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21.8 Urolithiasis

Table of Contents

This is a calculus which has formed in the urinary tract i.e. calyx, renal pelvis, ureters or urinary bladder as a result of urine which is supersaturated with respect to a stoneforming salt.

Diagnostic Criteria

  • Sudden onset of acute colic, localized to the flank, causing the patient to move constantly.
  • nausea and vomiting
  • blood in urine
  • referred pain to the scrotum or labium on the same side as the stone moves down the ureter
  • Urinalysis with features of infection or microscopic haematuria
  • Ultrasound with an acoustic shadow with features of obstructive uropathy eg. Hudroureter or hydronephrosis
  • Plain x-ray can pick up to 90% of calculi as they are radio-opaque
  • Conventional intravenous urogram or CT urography confirms upper urinary tract lithiasis.

Non- Pharmacological Treatment

  • Ensure adequate hydration. (Drink water 2.5 to 3 litres per day, diuresis more than 2.5 litres of urine)
  • Nutritional advice for a balanced diet-rich in vegetables and fibre, normal calcium content1-1.2 g/day limited NaCl content (4-5 g/day), limited animal protein content0.8-1.0g/kg/day
  • Surgical intervention is indicated
  • For patient with obstructive uropathy and infection, emergency decompression is indicated by percutenous nephrostomy placement or ureteric DJ Stenting

Pharmacological Treatment  Analgesia for pain, if needed:

A: Ibuprofen (PO) 400mg 8hourly for 3 days

OR

C: Tramadol inj 100mg stat then continue with PO 50mg 8 hourly

For distal ureteric calculi less than 7mm

D: Tamsulosin 0.4 mg (PO) once daily for a month may be prescribed for spontaneous stone expulsion.

Note: Refer patients for surgical interventions in centres where there is expertize and equipment

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