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Kidney stone disease

2,544 bytes removed, 13:16, 8 November 2018
→‎Evaluation: Moved to CT page
==Evaluation==
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File:3mmstone.png|[[Transverse plane|Axial]] [[X-ray computed tomography|CT scan]] of abdomen without contrast, showing a 3-mm stone (marked by an arrow) in the left proximal [[ureter]]
File:Ultrasonography of renal stone located at the pyeloureteric junction.jpg|[[Renal ultrasonograph]] of a stone located at the pyeloureteric junction with accompanying hydronephrosis.
File:CT measurement of kidney stone in soft tissue and bone window.jpg|Measurement of a 5.6 mm large kidney stone in soft tissue window (at left, with width of 400 HU, and center at 50 HU) versus skeletal window (right, W1800,C400). 145 HU is regarded as an appropriate cutoff to distinguish a stone from surrounding tissue.<ref name="LidénThunberg2015">{{cite journal|last1=Lidén|first1=Mats|last2=Thunberg|first2=Per|last3=Broxvall|first3=Mathias|last4=Geijer|first4=Håkan|title=Two- and three-dimensional CT measurements of urinary calculi length and width: a comparative study|journal=Acta Radiologica|volume=56|issue=4|year=2015|pages=487–492|issn=0284-1851|doi=10.1177/0284185114528490}}</ref>
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Objectives of the evaluation include:<ref>{{cite web|url=https://emedicine.medscape.com/article/381993-overview|title=Urinary Calculi Imaging|author=J Kevin Smith, Mark E Lockhart, Nicole W Berland and Philip J Kenney|website=Medscape|date=2015-10-27}}</ref>
*Presence of stones within the urinary tract
*Complications such as hydronephrosis (''See: [[Hydronephrosis]]'')
*Measure the size of stones. Proper sizing of a stone is important at around 5 mm and above, since smaller stones generally pass spontaneously.<ref group="notes">Ureteric stones less than 5 mm in diameter pass spontaneously in up to 98% of cases, while those measuring 5 to 10 in diameter pass spontaneously in less than 53% of cases.<br> - {{cite journal|last=Gettman|first=MT|last2=Segura|first2=JW|title=Management of ureteric stones: Issues and controversies|journal=British Journal of Urology International|volume=95|issue=Supplement 2|pages=85–93|year=2005|pmid=15720341|doi=10.1111/j.1464-410X.2005.05206.x}}</ref> Sizing of larger stones is also important in order to decide which treatment to choose.<ref group="notes">Small proximal ureteral calculi of less than 10 mm are best treated with shock wave lithotripsy and ureteroscopy, while those larger than 10 mm are best treated with flexible ureteroscopy combined with holmium laser lithotripsy.
<br> - {{cite web|url=https://www.uptodate.com/contents/management-of-ureteral-calculi|title=Management of ureteral calculi|author=Glenn M Preminger, Section Editors:Stanley Goldfarb, Michael P O'Leary. Deputy Editor:Albert Q Lam|date=2018-01-19|website=UpToDate}}</ref>
*Confirm any stone passage
*Assess the stone burden
==Report==
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