folusho ogunfiditimi dm, mph, pac administratve director ... · describe the risk factors and...
TRANSCRIPT
Folusho Ogunfiditimi DM MPH PAC
Administratve Director
Adult Clinical Services and Advanced Practice Provider
DMC Urology
Describe the risk factors and causes of Renal and Ureteral Calculi
Identify the various types of Renal and Ureteral Calculi
Demonstrate the medical and surgical treatment of Renal and Ureteral Calculi
Highlight the complications related to various Renal Calculi
Discuss the role of PAs in Stone management
Pure causes are unknown
Risk Factors are well defined Hypercalciuria
Hyperparathyroidism
Hypercalcemia
Primary Hyperoxaluria
12 Men 5 Women
Increasing prevalence
1 in 11 people 50 reoccurrence
Composition of stones well known
Causes are still uncertain
Urinary Supersaturating (SS)
24h urine test and urine pH
Crystals can start to form with SS levels gt1
Calcium OxalatesPhosphates Most common Radiopaque
Uric Acid Calculi Uric Acid levels Most are radiolucent
Cysteine Calculi Cystinuria Rare and more radiolucent than opaque Resistant to SWL
Staghorn Calculi
Most common stones
Patient with Plaque disease (Randallrsquos Plaque)
Propensity for UTI
Hypercalciuria
Low urine pH
Obesity
gt90 radiolucent SWL of little value Medical therapy
with K-Citrate or Na-
Citrate is mainstay Alkalize the urine UA levels low urine
pH Risk of Gout
Cystinuria
Rare
More radiolucent than opaque
Resistant to SWL
Increased risk of Renal Failure
Branched Stones within the collecting system calices
Mixture of Ammonium phos and calcium carbonate
Untreated results in Severe sepsis and kidney disease
Hx of Calculi
Family Hx of Calculi
Renal Colic ndash Severe Flank Pain
NauseaVomiting - systemic
FeverChills ndash ro Sepsis Lactate Acid Levels
Urinary Tract Infections
Appendicitis
Diverticulitis
Acute Back Pain
History Detailed Dietary hx is important Kidney stone pain is related to acute obstruction
Physical Flank Tenderness
Ancillary Testing UAUCS Uric Acid Levels Serum Creatinine ndash should be normal Imaging
KUB Radiolucent
Radiopaque
RUS Hydronephrosis
Ureteronephrosis
IVP
Abdominal CT scan (non contrast) Gold Standard
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Describe the risk factors and causes of Renal and Ureteral Calculi
Identify the various types of Renal and Ureteral Calculi
Demonstrate the medical and surgical treatment of Renal and Ureteral Calculi
Highlight the complications related to various Renal Calculi
Discuss the role of PAs in Stone management
Pure causes are unknown
Risk Factors are well defined Hypercalciuria
Hyperparathyroidism
Hypercalcemia
Primary Hyperoxaluria
12 Men 5 Women
Increasing prevalence
1 in 11 people 50 reoccurrence
Composition of stones well known
Causes are still uncertain
Urinary Supersaturating (SS)
24h urine test and urine pH
Crystals can start to form with SS levels gt1
Calcium OxalatesPhosphates Most common Radiopaque
Uric Acid Calculi Uric Acid levels Most are radiolucent
Cysteine Calculi Cystinuria Rare and more radiolucent than opaque Resistant to SWL
Staghorn Calculi
Most common stones
Patient with Plaque disease (Randallrsquos Plaque)
Propensity for UTI
Hypercalciuria
Low urine pH
Obesity
gt90 radiolucent SWL of little value Medical therapy
with K-Citrate or Na-
Citrate is mainstay Alkalize the urine UA levels low urine
pH Risk of Gout
Cystinuria
Rare
More radiolucent than opaque
Resistant to SWL
Increased risk of Renal Failure
Branched Stones within the collecting system calices
Mixture of Ammonium phos and calcium carbonate
Untreated results in Severe sepsis and kidney disease
Hx of Calculi
Family Hx of Calculi
Renal Colic ndash Severe Flank Pain
NauseaVomiting - systemic
FeverChills ndash ro Sepsis Lactate Acid Levels
Urinary Tract Infections
Appendicitis
Diverticulitis
Acute Back Pain
History Detailed Dietary hx is important Kidney stone pain is related to acute obstruction
Physical Flank Tenderness
Ancillary Testing UAUCS Uric Acid Levels Serum Creatinine ndash should be normal Imaging
KUB Radiolucent
Radiopaque
RUS Hydronephrosis
Ureteronephrosis
IVP
Abdominal CT scan (non contrast) Gold Standard
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Pure causes are unknown
Risk Factors are well defined Hypercalciuria
Hyperparathyroidism
Hypercalcemia
Primary Hyperoxaluria
12 Men 5 Women
Increasing prevalence
1 in 11 people 50 reoccurrence
Composition of stones well known
Causes are still uncertain
Urinary Supersaturating (SS)
