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URINARY STONE DISEASE. Dr. Murat UĞRAŞ Dep.of Urology. STUDY PLAN:. Epidemics Ethiology Symptoms and signs Diagnosis Treatment Prevention. Epidemics. Genetic Age Geographical localization Ater intake Diet Job Coexisting diseases. Ethiology:. How and why forming a stone?

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urinary stone disease

URINARY STONE DISEASE

Dr. Murat UĞRAŞ

Dep.of Urology

study plan
STUDY PLAN:
  • Epidemics
  • Ethiology
  • Symptoms and signs
  • Diagnosis
  • Treatment
  • Prevention
epidemics
Epidemics
  • Genetic
  • Age
  • Geographical localization
  • Ater intake
  • Diet
  • Job
  • Coexisting diseases
ethiology
Ethiology:
  • How and why forming a stone?
  • Why in some people, why not in others?
stone forming matters
Anorganic

1.     Calcium

2.      Oxalate

3.      Phosphate

4.      Sulphates

5.      Sodium

6.      Magnesium

 Organic

1.      Cystine

2.      Uric acid

3.      Xantin

4.      Struvite (Magnesium ammonium phosphate)

Stone forming matters
symptoms and signs
Symptoms and Signs:

1.     Acute-emergency

2.     Blunt-elective

slide7
Pain

     Renal colic:

1.  Strong curling-hitting pain, not altering with movement, decreasing by Fowler position

2.   localised at vaist, groin and sides

3.   Reflects to Testis- scrotum- L. Major

4.   Continuous or ondulant

slide8
Mild renal pain:

1.      Vogue, not disturbing

2.       localised at vaist, groin and sides

3.      does not reflect

4.      no difference at day-night

slide9
Suprapubic discomfort:

Bladder stones

   Urethral pain-burning:

Urethral stones

hematuria
Hematuria:
  • Distortion of mucosal microvessels
    • Usually microscopic (2-3 erythrocytes at x200 mag)
    • Rarely macroscopic (100.000 erythrocytes in 1ml urine)
signs of infection
Signs of infection:

-Due to obstruction and urine stazis

-In Struvite stones:

Proteus

Pseudomonas

Providencia

Klebsiella

Stafilokok

Mycoplasma

nausea and vomitting
Nausea and vomitting:

-Due to infection

-In acute obstruction, by “Celiac ganglion reflex”

patient history
Patient history
  • Localization, kind, duration of the pain, relation to position?
  • Hematuria?
  • Dysuria?
  • Coexisting diseases?
past medical history
                                                      Past medical history        

Stone?

Tbc?

Renal disease?

Urinary infections?

inspection
Inspection:
  • Position, posture, movements
  • Giant kidney!
palpation
Palpation:
  • Hydronephrosis
  • Pain on ureteral norrow points
  • Costovertebral tenderness
laboratory
Laboratory:
  • Biyochemistry- micrbiology
  • Radiology
biyochemistry micrbiology
CBC

Leucocytosis?

Anemia?

Biochemistry

Renal functions.

BUN

Kreatinin

Potassium

Urinalysis (TİT)

pH?

Kristals?

Hematuria?

Pyuria?

Density?

Urine culture

Biyochemistry- micrbiology:
radiology
Radiology:

Direct Urinary Graphy:

  • Stones are radioopaque by80-90%
  • Calcium!!
  • Supine position
slide24
Ultrasonography:
  • Non invazive
  • Easy
  • Detailed results
slide26
İntravenous pyelography
  • Anotomical details
  • Ureter!
  • Maps the surgery
  • Contrast medium!!
slide28
Computed tomography:
  • Non-opaque stones
  • Surgical anatomy
  • Other organs
other radiological interventions
Other radiological interventions:
  • Retrograde pyelography
  • Scintigraphy
  • Magnetic resonance???