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Prevention

Prevention. Fluid Intake. A bout 1.6 L/24 h E ncouraged during mealtime I ncreased approximately 2 h after meals E ncouraged to force a nighttime diuresis. Metabolic Intervention . Stone analysis Outpatient urine collection during typical activities & fluid intake Ca stone formers

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Prevention

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  1. Prevention

  2. Fluid Intake • About 1.6 L/24 h • Encouraged during mealtime • Increased approximately 2 hafter meals • Encouraged toforce a nighttime diuresis

  3. Metabolic Intervention • Stone analysis • Outpatient urine collection during typical activities & fluid intake • Castone formers • Initial 24-h urine collection • Include tests for Ca, uric acid, oxalate, citrate, Na, volume, & pH • Hypercalciuria: most common abnormality

  4. Oral Intervention • Alkalinizing pH agents • Potassium citrate: oral agent that elevates urinary pH effectively by 0.7–0.8 pH units • Adverse effect: abdominal discomfort • Indications: Caoxalate calculi 2° to hypocitraturia (<320 mg/day), including those with renal tubular acidosis; uric acid lithiasis& nonsevere forms of hyperuricosuricCanephrolithiasis. • Alternative alkalinizing agents: Na, potassium bicarbonate, orange juice, & lemonade • No effective long-term urinary acidifying agents

  5. Oral Intervention • Gastrointestinal absorption inhibitor • Cellulose phosphate binds Cain the gut & inhibits Caabsorption &urinary excretion • Decreases urinary saturation of Ca phosphate & Ca oxalate • Phosphate supplementation • Indicated for renal PO4 leak

  6. Oral Intervention • Diuretics • Thiazides can correct renal Ca leak associated with renal hypercalciuria • Prevents 2°hyperparathyroid state & its associated elevated vitamin D synthesis &intestinal calcium absorption • Hypokalemia  hypocitraturia

  7. Oral Intervention • Calcium supplementation • Indication: Enteric hyperoxaluricCa nephrolithiasis • Ca gluconate & Ca citrate • Uric acid-lowering medications • Allopurinol • Urease inhibitor • Acetohydroxamicacid: effective adjunctive treatment in chronic urea-splitting urinary tract infections associated with struvitestones • Prophylaxis after removal of struvitestone

  8. Oral Intervention • Prevention of cystinecalculi • Penicillamine: reduces the amount of urinary cystine that is relatively insoluble • Mercaptopropionylglycine (Thiola)

  9. Bladder Stones

  10. Bladder Stones • Manifestation of an underlying pathologic condition, including voiding dysfunction or a foreign body • Most seen in men • Developing countries: frequently found in prepubescent boys • Stone analysis: ammonium urate, uric acid, or Caoxalate stones • Irritative voiding symptoms, intermittent urinary stream, UTI, hematuria, or pelvic pain

  11. Prostatic Stones • Prostatic calculi: found within prostate gland per se & are found uncommonly within the prostatic urethra • Represent calcified corpora amylacea & rarely found in boys • Usually of no clinical significance, rarely they are associated with chronic prostatitis • Large prostatic calculi: may be misinterpreted as a carcinoma • Dx: radiograph or transrectal ultrasound

  12. Seminal Vesicle Stones • Smooth & hard • Associated with hematospermia • PE: stony hard gland; multiple stones present with crunching sensation • Confused with tuberculosis of the seminal vesicle

  13. Urethral Stones • Originate from bladder • Develop 2° to urinary stasis, urethral diverticulum, near urethral strictures, or at sites of previous surgery • Females: rarely develop urethral calculi due to short urethra &lower incidence of bladder calculi; associated with urethral diverticula • Symptoms : intermittent urinary stream, terminal hematuria, & infection • Dx: palpation, endoscopic visualization, or radiographic study

  14. Prepucial Stones • Occur in adults • Develop 2° to a severe obstructive phimosis or poor hygiene with inspissatedsmegma • Dxconfirmed by palpation • Tx: dorsal prepucialslit or formalcircumcision

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