Overview
Kidney and ureter calculi refer to mineral deposits that form within the kidneys or ureters, potentially causing obstruction and significant morbidity. Management involves both conservative and interventional approaches, tailored to stone characteristics and patient factors.Diagnosis
Imaging: Non-contrast CT scans are the gold standard for detecting kidney and ureteral stones 1.
Urine Analysis: To assess for infection or metabolic abnormalities 1.
Ultrasound: Useful, especially in pregnancy or for initial screening 1.
Renal Ultrasound: Can identify hydronephrosis or anatomical anomalies like ureteral triplication 4.Management
First-line Treatments:
- Increased Fluid Intake: Encourage high fluid consumption to promote stone passage 1.
- Pain Management: Use NSAIDs or opioids for pain control 1.
Interventional Treatments:
- Extracorporeal Shock Wave Lithotripsy (ESWL): For certain stone sizes and locations 1.
- Ureteroscopy (URS): Including flexible URS, often enhanced with mentor guidance for better outcomes 23.
- Percutaneous Nephrolithotomy (PCNL): For larger stones or those resistant to ESWL 1.Special Populations
Pregnancy: Ultrasound preferred over CT due to radiation concerns; ESWL may be considered cautiously 1.
Pediatrics: Flexible ureteroscopy training models using porcine kidneys can be effective for skill development 2.
Elderly: Consider comorbidities and functional status; conservative management may be prioritized 1.
Comorbidities: Tailor treatment based on coexisting conditions; active mentoring in procedural training can improve outcomes 3.Key Recommendations
Utilize non-contrast CT scans for definitive diagnosis of kidney and ureteral calculi (Evidence: Strong 1).
Incorporate mentor-led training for flexible ureteroscopy to enhance procedural skills and efficiency (Evidence: Moderate 23).
Tailor fluid management and pain control strategies based on individual patient needs, considering specific risks like pregnancy (Evidence: Expert opinion 1).References
1 Fu MZ, Islam R, DeMarzo J, Lichtbroun B, Tabakin AL, Park JH et al.. The Boot Camp Model in Urology: Preparing PGY1 Urology Interns for Practice. Current urology reports 2023. link
2 Hu D, Liu T, Wang X. Flexible ureteroscopy training for surgeons using isolated porcine kidneys in vitro. BMC urology 2015. link
3 Ganesamoni R, Mishra S, Kumar A, Ganpule A, Vyas J, Ganatra P et al.. Role of active mentoring during flexible ureteroscopy training. Journal of endourology 2012. link
4 Blumberg N. Ureteral triplication. Journal of pediatric surgery 1976. link80017-6)