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URINARY STONE DISEASE

URINARY STONE DISEASE. Dr. Murat UĞRAŞ Dep.of Urology. STUDY PLAN:. Epidemics Ethiology Symptoms and signs Diagnosis Treatment Prevention. Epidemics. Genetic Age Geographical localization Ater intake Diet Job Coexisting diseases. Ethiology:. How and why forming a stone?

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URINARY STONE DISEASE

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  1. URINARY STONE DISEASE Dr. Murat UĞRAŞ Dep.of Urology

  2. STUDY PLAN: • Epidemics • Ethiology • Symptoms and signs • Diagnosis • Treatment • Prevention

  3. Epidemics • Genetic • Age • Geographical localization • Ater intake • Diet • Job • Coexisting diseases

  4. Ethiology: • How and why forming a stone? • Why in some people, why not in others?

  5. Anorganic 1.     Calcium 2.      Oxalate 3.      Phosphate 4.      Sulphates 5.      Sodium 6.      Magnesium  Organic 1.      Cystine 2.      Uric acid 3.      Xantin 4.      Struvite (Magnesium ammonium phosphate) Stone forming matters

  6. Symptoms and Signs: 1.     Acute-emergency 2.     Blunt-elective

  7. Pain      Renal colic: 1.  Strong curling-hitting pain, not altering with movement, decreasing by Fowler position 2.   localised at vaist, groin and sides 3.   Reflects to Testis- scrotum- L. Major 4.   Continuous or ondulant

  8. Mild renal pain: 1.      Vogue, not disturbing 2.       localised at vaist, groin and sides 3.      does not reflect 4.      no difference at day-night

  9. Suprapubic discomfort: Bladder stones    Urethral pain-burning: Urethral stones

  10. Hematuria: • Distortion of mucosal microvessels • Usually microscopic (2-3 erythrocytes at x200 mag) • Rarely macroscopic (100.000 erythrocytes in 1ml urine)

  11. Signs of infection: -Due to obstruction and urine stazis -In Struvite stones: Proteus Pseudomonas Providencia Klebsiella Stafilokok Mycoplasma

  12. Nausea and vomitting: -Due to infection -In acute obstruction, by “Celiac ganglion reflex”

  13. Diagnosis:

  14. Patient history • Localization, kind, duration of the pain, relation to position? • Hematuria? • Dysuria? • Coexisting diseases?

  15.                                                       Past medical history         Stone? Tbc? Renal disease? Urinary infections?

  16.                                                               Family history: • Stone? • Tbc? • Renal disease?

  17. Physical examination:

  18. Inspection: • Position, posture, movements • Giant kidney!

  19. Palpation: • Hydronephrosis • Pain on ureteral norrow points • Costovertebral tenderness

  20. Laboratory: • Biyochemistry- micrbiology • Radiology

  21. CBC Leucocytosis? Anemia? Biochemistry Renal functions. BUN Kreatinin Potassium Urinalysis (TİT) pH? Kristals? Hematuria? Pyuria? Density? Urine culture Biyochemistry- micrbiology:

  22. Radiology: Direct Urinary Graphy: • Stones are radioopaque by80-90% • Calcium!! • Supine position

  23. Ultrasonography: • Non invazive • Easy • Detailed results

  24. İntravenous pyelography • Anotomical details • Ureter! • Maps the surgery • Contrast medium!!

  25. Computed tomography: • Non-opaque stones • Surgical anatomy • Other organs

  26. Other radiological interventions: • Retrograde pyelography • Scintigraphy • Magnetic resonance???

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