What is the most common risk of percutaneous stone surgery?

Bleeding, requiring transfusion

What is the most common risk of ureteroscopic laser lithotripsy?

Bleeding, requiring transfusion

What medication improves the rate of ureteral stone passage?

Nifedipine (calcium channel blocker)

A 34 y.o. a woman arrives for ESWL treatment of a non-obstructing renal stone. Preoperative urine analysis shows pyuria and bacteriuria consistent with urinary tract infection. What would be the appropriate next step, along with appropriate antibiotics?

Switch to ureteroscopy and stent placement

The same patient arrives, but now she has an obstructing ureteral stone with hydronephrosis and a fever. Start antibiotics and do what?

Switch to ureteroscopy and stent placement

What techniques can be reasonably used for proximal ureteral stones?

Percutaneous antergrade ureteroscopy

Quiz On Treating Kidney Stones! Trivia

1.

Which of the following stones would be radiolucent?
- A.
  
  Calcium oxalate
- B.
  
  Uric acid
- C.
  
  Struvite
- D.
  
  Cystine
- E.
  
  Calcium phosphate
Correct Answer
B. Uric acid

Explanation
Uric acid would be radiolucent because it does not absorb X-rays well, resulting in a lighter appearance on radiographic images. This is in contrast to the other stones listed, such as calcium oxalate, struvite, cystine, and calcium phosphate, which are radiopaque and appear darker on X-ray images due to their ability to absorb X-rays.

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2.

Shockwave lithotripsy is seldom performed on cystine stones. Why?
- A.
  
  Cystine stones are radiolucent
- B.
  
  Higher risk for the kidney
- C.
  
  Cystine stones are too brittle
- D.
  
  Cystine stones are too tough
Correct Answer
D. Cystine stones are too tough
3.

What is the most common risk of percutaneous stone surgery?
- A.
  
  Ureteral stricture
- B.
  
  Bleeding, requiring transfusion
- C.
  
  Ureteral injury
- D.
  
  Loss of renal function
Correct Answer
B. Bleeding, requiring transfusion

Explanation
The most common risk of percutaneous stone surgery is bleeding that is severe enough to require a blood transfusion. This procedure involves making a small incision in the back to access the kidney and remove or break up the stones. During the surgery, blood vessels may be damaged, leading to bleeding. In some cases, the bleeding can be significant and may require a transfusion to replace the lost blood. Other risks such as ureteral stricture, ureteral injury, and loss of renal function are also possible but are not as commonly seen as bleeding requiring transfusion.

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4.

What is the most common risk of ureteroscopic laser lithotripsy?
- A.
  
  Ureteral stricture
- B.
  
  Bleeding, requiring transfusion
- C.
  
  Ureteral injury
- D.
  
  Loss of renal function
Correct Answer
C. Ureteral injury

Explanation
Ureteral injury is the most common risk of ureteroscopic laser lithotripsy. This procedure involves using a laser to break up kidney stones in the ureter. However, there is a risk of the laser causing damage to the ureter, leading to injury. This can result in complications such as ureteral strictures, where the ureter becomes narrowed, potentially causing obstruction and urinary problems. Therefore, it is important for healthcare providers to carefully monitor and assess the patient during and after the procedure to minimize the risk of ureteral injury.

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5.

What medication improves the rate of ureteral stone passage?
- A.
  
  Flomax (alpha-blocker)
- B.
  
  Ditropan (anticholinergic)
- C.
  
  Nifedipine (calcium channel blocker)
- D.
  
  Oxycodone (opioid analgesic)
- E.
  
  Prednisone (steriod)
Correct Answer
A. Flomax (alpha-blocker)

Explanation
Flomax is an alpha-blocker medication that helps relax the muscles in the ureter, which can improve the rate of ureteral stone passage. By relaxing the muscles, Flomax can help the stone move more easily through the ureter, reducing pain and facilitating its passage. This medication is commonly prescribed to patients with ureteral stones to aid in their passage and improve symptoms associated with stone obstruction.

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6.

A 34 y.o. a woman arrives for ESWL treatment of a non-obstructing renal stone. Preoperative urine analysis shows pyuria and bacteriuria consistent with urinary tract infection. What would be the appropriate next step, along with appropriate antibiotics?
- A.
  
