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Related Concept Videos

Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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Urinary Tract Calculi III: Medical Management01:30

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The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
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Urinary Tract Calculi IV: Nutrition Therapy and Prevention01:27

Urinary Tract Calculi IV: Nutrition Therapy and Prevention

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Management of renal calculi focuses on effective strategies like tailored nutrition and hydration therapy. Adjusting diet and fluid intake reduces stone formation and recurrence, making these interventions simple yet powerful in kidney stone prevention and management.Understanding Kidney StonesKidney stones form when calcium, oxalate, uric acid, and cystine concentrate and crystallize in urine. Factors contributing to their formation include genetic predisposition, certain medical conditions,...
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Urinary Tract Calculi V: Nursing Management01:28

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AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
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Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations01:26

Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations

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Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
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Urinary Tract Calculi I: Introduction01:28

Urinary Tract Calculi I: Introduction

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Renal calculi, or kidney stones, are solid deposits of minerals and salts formed inside the kidneys. In medical terminology, "calculus" refers to the stone itself, while "lithiasis" describes the process of stone formation. Depending on their location within the urinary system, these stones may be classified as either urolithiasis, when situated within the urinary tract, or nephrolithiasis, when located within the kidneys. Each term signifies the specific impact of the stone.Predisposition...
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Do renal stones that fail lithotripsy require treatment?

Ben Pullar1, Catherine Lunter2, Jane Collie2

  • 1Department of Urology, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK. benpullar@doctors.org.uk.

Urolithiasis
|March 17, 2017
PubMed
Summary

Extracorporeal shock wave lithotripsy (SWL) is effective for single renal stones. For failed SWL, conservative management is suitable for asymptomatic, non-upper pole stones, while upper pole stones warrant early intervention.

Keywords:
LithotripsyStonesSurveillanceUrolithiasis

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Area of Science:

  • Urology
  • Nephrology
  • Medical Technology

Background:

  • Extracorporeal shock wave lithotripsy (SWL) is a common treatment for renal calculi.
  • Limited data exists on the natural history of renal stones following SWL failure.
  • Understanding outcomes after failed SWL is crucial for patient management.

Purpose of the Study:

  • To evaluate the effectiveness of SWL for single, previously untreated renal stones.
  • To investigate the natural history of renal calculi that do not respond to SWL.
  • To determine appropriate management strategies for residual stones after SWL.

Main Methods:

  • Retrospective review of a prospectively collected database (October 2010 - November 2013).
  • Inclusion criteria: patients undergoing first-time SWL for a single renal stone.
  • Outcomes categorized as success, need for subsequent intervention, or conservative management.

Main Results:

  • 313 patients met inclusion criteria; 144 achieved successful SWL treatment.
  • 170 patients had residual stones; 51 proceeded directly to ureteroscopy due to symptoms.
  • Of 79 conservatively managed patients, 63 (80%) remained asymptomatic; 16 (20%) required later intervention, predominantly for upper pole stones (87%).

Conclusions:

  • Conservative management is a viable option for asymptomatic renal stones after failed SWL, particularly for non-upper pole locations.
  • Patients with upper pole stones following failed SWL have a high likelihood of requiring subsequent intervention, warranting early treatment.
  • SWL demonstrates effectiveness, but careful consideration of residual stone management is essential.