URETERIC CALCULI
URETERIC CALCULI
- Stone in the ureter usually comes from the kidney
Ureteric colic
- Waves of agonizing loin pain referred to the groin, external genitalia and anterior surface of the thigh
- When the stone is in the intramural ureter, the pain is referred to the tip of the penis
- Strangury -painful passage of few drops of urine, when the stone is in the intramural part of the ureter
Impaction
- Five sites of anatomical narrowing where the stones may be arrested
- Ureteropelvic junction
- Crossing the iliac artery
- Juxtaposition of vas deferens/broad ligament
- Entering the bladder wall
- Ureteric orifice
- When the stone gets impacted, attacks of colic give way to more consistent dull pain, often felt in the iliac fossa
- Distension of renal pelvis because of obstruction may cause pain and discomfort in the loin
Hematuria: Every attack of renal colic is associated with microscopic hematuria
Investigations
- X ray shows radio opaque stones in the line of ureter
- Near the tip of the transverse processes of lumbar vertebrae
- Sacroiliac joint
- Medial to ischial spine
- IVU performed at the time of pain can confirm the diagnosis
- Spiral CT is being increasingly used
Endoscopic stone removal
- Dormia basket: now replaced by ureteroscopic techniques
- Ureteric Meatotomy: impacted stones in the intramural part of the ureter
- Ureteroscopic removal: impacted stones
- Push bang: stones in the middle or upper part can be flushed back into the kidney using a ureteric catheter. Subsequently treated with ESWL
| Upper third stone | Middle third stone | Lower third stone |
|
Exam Important
- A 45-year-old male with history of recurrent ureteric calculi presented with fever. Right-sided nephrectomy was performed. Gross view and histology have been provided.the diagnosis will be uteric calculi.
Don’t Forget to Solve all the previous Year Question asked on URETERIC CALCULI
