Urinary stones

• Urinary stones may be caused by any process that promotes an alkaline pH of the urine.

• These include urinary tract infections and metabolic diseases, such as

hyperparathyroidism, renal tubular acidosis, and medullary sponge kidney.

• The calcium oxalate stone is most common, followed by mixtures of calcium oxalate and
phosphate, magnesium ammonium phosphate, pure calcium phosphate, and cysine.

• When patients present with flank pain that radiates down into the ipsilateral lower
abdominal quadrant, groin, and perineum with hematuria, diagnostic evaluation must be
performed.

• The contrast CT scan and intravenous pyelogram are most commonly employed.

• Occasionally, ultrasound examinations are useful, especially with larger stones.

• Not all stones require surgical removal.

• Smaller stones often pass during observation, but larger stones should be treated,
especially when pain is unrelenting, urinary tract obstruction is complete, and the patient
develops an infection or when renal functional deterioration occurs.

• Extracorporeal lithotripsy is now utilized to fragment stones into smaller particles that
usually will pass.

• Lithotripsy uses bursts of high frequency ultrasound administered to a sedated patient,

and the procedure reduces the incidence of open surgical removal of stones, which
requires opening the pelvis or kidney with attendant risks.

• Larger stones, such as the staghorn calculus which fills the calyces and assumes the
gross appearance of a stag’s horns, must be surgically removed.

• Of great importance in the management of stones is the establishment of medical therapy

to reduce the incidence of stone recurrence, the identification of an associated metabolic
disorder, and the control of urinary sepsis.

Renal obstruction

• Renal obstruction can occur from a stone in the renal pelvis, which blocks the pelvic-
ureteric junction (PUJ).

• PUJ obstruction of congenital origin will cause long-standing obstruction to the renal
outflow and may affect the function of the kidney.

• The condition is often not discovered until adult life.

Hydronephrosis

• Hydronephrosis is a "stretching" or dilation of the inside or collecting part of the kidney.

• The condition results from a blockage in the ureter and prevents urine from draining into
the bladder resulting in dilated calyces.
 • Hydronephrosis may also be due to abnormal backwash or "reflux" of urine from the
bladder.

Intravenous Urogram (IVU)

• A radio-opaque solution that is concentrated and excreted by the kidneys is injected

intravenously and a series of X-rays are performed.

• This allows visualisation of the kidneys (nephrogram), renal pelvis (pyelogram), ureters
and bladder.

• This X-ray was taken one hour after injection of the dye and shows a dilated left ureter.
The dye has cleared normally from the right kidney and the bladder is full of the radio-
opaque dye.