Ureterolithiasis

Anamnesis
• The sypmtomps of ureterolithiasis are:
1. Renal colic or noncolickly renal pain
ureteropelvic stone severe costovertevral
angle pain from capsular and pelvic distention
mid ureteral stone pain in the lower
abdominal quadrant
low ureteral stone pain radiating into bladder,
vulva, or scrotum. The scrotal wall is
hyperesthetic, testicular sensitivity is absent
2. Fever
3. Nausea and vomitting
upper tract obstruction is frequently
associated with nausea and vomitting
4. Hematuria
patients frequently admit to intermitent gross
hematuria or occasional tea-colored urine (old
blood). Most patients will have at least
microhematuria
 Physical Examination
• The patient presenting with acute renal colic
typically is in severe pain, often attempting to
find relief in multiple, frequently bizzare,
positions.
• Tachycardia, sweating, and nausea often
prominent
• Costovertebral angle tenderness may be
apparent
• Referred pain may be similar owing to
common afferent neural pathways
• A rectal examination helps exclude other
pathologic conditions
 Laboratory test
• Urinalysis
• Darah rutin
• Ureum and creatinine
 Radiologic Investigations
• FPA: untuk melihat kemungkinan adanya batu
radioopak di saluran kemih. Batu jenis kalsiu
moksalat dan kalsium fosfat bersifat radioopak
dan paling sering dijumpai
• Abdominal USG
• Intravenous Pyelography: it can
simultaneouslu document nephrolitiasis and
upper tract anatomy
• CT Scan
 Differential Diagnosis
• Appendicitis
• Acute diverticulitis
• Pelvic Inflammation Disease
• Nephrolithiasis
 Intervention
• Conservative Observation
Alpha-blocker, non-steroid inflammatory
medications with or without low-dose steroids.
The vast majority of stones that pass do so within
6 week period after the onset of symptoms.
• Dissolution Agents
the effectiveness of dissolution agents depends
on stone surfcae area, stone type, volume of
irrigant, and mode of delivery
- Cystine calculi can be dissolved with a variety f
thiols, including D-penicillamine (0.5%
solution), N-acetylcysteine (2-5% solution),
and alpha-mercaptopropriopionyglycine
(Thiola) (5% solution)
- Struvite stone dissolution requires
acidification and may be acheved successfully
with Suby’s G solution and hemiacidrin
(Renacidin)
 Operative Interventions:
• Extracorpal shockwave Lithotripsy
• Endoscopic ureterolithotomy
• Open surgery
• Laparoscopy