24h urine test and urine pH
Crystals can start to form with SS levels gt1
Calcium OxalatesPhosphates Most common Radiopaque
Uric Acid Calculi Uric Acid levels Most are radiolucent
Cysteine Calculi Cystinuria Rare and more radiolucent than opaque Resistant to SWL
Staghorn Calculi
Most common stones
Patient with Plaque disease (Randallrsquos Plaque)
Propensity for UTI
Hypercalciuria
Low urine pH
Obesity
gt90 radiolucent SWL of little value Medical therapy
with K-Citrate or Na-
Citrate is mainstay Alkalize the urine UA levels low urine
pH Risk of Gout
Cystinuria
Rare
More radiolucent than opaque
Resistant to SWL
Increased risk of Renal Failure
Branched Stones within the collecting system calices
Mixture of Ammonium phos and calcium carbonate
Untreated results in Severe sepsis and kidney disease
Hx of Calculi
Family Hx of Calculi
Renal Colic ndash Severe Flank Pain
NauseaVomiting - systemic
FeverChills ndash ro Sepsis Lactate Acid Levels
Urinary Tract Infections
Appendicitis
Diverticulitis
Acute Back Pain
History Detailed Dietary hx is important Kidney stone pain is related to acute obstruction
Physical Flank Tenderness
Ancillary Testing UAUCS Uric Acid Levels Serum Creatinine ndash should be normal Imaging
KUB Radiolucent
Radiopaque
RUS Hydronephrosis
Ureteronephrosis
IVP
Abdominal CT scan (non contrast) Gold Standard
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
12 Men 5 Women
Increasing prevalence
1 in 11 people 50 reoccurrence
Composition of stones well known
Causes are still uncertain
Urinary Supersaturating (SS)
24h urine test and urine pH
Crystals can start to form with SS levels gt1
Calcium OxalatesPhosphates Most common Radiopaque
Uric Acid Calculi Uric Acid levels Most are radiolucent
Cysteine Calculi Cystinuria Rare and more radiolucent than opaque Resistant to SWL
Staghorn Calculi
Most common stones
Patient with Plaque disease (Randallrsquos Plaque)
Propensity for UTI
Hypercalciuria
Low urine pH
Obesity
gt90 radiolucent SWL of little value Medical therapy
with K-Citrate or Na-
Citrate is mainstay Alkalize the urine UA levels low urine
pH Risk of Gout
Cystinuria
Rare
More radiolucent than opaque
Resistant to SWL
Increased risk of Renal Failure
Branched Stones within the collecting system calices
Mixture of Ammonium phos and calcium carbonate
Untreated results in Severe sepsis and kidney disease
Hx of Calculi
Family Hx of Calculi
Renal Colic ndash Severe Flank Pain
NauseaVomiting - systemic
FeverChills ndash ro Sepsis Lactate Acid Levels
Urinary Tract Infections
Appendicitis
Diverticulitis
Acute Back Pain
History Detailed Dietary hx is important Kidney stone pain is related to acute obstruction
Physical Flank Tenderness
Ancillary Testing UAUCS Uric Acid Levels Serum Creatinine ndash should be normal Imaging
KUB Radiolucent
Radiopaque
RUS Hydronephrosis
Ureteronephrosis
IVP
Abdominal CT scan (non contrast) Gold Standard
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Calcium OxalatesPhosphates Most common Radiopaque
Uric Acid Calculi Uric Acid levels Most are radiolucent
Cysteine Calculi Cystinuria Rare and more radiolucent than opaque Resistant to SWL
Staghorn Calculi
Most common stones
Patient with Plaque disease (Randallrsquos Plaque)
Propensity for UTI
Hypercalciuria
Low urine pH
Obesity
gt90 radiolucent SWL of little value Medical therapy
with K-Citrate or Na-
Citrate is mainstay Alkalize the urine UA levels low urine
pH Risk of Gout
Cystinuria
Rare
More radiolucent than opaque
Resistant to SWL
Increased risk of Renal Failure
Branched Stones within the collecting system calices
Mixture of Ammonium phos and calcium carbonate
Untreated results in Severe sepsis and kidney disease
Hx of Calculi
Family Hx of Calculi
Renal Colic ndash Severe Flank Pain
NauseaVomiting - systemic
FeverChills ndash ro Sepsis Lactate Acid Levels
Urinary Tract Infections
Appendicitis
Diverticulitis
Acute Back Pain
History Detailed Dietary hx is important Kidney stone pain is related to acute obstruction
Physical Flank Tenderness
Ancillary Testing UAUCS Uric Acid Levels Serum Creatinine ndash should be normal Imaging
KUB Radiolucent
Radiopaque
RUS Hydronephrosis
Ureteronephrosis
IVP
Abdominal CT scan (non contrast) Gold Standard
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Most common stones
Patient with Plaque disease (Randallrsquos Plaque)
Propensity for UTI
Hypercalciuria
Low urine pH
Obesity
gt90 radiolucent SWL of little value Medical therapy
