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UROLOGY – part 10


Calcified renal or adrenal lesion

The hilum of the kidney will be at the level of L1 (first lumbar vertebra) when the patient is supine. When the
patient is erect it will be at the level of L3. However, the Stag yuuyt calculi can be diagnosed only by an X-ray KUB.

Ultrasound scan – KUB (Kidney, Ureter, Bladder)
To see any hydroureter or hydronephrosis, urinary stones and the corticomedullary pattern of the kidney.

80% of the stones which are less than
spontaneously within 48 hours. To enhance this process

A high fluid intake, to maintain a urine output of at least 2 litres for 24 hours

encourage citric acid containing food eg: lemon, lime, oranges

Avoidance of oxalate containing food eg: spinach, tomato

Optimization of calcium intake

Diclofenac sodium 50mg bd for painThe patients are kept under surveillance

Intravenous urogram (IVU)
Is useful to detect:
Any hydroureter, hydronephrosis
Whether the obstruction is complete or partial
A crude assessment of the renal function
Radiolucent stones

Disadvantages of IVU
Anaphylactic shock
When the blood urea level is high it cannot be performed.
It cannot differentiate a blood clot, a radiolucent stone or a ureteric tumour.

Preparation for IVU
Blood urea.
Allergic history.
Date from the department of Radiology.
Bowel preparation Bisacodyl 4 tablets nocte for 3 days or Polyethylene glycol (Klean prep).
Emergency trolley with Adrenaline 0.5% 1:1000 and Hydrocortisone, Oxygen, Ambu bag.

Advantages of an ultrasound scan- KUB
Freely available
No complications
No contraindicat,
Contrast enhanced CT
Has become the gold standard in investigating the patients
with ureteric colic in the developed countries.

DTPA isotope scan
To assess the total GFR (glomerular filtration rate) and the differential renal function 1.e. DTPA scan will indicate the
contribution from each kidney for the total GFR as a percentage.
If the percentage of a particular kidney is less than 10% that kidney needs simple nephrectomy rather than pyelolithotomy or nephrolithotomy. This test is done in patients with bilateral renal or ureteric stones With compromised renal function.

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