the site,please write to address above.
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