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Urinary Stones (Tests (Imaging (XR KUB: AXR will not see stones as well.…

- - - - 3 points of constriction
        
        at the pelvi-ureteric junction (PUJ) of the renal pelvis and the ureter
        
        as the ureter enters the pelvis and crosses over the common iliac artery bifurcation
        
        at the vesicoureteric junction (VUJ) as the ureter obliquely enters the bladder wall
    - - Only good for stones, will not see kidney tumor. <3 mm stones cannot see. Stones formed from indinavir (HIV) only can be seen on ureteroscope.
    - - Not really used
    - - 3 phases: Normal (see stones), Cortico-Medullary (cysts, parenchymal), Delayed (to see flow)
    - - Contraindications: renal, metformin, asthma
    - - Pregnant women
- - - - SE: postural giddiness, take before sleeping
  - - - Stent
    - - Endoscopic (preferred): Ureteroscopy and laser lithotripsy (GA, no external cut)
        
        Pass a scope (ureteroscope/ nephro ureteroscope) up and laser the stone. Hard to do for lower stone, because of curve.
      - ESWL
        
        Least invasive, upper ureteric stone. Mid ureter efficacy drops a lot though can be done (because at sacroiliac joint, bone blocks). Lower stone can't be passed out.
        
        Entails having a generator to produce a shock. When it crosses a stone, the energy is deposited due to change in tissue volume.
      - Percutaneous nephrostomy and lithotripsy: Percutaneously to access the kidney/ bladder and send a machine in to destroy the stone. Use nephroscope, because it is very stiff.
        
        But bladder stones are usually treated retrograde. Best method for staghorn stones, because need to remove all of stones, remove early!!
        
        Pneumatic (outdated) or Ultrasonic laser. (shock stones and suck out small stones)
      - Anatrophic nephrolithotomy
        
        Very barbaric, can be done for staghorn stones (urease producing bacteria: klebsiella, proteus, anaerobes, and GP also can), though rarely done.
- - - - Cystine stone (very rare and hard, usually see in paeds because congenital)
      - Uric acid is common