Stones, moans and groans - what you need to know.pptx

Stones

1. Stones, moans and groans Assoc Prof Dr Christopher C.K. Ho MD, MS, MRCSEd , MBU, MFSTEd , AM, FICS, FECSM, FRCSEd , FRCS( Urol )( Glasg ) Consultant Urologist

2. What?

3. What is the urinary tract?

4. What are urinary stones?

5. What type of stones?

6. What are the complaints?

7. Blood in urine ( haematuria )

8. Fever (infection)

9. What is the complication?

10. Why?

11. Why do stones form? Dehydration Supersaturation Nucleation Precipitation Crystallization Aggregation Stone formation

12. Why do stones form in only a certain group of people? Normal urine contains inhibitors of stone formation like citrate, Tamm– Horsfall protein,  glycosaminoglycans , uropontin In stone formers, this is defective

13. How?

14. How to diagnose?

15. X-ray

16. Ultrasound

17. CT scan

18. Blood test

19. Urine test

20. How are stones treated?

21. Drink lots of water

22. Medication

23. Medication

24. Extracorporeal shock wave lithotripsy (ESWL)

25. ESWL

26. Ureteroscope (URS)

27. Ureteroscope

28. Retrograde intrarenal surgery (RIRS)

29. Percutaneous nephrolithotomy (PCNL)

30. PCNL

31. Open surgery

32. Stent

33. How to prevent? Increasing total fluid intake to more than two liters per day of urine output. Increasing citric acid intake; lemon/lime juice is the richest natural source . Moderate calcium intake Limiting sodium intake Limiting vitamin C intake Limiting animal protein intake to no more than two meals daily (an association between animal protein consumption and recurrence of kidney stones has been shown in men). Limiting consumption of cola soft drinks ,   which contain  phosphoric acid, to less than one liter of soft drink per week

34. When?

35. When should be treated? Large stones (>2cm) Symptomatic Pain Blood in urine Complication Infection Blood Hydronephrosis (swollen kidneys)

36. Conclusion Stones very common in Malaysia Both sexes and all ages can get stones Those with family history of stone or previous history of stone more prone Loin pain, blood in urine common CT scan best investigation Complications include bleeding, kidney failure Treatment available, don’t wait until too late UKMSC has one of the best facilities for stones treatment including laser

37. Questions?