Chances of passing stone spontaneously
- <2 mm: 3% get surgery
- 3 mm: 14% get surgery
- 4-6 mm: 50% get surgery
- >6 mm: 99% get surgery
Evaluation
Blood tests: Urea, creatinine, uric acid, Na, K, Cl, Ca, P, Mag, bicarb
Random Urine tests (not 24 hr urine collection): creatinine, protein, Microalbumin, sodium, K, Ca, Uric Acid, Citrate
Stones types
Calcium oxalate/calcium phosphate 75%. No metabolic disorder found in 25%. The others can have idiopathic hypercalciuria, hyperoxaluri,a etc.
Struvite 10-15%
Uric Acid. 6%. Treat with urine alkalinzation.
Cystine 1-2%.Not amenable to swl
Distilled water can be used to lyse clots during ureteroscopy
Keep bladder empty during URS (girls small feeding tube alongside the ureteroscope, boys with an angiocath in the bladder if not using an access sheath.