with K-Citrate or Na-
Citrate is mainstay Alkalize the urine UA levels low urine
pH Risk of Gout
Cystinuria
Rare
More radiolucent than opaque
Resistant to SWL
Increased risk of Renal Failure
Branched Stones within the collecting system calices
Mixture of Ammonium phos and calcium carbonate
Untreated results in Severe sepsis and kidney disease
Hx of Calculi
Family Hx of Calculi
Renal Colic ndash Severe Flank Pain
NauseaVomiting - systemic
FeverChills ndash ro Sepsis Lactate Acid Levels
Urinary Tract Infections
Appendicitis
Diverticulitis
Acute Back Pain
History Detailed Dietary hx is important Kidney stone pain is related to acute obstruction
Physical Flank Tenderness
Ancillary Testing UAUCS Uric Acid Levels Serum Creatinine ndash should be normal Imaging
KUB Radiolucent
Radiopaque
RUS Hydronephrosis
Ureteronephrosis
IVP
Abdominal CT scan (non contrast) Gold Standard
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
gt90 radiolucent SWL of little value Medical therapy
with K-Citrate or Na-
Citrate is mainstay Alkalize the urine UA levels low urine
pH Risk of Gout
Cystinuria
Rare
More radiolucent than opaque
Resistant to SWL
Increased risk of Renal Failure
Branched Stones within the collecting system calices
Mixture of Ammonium phos and calcium carbonate
Untreated results in Severe sepsis and kidney disease
Hx of Calculi
Family Hx of Calculi
Renal Colic ndash Severe Flank Pain
NauseaVomiting - systemic
FeverChills ndash ro Sepsis Lactate Acid Levels
Urinary Tract Infections
Appendicitis
Diverticulitis
Acute Back Pain
History Detailed Dietary hx is important Kidney stone pain is related to acute obstruction
Physical Flank Tenderness
Ancillary Testing UAUCS Uric Acid Levels Serum Creatinine ndash should be normal Imaging
KUB Radiolucent
Radiopaque
RUS Hydronephrosis
Ureteronephrosis
IVP
Abdominal CT scan (non contrast) Gold Standard
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Cystinuria
Rare
More radiolucent than opaque
Resistant to SWL
Increased risk of Renal Failure
Branched Stones within the collecting system calices
Mixture of Ammonium phos and calcium carbonate
Untreated results in Severe sepsis and kidney disease
Hx of Calculi
Family Hx of Calculi
Renal Colic ndash Severe Flank Pain
NauseaVomiting - systemic
FeverChills ndash ro Sepsis Lactate Acid Levels
Urinary Tract Infections
Appendicitis
Diverticulitis
Acute Back Pain
History Detailed Dietary hx is important Kidney stone pain is related to acute obstruction
Physical Flank Tenderness
Ancillary Testing UAUCS Uric Acid Levels Serum Creatinine ndash should be normal Imaging
KUB Radiolucent
Radiopaque
RUS Hydronephrosis
Ureteronephrosis
IVP
Abdominal CT scan (non contrast) Gold Standard
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Branched Stones within the collecting system calices
Mixture of Ammonium phos and calcium carbonate
Untreated results in Severe sepsis and kidney disease
Hx of Calculi
Family Hx of Calculi
Renal Colic ndash Severe Flank Pain
NauseaVomiting - systemic
FeverChills ndash ro Sepsis Lactate Acid Levels
Urinary Tract Infections
Appendicitis
Diverticulitis
Acute Back Pain
History Detailed Dietary hx is important Kidney stone pain is related to acute obstruction
Physical Flank Tenderness
Ancillary Testing UAUCS Uric Acid Levels Serum Creatinine ndash should be normal Imaging
KUB Radiolucent
Radiopaque
RUS Hydronephrosis
Ureteronephrosis
IVP
Abdominal CT scan (non contrast) Gold Standard
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Hx of Calculi
Family Hx of Calculi
Renal Colic ndash Severe Flank Pain
NauseaVomiting - systemic
FeverChills ndash ro Sepsis Lactate Acid Levels
Urinary Tract Infections
Appendicitis
Diverticulitis
Acute Back Pain
History Detailed Dietary hx is important Kidney stone pain is related to acute obstruction
Physical Flank Tenderness
Ancillary Testing UAUCS Uric Acid Levels Serum Creatinine ndash should be normal Imaging
KUB Radiolucent
Radiopaque
RUS Hydronephrosis
Ureteronephrosis
IVP
Abdominal CT scan (non contrast) Gold Standard
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Urinary Tract Infections
Appendicitis
Diverticulitis
Acute Back Pain
History Detailed Dietary hx is important Kidney stone pain is related to acute obstruction
Physical Flank Tenderness
Ancillary Testing UAUCS Uric Acid Levels Serum Creatinine ndash should be normal Imaging
KUB Radiolucent
Radiopaque
RUS Hydronephrosis
Ureteronephrosis
IVP
Abdominal CT scan (non contrast) Gold Standard
