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Pediatric Surgery (Pg 68-81) - page 28 / 33

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Cystine stones in families with cystinuria (disorder of cysteine, ornithine, lysing, arginine reabsorption) → stones early in life

Struvite stones with chronic UTI (esp indwelling foleys!), called staghorn when occupy entire collecting system

Presenting symptom for stones: renal colic (usually Dx’d in ER)

Constant pain in flank often radiating to groin with N/V

Microhematuria is common

Requires imaging study to Dx → classically IVP

Elective metabolic workup: mostly in kids or pts with recurrent stones, may include: serum calcium, PTH, electrolytes, urine pH, 24 hour urine collection to measure calcium and other electrolytes

Treatment depends on size, location, composition

Obstructive pyelonephritis → urologic emergency (pus under pressure)

o

Cystoscopically placed stent or percutaneous nephrostomy

o

Do NOT remove stone (can lead to sepsis)

o

Goal: promote drainage

<5mm: pass spontaneously

>8mm require intervention

o

stent placement

o

flexible or rigid uereteroscopy with stone fragmentation and extraction (electrohydraulic lithotripsy or Holmium laser)

o

extracorporeal shock wave lithotripsy (see p 435 for mechanism)

stones in collecting system: extracorporeal shock wave lithotrips or percutaneous removal

uric acid stones can be treated medically by alkalization of urine with fluids

Penis  may be worth reading for humor/shock factor

Anatomy:

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