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Urology And Genito Urinary Medicine Notes

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Renal calculi

Testicular torsion Genito-urinary medicine



Genital warts




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Renal calculi are stones in the urinary tract formed from urine, salt and most commonly calcium oxalate

Patients present with sudden and severe abdominal pain associated with nausea, vomiting and dysuria

Confirm with urinalysis and kidney-urine-bladder X-ray

Management is largely conservative with analgesia, fluids and watchful waiting Aetiology and Pathophysiology Urinary tract stones, also known as renal calculi (nephrolithiasis) are made when urine is supersaturated with salt and other mineral products e.g. calcium oxalate 75%, struvite (magnesium ammonium phosphate) 10%, uric acid 5% and cystine 1%. Their size can vary greatly.

There is a proposed mechanism whereby nanobacteria form a calcium phosphate shell, which may be involved in the first steps of stone formation. Associated risk factors with this problem by either excess of normal constituents, impaired drainage or presence of abnormal constituents. Schistosomiasis is a known association in developing countries. Epidemiology and Associated Risk Factors They are common with a lifetime incidence of 15%. Peak age is 20-40 yrs. Associated risk factors:

Male (3:1)

Family history

Anatomical problems e.g. horseshoe kidney, strictures






Metabolic disorders - metabolic acidosis, hypercalciuria, hyperuricosuria, citrate deficiency in urine

Drugs - thiazide diuretics

Hot climates

Higher socioeconomic groups Presentation Sudden and severe abdominal pain (renal or ureteric colic), commonly starting at the costovertebral angle, gradually moving to the groin as the stone passes through the ureter. A passing stone is often more painful than a static one. Unlike biliary and intestinal colic, renal colic is a constant pain. Patients can't sit still. Classically associated with nausea, vomiting and rigors. There may be co-existing infection, so patients can be pyrexial and feel generally unwell, tired and malaised. Urinary symptoms - dysuria, haematuria, retention, proteinuria Patients can be asymptomatic. (Beware the drug addict that fakes renal colic for opiates!) Assessment
- O/E - On observation, patient is constantly moving (differentiates from peritonitis)
- Ix - Urine -

Urinalysis for blood, protein, pH

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