  Cancel ESWL, but place stent
- B.
  
  Antibiotic therapy alone
- C.
  
  Proceed with ESWL procedure
- D.
  
  Switch to ureteroscopy and stent placement
Correct Answer
B. Antibiotic therapy alone

Explanation
The appropriate next step would be to treat the urinary tract infection with antibiotic therapy alone. This is because the presence of pyuria and bacteriuria indicates an active infection, which should be resolved before proceeding with any invasive procedure like ESWL or ureteroscopy. Antibiotics will help to clear the infection and prevent any complications that could arise from the procedure. Placing a stent or proceeding with ESWL without treating the infection could lead to worsening of the infection and potential complications. Therefore, antibiotic therapy alone is the most appropriate next step in this case.

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7.

The same patient arrives, but now she has an obstructing ureteral stone with hydronephrosis and a fever. Start antibiotics and do what?
- A.
  
  Cancel ESWL, but place stent
- B.
  
  Antibiotic therapy alone
- C.
  
  Proceed with ESWL procedure
- D.
  
  Switch to ureteroscopy and stent placement
Correct Answer
A. Cancel ESWL, but place stent

Explanation
In this scenario, the patient has an obstructing ureteral stone with hydronephrosis and a fever. The correct course of action is to cancel the extracorporeal shock wave lithotripsy (ESWL) procedure and instead place a stent. This is because the presence of a fever indicates a possible infection, and performing ESWL can cause the stone fragments to become lodged in the ureter, exacerbating the obstruction and potentially leading to further complications. Placing a stent will help relieve the obstruction and allow for drainage of urine, while also providing a pathway for the stone to pass.

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8.

What best describes the da Vinci surgical system?
- A.
  
  Autonomous robot
- B.
  
  Artificial intellegence
- C.
  
  Slave-master system
- D.
  
  Augmented reality
- E.
  
  None of the above
Correct Answer
C. Slave-master system

Explanation
The da Vinci surgical system is best described as a slave-master system. This means that it is controlled by a surgeon who acts as the "master" and uses the system to perform surgical procedures. The system consists of robotic arms that are controlled by the surgeon's hand movements, allowing for precise and minimally invasive surgeries. The surgeon remains in control throughout the procedure, with the system acting as an extension of their own movements.

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9.

In what country was shockwave lithotripsy developed?
- A.
  
  United States
- B.
  
  United Kingdom
- C.
  
  France
- D.
  
  Germany
- E.
  
  Japan
Correct Answer
D. Germany

Explanation
Shockwave lithotripsy is a non-invasive medical procedure used to break down kidney stones into smaller pieces, allowing them to pass more easily. It was developed in Germany. This procedure uses shock waves generated outside the body to target and break down the stones. The technique was first introduced by German urologist Dr. Dornier in the 1980s. Since then, shockwave lithotripsy has become a widely used and effective treatment for kidney stones worldwide.

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10.

What techniques can be reasonably used for proximal ureteral stones?
- A.
  
  Laparoscopic ureterolithotomy
- B.
  
  Shockwave lithotrispy
- C.
  
  Ureteroscopy
- D.
  
  Percutaneous antergrade ureteroscopy
- E.
  
  All of the above
Correct Answer
E. All of the above

Explanation
All of the techniques mentioned - laparoscopic ureterolithotomy, shockwave lithotripsy, ureteroscopy, and percutaneous antegrade ureteroscopy - can be reasonably used for proximal ureteral stones. These techniques are commonly employed to remove or break down stones located in the proximal ureter. Laparoscopic ureterolithotomy involves making small incisions and using a laparoscope to remove the stone. Shockwave lithotripsy uses sound waves to break the stone into smaller fragments. Ureteroscopy involves inserting a thin tube with a camera into the ureter to locate and remove the stone. Percutaneous antegrade ureteroscopy involves accessing the stone through a small incision in the back and using a scope to remove it.

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Quiz On Treating Kidney Stones! Trivia

Which of the following stones would be radiolucent?

Shockwave lithotripsy is seldom performed on cystine stones. Why?