cache
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a man presented with renal colic and was found to have a 4mm calculus at the uretero-vesical junction and hydronephrosis. what is the next step in management
a. put a stent up to the kidney via cystoscopy
b admit the pt , give IV fluids and reasses
c. lithotripsy
d. basket calculi removal
e. send him home and reasses later
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| cool
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we do conseravtive management for stones 0f 3 mm at uterovesical junction by giving lots of fluid , and if it is 7 mm then do lithitripsy/extraction.
but if a stone is 3-4 mm causing any problem, like in this case hydronephrosis, then i think we will go for lithotripsy
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| asmi
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c...
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| usmleasr
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d.basket calculi removal
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| dimps
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i go for B
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hi how r u
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| son64
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I would go for D
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| minu
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B..
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| cache
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the patient has got some obstructive symptoms, so is a case for intervention, expectant treatment wont do.
lithotripsy does work for <2cm , but i am not sure, could anyone shed more light on option A.
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| minu
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actually I had seen a patient who is having renal calculi &hydronephrosis
in a hospital here and their treatment option was stent placement,
but I dont know what is the answer for exam.
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| cool
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we will do stenting . coz i did mcq of q book and it was written in that that if a stone is at uteropelvic junction , of size 3mm and no s/s of infection and obstrution then we will do conservative management, but if it is cauing obstrution or infection then we will decompress it and we will go for stenting/nephrostomy
so answer is stenting
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| cache
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thanks cool and minu
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| Manal
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This question makes you confused only if you think like what the book said…
The best next step in the management of this patient is option A.
Although stones less than 6mm in diameter commonly pass spontaneously, it is difficult to determine which stones will pass.
When stones fail to pass spontaneously and impede urine flow, surgical measures are often indicated.
Typically, stones fail to pass spontaneously at three main sites: the ureteropelvic junction, the point at which the ureter crosses the iliac vessels, and the ureterovesical junction.
However, hydronephrosis is the main issue here because of the obstruction. ”From this point on you need to consider even a small size stones”.
The obstruction must be relieved, even if it is partial or functional, as in the case of reflux. If not, the kidney will ultimately be damaged, infection will appear, or both.
And remember that infection is a serious complication of hydronephrosis you do not want to get into.
Open for comments.
Thanks.
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| son64
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Putting a stent up to the kidney makes sence but I dont think it should be by cystescopy.
That is why I choosed D.
The best answer would be(I think) percutaneous nephrestomy an option not given in this vignett,so I would go for D.
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| cache
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Ureteroscopy is especially suitable for removal of stones lodged below the iliac crest. Stones smaller than 5 mm in diameter generally are retrieved using a stone basket, while tightly impacted stones or those larger than 5 mm are manipulated proximally for ESWL or are fragmented using an endoscopic direct-contact fragmentation device.
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