134 - Management of upper urinary tract calculi

Summary

The term “endourology” was adopted for the minimally invasive endoscopic surgery of upper urinary calculus disease. Since the introduction of shock wave lithotripsy, this modality has become the most common form of stone therapy as it allows virtual hands-off treatment for radio opaque calculi. Owing to the technological advances of endourologic procedures such as ureteroscopy and percutaneous nephrolithotomy, the incidence of open kidney stone surgery is almost non-existent. Despite the evolution of surgical intervention for nephrolithiasis, it is important to note that the medical management and prevention of complicated urolithiasis remains difficult.

Nephrolithiasis affects as much as 12% of the population in industrialized nations. Urolithiasis patients will agree that the sensation of stone passage is perhaps the most painful and intense experience of their lives. Urolithiasis may present as hematuria (ranging from asymptomatic microscopic hematuria to painful gross hematuria), abdominal/flank/back pain, urinary tract infection, renal failure, or an incidental radiologic finding. Decompression of the acutely obstructed system with either cystoscopic stenting or percutaneous nephrostomy drainage is emergently mandatory for patients with a solitary kidney, infected obstruction, immunocompromised state (diabetes, AIDS, transplant), history of renal insufficiency, and worsening renal function.

The absolute minimum work-up of the potential nephrolithiasis patient should include: general history, determination of any prior history or family history of nephrolithiasis, physical examination, urine analysis (and culture for any hematuria, pyuria, fevers, or elevated WBC count), and radiologic examination if clinically warranted.