Right flank pain, sharp and "stabbing", radiating to testicle.
1) No contrast in right renal pelvis
2) Dilated right renal pelvis
3) Calcific density in right ureter
4) Periureteral inflammation
Ureterolithiasis with secondary obstruction and hydronephrosis
Urinary Tract Stone Disease - Nephrolithiasis
(Lith - Gr. for stone or rock)
Sx: Renal Colic (impacted or moving stone)
Stones hangup at ureteropelvic junction (UPJ), where ureter crosses the iliac vessels, ureterovesicle junction.
Regarding the stones:
90% have Ca++
About 60% visible on plain film
Virtually ALL visible on CT - and may be precisely localized
Plain Film - good first step to screen for other disease
IVP/IVU - evaluates possible obstruction (stone in ureter)
CT - Best Exam, but highest radiation dose to patient
Rapid - some scans < 5 min.
Plain (unenhanced CT) otherwise contrast may mask stone
May detect other coexistent pathology:
- Adnexal Disease (in women)
Localization of Stones:
- 22% proximal ureter (-> ESWL)
- 71% distal (extraction or ESWL)
Size of Stones:
< 5mm likely to pass
> 5mm Â» Get a Urology Consult
> 7mm unlikely to pass
- Dilated Ureter
- Perinephric/periureteral stranding
- Ca++ density in ureter w/rim of soft-tissue
ESWL (Extra-Corporeal Shockwave Lithotripsy) is effective for most stones < 2cm in the renal pelvis and < 1 cm in the ureter. NOTE: NSAIDS are a contraindication prior to ESWL because of possible perinephric bleeding.
Larger stones in the renal pelvis may be extracted by ureteroendoscopy or percutaneous nephrolithotomy.
More on Nephrolithiasis:
- LINK -
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