Urinary Calculi

• Urinary Calculi (Urolithiasis)

  MOST common cause: UTI that leads lead to urinary stasis
• Urinary Calculi (Urolithiasis)

  Urinary stones cause obstruction of urine flow
• The clinical manifestations of Urinary Calculi:

  • Pain: Colicky - originating from lumbar area
  • Pain radiating to: Lower abdomen
  • Nausea, vomiting, diarrhea or constipation - GI-GU tract have common nerve supply called reno-intestinal innervation
  • Urine: Hematuria, dysuria, frequency
  • Temp: Fever, chills
• The types of urinary calculi are as follows:

  Alkaline stones

  • calcium oxalate stones
  • calcium phosphate stones
  • struvite or staghorn stone (MgNH3PO4)

  Acidic stones

  • uric acid stones
  • cystine stones
• Types of Renal Stones

  Alkaline stones - calcium oxalate stones
• Types of Renal Stones

  Alkaline stones - Struvite or staghorn stones (MgNH,PO4)
• Types of Renal Stones

  Acidic stones - Uric acid stones
• Types of Renal Stones

  Acidic stones - Cystine stones
• Types of Renal Stones

  Alkaline stones - Calcium phosphate stones
• Urinary Calculi: Management

  • Increase fluid intake to at least 3000 mL per day. To help pass the stone.
  • Strain all urine.
  • Adjust urine pH
  • Encourage ambulation
  • Allopurinol for uric acid stone
• Urinary Calculi: Management

  Adjust urine pH

  • For calcium stones (alkaline)
  • Diet: Limit dairy products; Acid-ash diet (cranberry juice, prune juice, meat, eggs, fish, poultry, tomatoes, grapes, whole grains, corn, legumes)
• Urinary Calculi: Management

  Adjust urine pH

  • For acidic stones
  • Diet:  Alkaline-ash diet (milk; vegetables, fruits except cranberries, plums and prunes; rhubarb; small amounts of beef; halibut; veal; trout; and salmon)
• Urinary Calculi: Management


  Adjust urine pH

  • For uric acid stones
  • Diet: AVOID purine-rich foods
• Procedures for Urolithiasis

  Extracorporeal Shock Wave Lithotripsy (ESWL)

  • It is crushing of stone with the use of high frequency or ultrasonic waves while the body is half - immersed in water; NO incision, NO drains
• Procedures for Urolithiasis

  Percutaneous lithotripsy

  • A guide is inserted under fluoroscopy near the area of the stone; Ultrasonic waves break stones into fragments; A nephrostomy tube will be in place