CALCULI

 

 

 

Renal/Bladder/Ureteric Stone:

🍎Location (L)

🍎Size (S)

🍎Complication (Cx)

 

1)Renal

L: - pole - upper/mid/lower

Size :

< 0.5 cm : Treat with medication : chemolysis (potasium citrate 1080mg TDS ) - urine alkalinizer, dissolve small stone, prevent new stone formation

Other med : Ural

+ Allopurinol 300mg OD ( provided uric acid pt high)

 

0.5 cm - 2cm - ESWL (Extracorporeal shock wave lithotripsy - but it can make some parencymal injury (fibrosis), so need to to do maximum 2 times only, 2 week apart. ESWL can do at proximal ureter, cant do in middle (present of bowel), distal cannot because theres pelvic bone.

 

Complication

- Pyonephrosis

- Hydronephrosis

 

2) Bladder

L : mobile, no specific location because bladder quite big, stone can mobile depend on position

Shape : round (possible obstruct bladder outlet, need change position during urinate) (if elongated and thin, posible blockage, so better put CBD before dc until day op)

Size :

<5cm Vesicolithotripsy

> 5cm Open vesicolithotomy

 

3) Ureteric

L : Proximal - Mid Ureter - Distal

S : size

< 0.5 cm or pt c/o pain

Medication : Medical expulsion therapy

- Chemolysis (urine alkalinizer +allopurinol (if uric acid high)

- Add alpha blocker (niphedipine @ Tamsulosin)

> 0.5 cm : Lithotripsy

Complication: ureteric colic