外科学泌尿系结石英文版.ppt

Urolithiasis

Epidemiology3:1M:F(~7%men/3%women)3rd-5thdecademostcommon(70%)Hereditarypredisposition(RTAtype1,Hyper-parathyroidism,cysteinuria,milk-alkalisyndrome,sarcoidosis,Crohnsdisease)

EpidemiologyClimate(mountainous,desert,ortropical)Timeofyear(warmestthreemonths)Lifestyle(sedentary)Medications:proteaseinhibitors,carbonicanhydraseinhibitors,laxatives,triamterene

PatientCharacteristics16yearoldcomprise7%ofcases1:1M:FCauses:metabolicabnormalities50%,urologicalabnormalities20%,infection15%,immobilization5%1/3haverecurrencewithin1year50%within5years

PathophysiologyFormationrequiresthreekeyelementsSupersaturationofurinewithsolutesRelativelackoftheinhibitorscitratepyrophosphateStasisorlackofurineflowComposition:75%calciumoxalate10%staghorncalculi(struvite):associatedwithurease-splittingbacteria,poorAb.penetrationandusuallyrequiresurgeryUricacidstones10%(Radiolucent!!!)

Placesforobstruction

Obstructionleadsto:Rapidredistributionofrenalbloodflow?,↓glomerularfiltrationrate?renalexcretionshiftstounaffectedkidney

Obstructionleadsto:CausesrapiddecreaseinureteralperistalticactivityCompleteobstructionmayleadtolossofrenalfunctionIncreasedoccurrenceofirreversibledamageafter1to2weeksofobstructionPartialobstructionlowerlikelihoodofrenalinjury,maystillresultinirreversibledamage.

Criticalsize5mm~90%5mmandlocatedinthelowerureterpassspontaneously15%passifbetween5and8mm95%8mmbecomeimpactedgenerallyrequiringlithotripsyorsurgicalremoval75%ofstonesarelocatedinthedistalthirdoftheureter

ClinicallyUsuallyasymptomaticuntilobstructsacuteonsetseverepain,typicallyatrestTypicallyflank,abdomenwithreferraltoipsilaterallabiaortesticleMaybewrithinginpain,reluctanttoliestillEpisodicaspasses,painfreeuntilobstructsmoredistally

CausesofpainColicky,severef