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Ureteric colic and Urinary tract stones. Richard Napier-Hemy Consultant Urological Surgeon Central Manchester. Important Diagnosis?. AAA. Classical NSAIDS Opiates Normal fluids Exclude sepsis 3 of Classical history Urinalysis +ve for blood KUB shows stone. Beware Pancreatitis OA

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ureteric colic and urinary tract stones

Ureteric colicandUrinary tract stones

Richard Napier-Hemy

Consultant Urological Surgeon

Central Manchester

ureteric colic
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
slide4

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

management of urinary stone disease
Management of urinary stone disease
  • Conservative
  • Extracorporeal Shock Wave Lithotripsy (ESWL)
  • Endoscopic (Along natural tubes)
  • Endoscopic (Percutaneous)
  • Endoscopic (Laparoscopic)
  • Open operation
which treatment
Which Treatment?
  • Symptoms
  • Function
  • Anatomy
ct kub or ivu is essential
CT KUB (or IVU) is essential
  • Anatomy
  • Drainage
  • Access
  • Function
    • effects of stone
    • Is the kidney working?
    • What’s the other kidney like?
conservative management1
Conservative management
  • Conservative management
  • Good for small stones <5mm
    • Lower ureter
    • Moving
    • Absence of obstruction
    • Spiky ones
extracorporeal shockwave lithotripsy eswl
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
steinstrasse
Steinstrasse

Steinstrasse

ureteroscopy
Ureteroscopy
  • Easier for lower stones
  • Extraction of stone fragments
  • Fragmentation
    • Laser Holmium YAG
    • Mechanical EKL
    • Explosive EHL
    • Ultrasound
  • Risks
pcnl percutaneous nephrolithotomy
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
less commonly
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
then what
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?