×
Choose Speciality

EXPLORE!

LOGIN

What a Nephrologist should Known About Surgical Management of Urolithiasis?

  1074 Views

Prof Datteswar Hota, Cuttack    29 December 2018

  • The size of the stone is an important predictor of spontaneous passage. A stone <4 mm in diameter has an 80% chance of spontaneous passage. This falls to 20% for stones >8 mm in diameter.
  • Active medical expulsive therapy (MET) - Paracetamol PRN for pain with or without codeine; NSAID PRN for pain; Oral opioid analogue for severe pain; Alpha-blockers; Antiemetic PRN for nausea and/or vomiting. With MET, stones 5-8 mm in size often pass, especially if located in the distal ureter.
  • Indications for surgery - Pain; Infection; Obstruction. Indications for urgent intervention - Obstruction complicated by evident infection; Obstruction complicated by acute renal failure; Solitary kidney; Bilateral obstruction.
  • Surgical options - Obstruction relief: Ureteral stent insertion; Percutaneous nephrostomy; Definitive surgical treatment: Extracorporeal shockwave lithotripsy (ESWL); Ureteroscopy; PCNL; Open, laparoscopic and robotic pyelolithotomy, ureterolithotomy, cystolithotomy; Open anatrophic nephrolithotomy. ESWL and ureteroscopy are internationally recognized as first-line treatments for ureteral stones.
  • Ureteral stent - Guarantees drainage of urine from kidney into the bladder and bypass any obstruction; relieves renal colic pain even if the actual stone remains; dilates the ureter, making ureteroscopy and other endoscopic surgical procedures easier to perform later. ESWL is the least invasive of the surgical methods of stone removal. It is especially suitable for stones <2 cm and lodged in: the upper or middle calyx; upper ureter.
  • Ureteroscopic manipulation of a stone is a commonly applied method of stone removal. Percutaneous procedures are generally reserved for large and/or complex renal stones. Percutaneous nephrostolithotomy is especially useful for stones >2 cm in diameter. Open surgery has been used less and less often since the development of the newer techniques. Disadvantages of open surgery include: Longer hospitalization; longer convalescence; increased requirements for blood transfusion. General dietary guidelines are to avoid excessive salt and protein intake. Moderation of calcium and oxalate intake is also reasonable.

To comment on this article,
create a free account.

Sign Up to instantly get access to 10000+ Articles & 1000+ Cases

Already registered?

Login Now

Most Popular Articles

News and Updates

eMediNexus provides latest updates on medical news, medical case studies from India. In-depth medical case studies and research designed for doctors and healthcare professionals.