URINARY TRACT STONES

Mars Dwi Tjahjo

URINARY TRACT STONES

Urolithiasis : presence of urinary calculi at any point along the collecting system. The most common type of calculus contains calcium and oxalate.

Kidney stone composition

Crystal composition Calsium oxalat Calsium phosphate Percentage of stone analyzed 60 20

Uric acid
cystine struvit total

10
3 7 100

Epidemiology
Stone disease effect 1-5% of the population. 10-20% of cases will require surgical intervention. Attention to pathofisiology identifies etiology in over 90% of cases. The recurrence rate of urolithiasis is 50% within 5 years.

Pathofisiology
Low urinary volume is the most important factor. Hypercalciuria : excretion of urinary calcium more than 200 mg/ 24 hours. Absorptive hypercalciuria : increased intestinal absorption of calcium.

Pathofisiology
Renal (leak) hypercalciuria : impairment in renal tubular reabsorption of calcium. Reabsorptive hypercalciuria (primary hyperparathyroidism) : exsessive bone resorption increase serum calcium level. Calcium restriction is recommend for patient with absorptive hypercalciuria.

Pathofisiology
Hyperoxaluria : urinary oxalat excretion > 45 mg/day. Hyperuricosuria : urinary uric acid excretion > 600 mg/day. Hypercystinuria : urinary cystine excretion > 250 mg/day.

Pathofisiology
Struvite stone : stone commpossed purely of struvite were produced by urea splitting organism. Low urine volume : urine output < 1 L/day. The typical etiology of this condition is low fluid intake. Low urine output contributes to the development of all types of urinary stones.

Principles of management
History :
risk factor underlying predisposing condition Dietary excesses Inadequate fluid intake

Principles of management
Sign and symptom :
Asymptomatic. colicky flank pain. Hematuria. frequency, urgency and dysuria. Nausea and vomiting. Fever or sepsis.

Principles of management
Blood screen :
complete blood count Blood chemistry : uric acid, sodium, calcium, PTH. Renal function : ureum, creatinine.

Urine : urinalysis and urine culture. Radiologic evaluation : x-ray ( BNO-IVP), CTscan, USG. Stone analisys.

Medical management
Conservative management (patient clinically stable and no evidence of systemic infection)
Increase fluid intake to at least 3 L/day Pain management Diet

Surgical management
ESWL (extracorporeal shock wave litotripsy) PNL (percutaneous nephrolithotomy) URS (ureterorenoscopy) Open surgical procedure.

Summary
Management of urinary tract stone has changed dramatically. With non invasive technique (ESWL), and minimal invasive technique (PNL and URS), stone retrieval is succsesful in more than 90 % of casses, with minimal complication. Selective medical therapy is highly effective in preventing new stone formation.