2. Causes of urinary stasis
Benign prostatic hyperplasia. (enlargement)
A urethral stricture.
External meatal stenosis.
The above will result in chronic retention, vecico ureteric reflux, bilateral hydroureter and hydronephrosis, infection and stone formation.
Vesicoureteric (VUJ) and pelviureteric junction (PUJ)obstruction are the other causes of urinary stasis.
3- Infection. The exudate provides a nidus for stone formation.
Composition of stones
Cystine calcium oxalate (85%)
Less than I cm
Irregular surface (Spiky, sea urchin)
Produces symptoms at an early stage. eg: Ureteric colic
Triple phosphate (10%)
Calcium, Magnesium, Ammonium phosphate (Struvite stones)
Form in alkaline urine
There has to be an infection
with increased urease
activity which produces ammonia.
eg: Proteus mirabilis.
Attain a large dimension.
Acquire the shape of the renal pelvis, major and minor calyceal system, hence the shape of a stag horn.
Often results in CRF because they are usually bilateral andlarge.
Uric acid and Cystine stones are rare.
Kidney is a solid organ. It cannot contract, hence the name renal colic is a misnomer. Calyceal colic is the acute onset agonizing loin pain associated with vomiting. Stag horn calculi are asymptomatic. vague loin pain is experienced by some patients Some times.
Ureteric stones (Ureteric colic)
Loin to groin pain which may radiate to the inner aspect of the thigh, labia majora or the testicles
Responds to Pethidine
Associated with vomiting , dysuria, frequency, and haematuria
The patient is restless
Ureteric colic may be due to:
A blood clot (Clot colic)
A ureteric stricture
A ureteric tumour ( a transitional cell cancers)
External compression of the ureter (A retroperitoneal tumour)
Most are asymptomatic,
Pain induced by movement
Pain referred to the tip of the penis.
intermittent attacks of retention of urine or intermittent flow.
The narrowest part of the urethra is the external urethral meatus, Often the stone can be seen protruding through the meatus. Otherwise, patient develops acute retention. The stone will be
felt along the ventral surface of the shaft of the penis.
Treatment of ureteric colic
Pethidine 75mg IM.
Promethazine 25mg IM-if there is vomiting.
Diclofenac sodium 100mg suppository for moderate
X-ray KUB is obtained after bowel preparation with bisacodyl 4 tablets nocte. 90% of the urinary stones are radio opaque. In a plain X-ray if there is an opacity with a diameter of 1cm the differential diagnosis would be (at the
region of right hypochondrium).
Calcified lymph node
Continue read… Part 10