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
History Detailed Dietary hx is important Kidney stone pain is related to acute obstruction
Physical Flank Tenderness
Ancillary Testing UAUCS Uric Acid Levels Serum Creatinine ndash should be normal Imaging
KUB Radiolucent
Radiopaque
RUS Hydronephrosis
Ureteronephrosis
IVP
Abdominal CT scan (non contrast) Gold Standard
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
KUB Radiolucent
Radiopaque
RUS Hydronephrosis
Ureteronephrosis
IVP
Abdominal CT scan (non contrast) Gold Standard
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
bull Abdominal CT - Gold standard
Non Contrast
Pyelogram ndash Antegrade vs Retrograde
Cystoscopy
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Goals of treatment Pain relief Emergency Management
Definitive treatment
Stone stratification Stone Location (Renal Proximal mid or distal)
Stone size (lt=5mm gt5mm lt=10mm gt10mm)
Observation and Medical Explusive Therapy
Surgical Endoscopic and Extracorporeal
Percutaneous and Open
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Observation Stones lt = 5mm
No ureteral Obstruction No pain
68 spontaneous expulsion rate
Stones gt 5mm lt 10mm
47 spontaneous expulsion rate
Medical Expulsive Therapy Alpha Blockers ndash 81 (Preferred agent)
Calcium Channel Blockers ndash 71
Dietary Modifications 25liters of water per day
AUA 2007
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Primary surgical treatment of RenalUreteral stones
The only non invasive surgical management of renal and ureteral stones
Approved in 1980
Series of shockwaves delivered through a lithotripter
Success is influenced by stone size location and patient body habitus etc
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
httpswwwyoutubecomwatchfeature=player_detailpageampv=GwQBpp3KiPc
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
First Line surgical therapy
Flexible or rigid scope through the ureter
Basket deployment to capture the stone
100 clearance if successful
Laser to fracture large stone
+- Ureteral stent
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
httpswwwyoutubecomwatchfeature=player_detailpageampv=u9O-kKSxKi0
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
More surgically invasive
Reserved for Complex stones like staghorn
Open or Robotic approach
Stones gt15cm
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Complex management Strategies Requires multiple approach
Goal is Renal Protection
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
httpswwwyoutubecomwatchfeature=player_detailpageampv=BCzxODuF3R8
httpswwwyoutubecomwatchfeature=player_detailpageampv=_Sk4MDsbukg
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Pregnancy Renal colic is the most common non OB cause of
pain during pregnancy
Deliver Deliver and then Deliver
Pain Relief
US or limited IVP
Surgery - Ureteral Stenting or PCN
Sepsis Fluids Abx
Surgery
Acute Renal Failure
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Medical Assessment and treatment
Counseling and education
Diagnosing and Ancillary testing
Emergent consults and management
Pre op and Post Op management
First Assist ndash Robotic Pyelolitotomy
Cystoscopy and Stent removals
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
Questions
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
wwwnatural-homeremediesorg
wwwaafporg
httpswwwstudybluecomnotesnotenrenal-stonesdeck4444591
httpswwwstonediseaseorgkidney-stone-photos
httpwwwcomiterpacom2Fhematuria2520radiologic_studieshtmampbvm
httpwwwwebmdcomkidney-stoneskidney-stone-seen-on-intravenous-pyelogram-ivp
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-
httpmanju-imagingxpertblogspotcom2011_04_01_archivehtml
httpintranettdmueduuadatakafedrainternalendoscop_fpoclasses_studenmedlikptnurology420yearLesson203htm
httpwwwmainstreetradiologycomct_scansmsr-cs_urographyhtm
httpswwwauanetorgeducationguidelinesmanagement-kidney-stonescfm
Clin J Am Soc Nephrol 2014 Oct 7 9(10) 1757ndash1763 Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randalls Plaque Xiangling Wang Amy E Krambeckdagger
James C Williams JrDagger Xiaojing Tang Andrew D Rule Fang Zhao Eric
Bergstralhsect Zejfa Haskic Samuel Edeh David R Holmes III Loren P Herrera Hernandezpara and John C Lieske
httpurologyjhueduMISESWLphp
httpwwwmedandlifero2Farchive2F113-vol-v-iss-2-april-june-20122Fspecial-articles-vol-v-iss22F292-impact-of-obesity-on-retrograde-ureteroscopic-