URINARY TRACT STONES

Mars Dwi Tjahjo

URINARY TRACT STONES

Urolithiasis : presence of urinary
calculi at any point along the
collecting system.
The most common type of calculus
contains calcium and oxalate.

Kidney stone composition

Crystal composition

Percentage of stone analyzed

Calsium oxalat

60

Calsium phosphate

20

Uric acid

10

cystine

struvit

total

100

Epidemiology
Stone disease effect 1-5% of the
population.
10-20% of cases will require surgical
intervention.
Attention to pathofisiology identifies
etiology in over 90% of cases.
The recurrence rate of urolithiasis is
50% within 5 years.

Pathofisiology
Low urinary volume is the most
important factor.
Hypercalciuria : excretion of urinary
calcium more than 200 mg/ 24 hours.
Absorptive hypercalciuria : increased
intestinal absorption of calcium.

Pathofisiology
Renal (leak) hypercalciuria :
impairment in renal tubular
reabsorption of calcium.
Reabsorptive hypercalciuria (primary
hyperparathyroidism) : exsessive
bone resorption increase serum
calcium level.
Calcium restriction is recommend for
patient with absorptive
hypercalciuria.

Pathofisiology
Hyperoxaluria : urinary oxalat
excretion > 45 mg/day.
Hyperuricosuria : urinary uric acid
excretion > 600 mg/day.
Hypercystinuria : urinary cystine
excretion > 250 mg/day.

Pathofisiology
Struvite stone : stone commpossed
purely of struvite were produced by
urea splitting organism.
Low urine volume : urine output < 1
L/day. The typical etiology of this
condition is low fluid intake. Low
urine output contributes to the
development of all types of urinary
stones.

Principles of management
History :
risk factor
underlying predisposing condition
Dietary excesses
Inadequate fluid intake

Principles of management
Sign and symptom :
Asymptomatic.
colicky flank pain.
Hematuria.
frequency, urgency and dysuria.
Nausea and vomiting.
Fever or sepsis.

Principles of management
Blood screen :
complete blood count
Blood chemistry : uric acid, sodium,
calcium, PTH.
Renal function : ureum, creatinine.

Urine : urinalysis and urine culture.

Radiologic evaluation : x-ray ( BNOIVP), CT-scan, USG.
Stone analisys.

Medical management
Conservative management (patient
clinically stable and no evidence of
systemic infection)
Increase fluid intake to at least 3 L/day
Pain management
Diet

Surgical management
ESWL (extracorporeal shock wave
litotripsy)
PNL (percutaneous nephrolithotomy)
URS (ureterorenoscopy)
Open surgical procedure.

Summary
Management of urinary tract stone
has changed dramatically. With non
invasive technique (ESWL), and
minimal invasive technique (PNL and
URS), stone retrieval is succsesful in
more than 90 % of casses, with
minimal complication.
Selective medical therapy is highly
effective in preventing new stone
formation.

Terimakasih