Bladder Stone
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Bladder Stone as PDF for free.
More details
- Words: 348
- Pages: 2
Surgery Essay
Outline the management of a 70year old man with a 3cm stone in the bladder. IN an acute presentation, were there has been ureteric obstruction by a bladder stone and acute urinary retention, the patient will present with agonising suprapubic pain. Analgesia such as diclofenac 100mg PR is given together with an antiemetic such as metroclopramide 10mg IV. The patient is supplemented by IV fluids. Since this patient does not have a small stone, he cannot be managed expectantly because it is unlikely he will pass the stone spontaneously. Extra-corporeal shock-wave lithotripsy (ESWL) is most likely to be used. This involves focused, externally generated electro hydraulic or ultrasonic shockwaves. Using ultrasound, X ray or a combination of both the ESWL can be targeted on the calculus. This will cause stone disintegration and the fragments are then voided. This avoids removal of stones from the renal tract as an open operation which prevents a lot of problems in an elderly male. The elderly have multiple co morbidities, which are often silent due to atypical presentation or underreporting of symptoms. Also an elderly male might be prone to mild or moderate malnutrition increasing surgical complication rates. In addition a 70- year old male might have reduced or acutely impaired mental faculties and this may make operation consent taking difficult. 1
Surgery Essay
To prevent recurrence, advice must be given to the patient and his family and carers. This includes an increase in his oral intake and to reduce calcium intake as 75% of all urinary tract stones are calcium stones. Any metabolic abnormality, such as hyperparathyroidism, sarcoidosis and hypervitaminosis D, needs to be corrected as these are aetiological factors for stone formation. Infection is another aetiological factor; therefore if it is treated promptly, there is prevention of recurrence. Urinary alkalization, e.g. Sodium bicarbonate or potassium citrate 5-10mg/24hr PO in water is useful to prevent the recurrence of cystine and urate stones. If there is a high urate in blood, allopurinol is useful to block its synthesis via xanthine oxidase. Thiazide diuretics are useful for idiopathic hypercalciuria. 27/01/09
2
Outline the management of a 70year old man with a 3cm stone in the bladder. IN an acute presentation, were there has been ureteric obstruction by a bladder stone and acute urinary retention, the patient will present with agonising suprapubic pain. Analgesia such as diclofenac 100mg PR is given together with an antiemetic such as metroclopramide 10mg IV. The patient is supplemented by IV fluids. Since this patient does not have a small stone, he cannot be managed expectantly because it is unlikely he will pass the stone spontaneously. Extra-corporeal shock-wave lithotripsy (ESWL) is most likely to be used. This involves focused, externally generated electro hydraulic or ultrasonic shockwaves. Using ultrasound, X ray or a combination of both the ESWL can be targeted on the calculus. This will cause stone disintegration and the fragments are then voided. This avoids removal of stones from the renal tract as an open operation which prevents a lot of problems in an elderly male. The elderly have multiple co morbidities, which are often silent due to atypical presentation or underreporting of symptoms. Also an elderly male might be prone to mild or moderate malnutrition increasing surgical complication rates. In addition a 70- year old male might have reduced or acutely impaired mental faculties and this may make operation consent taking difficult. 1
Surgery Essay
To prevent recurrence, advice must be given to the patient and his family and carers. This includes an increase in his oral intake and to reduce calcium intake as 75% of all urinary tract stones are calcium stones. Any metabolic abnormality, such as hyperparathyroidism, sarcoidosis and hypervitaminosis D, needs to be corrected as these are aetiological factors for stone formation. Infection is another aetiological factor; therefore if it is treated promptly, there is prevention of recurrence. Urinary alkalization, e.g. Sodium bicarbonate or potassium citrate 5-10mg/24hr PO in water is useful to prevent the recurrence of cystine and urate stones. If there is a high urate in blood, allopurinol is useful to block its synthesis via xanthine oxidase. Thiazide diuretics are useful for idiopathic hypercalciuria. 27/01/09
2
Related Documents
Bladder Stone
June 2020 10
Stone
November 2019 41
Neurogenic Bladder
May 2020 5
Bladder Kontribusi.docx
April 2020 14
Kidney, Ureter, Bladder
December 2019 11