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Ureteric colic and Urinary tract stones

Ureteric colic and Urinary tract stones. Richard Napier-Hemy Consultant Urological Surgeon Central Manchester. The first speciality. Hippocrattic oath. Father of modern surgery. Father of minimally invasive therapy. Classical NSAIDS Opiates Normal fluids Exclude sepsis 3 of

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Ureteric colic and Urinary tract stones

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  1. Ureteric colicandUrinary tract stones Richard Napier-Hemy Consultant Urological Surgeon Central Manchester

  2. The first speciality

  3. Hippocrattic oath

  4. Father of modern surgery

  5. Father of minimally invasive therapy

  6. Classical NSAIDS Opiates Normal fluids Exclude sepsis 3 of Classical history Urinalysis +ve for blood KUB shows stone Beware Pancreatitis OA Gallstones Metastases AAA Musculoskeletal pain Ureteric colic

  7. Important Diagnosis? AAA

  8. L1/L2 Junction Tips of transverse processes Stone Sacroiliac joint Curves medially, Lateral to curve of sacrum Enters bladder near sacro-coccygeal junction. Level with Ischial spines Phlebolith

  9. Management of urinary stone disease • Conservative • Extracorporeal Shock Wave Lithotripsy (ESWL) • Endoscopic (Along natural tubes) • Endoscopic (Percutaneous) • Endoscopic (Laparoscopic) • Open operation

  10. Which Treatment? • Symptoms • Function • Anatomy

  11. IVU is essential • Anatomy • Drainage • Access • Function • effects of stone • Is the kidney working? • What’s the other kidney like?

  12. Conservative management Stone

  13. Conservative management • Conservative management • Good for small stones <5mm • Lower ureter • Moving • Absence of obstruction • Spiky ones

  14. Extracorporeal Shockwave Lithotripsy. (ESWL) • Day case. Analgesia only • Various ways of generating shock • Xray or USS targeting • Coupling medium • 80% success • Multiple treatments • Steinstrasse • JJ stents for stones >1.5cm

  15. Steinstrasse Steinstrasse

  16. Ureteroscopy • Easier for lower stones • Extraction of stone fragments • Fragmentation • Laser Homium Yg • Mechanical EKL • Explosive EHL • Ultrasound • Risks

  17. PCNLPercutaneous Nephrolithotomy • X-ray control • Contrast and methylene blue via a ureteric catheter • Dilate up a track • Nephroscopic surgery • Nephrostomy post op • Fragmentation and stone removal easier

  18. Laparoscopy Ureteric stones Resisted first line treatments Must have stent in situ Open Surgery Big bladder stones Complex intrarenal stones Rare for ureteric stones Less commonly

  19. Metabolic analysis Serum Calcium reserve fancier tests for recurrent, complicated, bilateral disease or radiolucent stones Idiopathic stone former Fluids Fibre Animal protein Salt Sugar Alcohol( 1 unit) Then what?

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