Can Kidney Stones Cause Nitrites In Urine – Between 120 and 140 per 1000, 000 will develop urinary stones each year with a male / female ratio of 3:1. A number of factors known to influence the development of rocks are discussed below.

Correct classification of stones is important because it will affect treatment decisions and outcomes. Urinary stones can be classified according to the following aspects: stone size, stone location, stone radiographic characteristics, etiology of stone formation, stone composition (mineralogy), and risk group for recurrent stone formation.

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The risk status of an old stone is of particular interest as it defines both the probability of recurrence or (re)growth of stones and is imperative for pharmacological treatment.

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Solitary kidney (solitary kidney itself does not have a particular increased risk of stone formation, but the prevention of a potential stone recurrence is more important)

Standard evaluation of a patient includes taking a detailed medical history and physical examination. The clinical diagnosis should be supported by an appropriate imaging procedure.

In patients with fever or a solitary kidney, and when the diagnosis of stones is in doubt, immediate imaging is indicated.

Ultrasound should be used as the main procedure. KUB should not be performed if a NCCT (Non-contrast enhanced computed tomography) is considered.

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NCCT has become the standard for diagnosing acute flank pain and has higher sensitivity and specificity than IVU.

Use of NCCT to confirm a stone diagnosis in pts presenting with acute flank pain is superior to IVU.

Every emergency patient with urolithiasis needs a complete biochemical workup of urine and blood in addition to imaging studies. At this point there is no difference between high and low risk patients.

Sediment test/urine stick outside urine sample for: red blood cells / white blood cells / nitrite / urine pH level approx.

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Spasmolytics (metamizole sodium etc.) are alternatives that may be given in circumstances where parenteral administration of a non-narcotic agent is required.

Alpha-blocking agents, given daily, also reduce the number of recurrent colic. If pain relief cannot be obtained by medical means, drainage, using stenting or percutaneous nephrostomy, or stone removal should be performed.

For septic patients with stone obstruction, the collecting system should be decompressed urgently, using either percutaneous drainage or ureteral stenting.

When deciding between active stone removal and conservative treatment using MET, it is important to carefully consider all of a patient’s individual circumstances that may affect the treatment decision.

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In a patient with a newly diagnosed ureteral stone < 10 mm and if active stone removal is not indicated, observation and periodic evaluation is an option as initial treatment.

Kidney stones should be treated in cases of stone growth, de novo obstruction formation, associated infection, and acute and/or chronic pain.

For patients with ureteral stones that are expected to pass spontaneously, NSAID tablets or suppositories (ie diclofenac sodium, 100-150 mg/day, over 3-10 days) can help reduce inflammation and the risk of recurrent pain.

Alpha-blocking agents, given daily, also reduce the number of recurrent colic (LE: 1a). Tamsulosin, the most commonly used alpha blocker in the studies.

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Patients should be counseled about the risks of MET, including the side effects of associated drugs, and should be informed that it is administered as ‘off label’ use.

Patients, who choose for an attempt at spontaneous passage or MET, should have well-controlled pain, no clinical evidence of sepsis, and adequate renal function reserve.

After ESWL for ureteral or renal stones, MET seems to accelerate and increase stone-free rate, reducing additional analgesic requirements.

Oral or percutaneous irrigation chemolysis of stones may be a useful first-line therapy or an adjunct to ESWL, PNL, URS, or open surgery to support elimination of residual fragments. However, its use as first-line therapy may take several weeks to be effective.

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In percutaneous chemolysis, at least two nephrostomy catheters should be used to allow irrigation of the renal collecting system, while preventing flow of chemolytic fluid into the bladder and reducing the risk of increased intrarenal pressure.

Oral chemolitholysis is effective for uric acid stones only. Urine pH should be adjusted between 7.0 and 7.2.

The dose of alkalizing medicine must be modified by the patient according to the urine pH, which is a direct consequence of the alkalising medicine.

The patient is required to monitor the urine pH in drops at regular intervals during the day. Morning urine must be included.

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A double-J stent reduces the complications (evidence of renal colic) but does not reduce the formation of steinstrasse or infectious complications.

Patients with a pacemaker can be treated with ESWL provided that the patient’s cardiologist is consulted before ESWL is undertaken. Patients with implanted cardioverter defibrillators must be managed with special care, as some devices need to be deactivated during ESWL.

Treatment results depend on the operator. Careful control of localization will contribute to the quality of the results.

Antibiotics should be given before ESWL and continue for at least 4 days after the treatment, in the case of infected stones or bacteriuria.

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MET after ESWL for ureteral or renal stones may accelerate expulsion and increase stone-free rates, as well as a reduction in additional analgesic requirements.

Pre-procedure imaging, including a contrast media study, is required to assess stone size, the anatomy of the collecting system, and ensure safe access to the kidney stone.

Traditionally, the patient is positioned prone to PNL, however the supine position has been described, which shows the advantage of shorter operating time, the possibility of simultaneous retrograde transurethral manipulation, an easier anesthesia and disadvantages such as limitations in the maneuverability of the instruments and the need for appropriate equipment. .

In uncomplicated cases, tubeless (no nephrostomy tube) or totally tubeless (no nephrostomy tube and no ureteral stent) PNL procedures provide a safe alternative.

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Apart from a general consideration related to general anesthesia, URS can be performed in all patients without any specific contraindications.

Most interventions are performed under general anesthesia, although it is possible to use spinal anesthesia. Intravenous sedation is possible for distal stones, especially in women. Antegrade URS is an option for large, proximal ureteral calculus.

Fluoroscopic equipment must be available in the operating room. If ureteral access is not possible, insertion of a double-J stent followed by URS after a delay of 7-14 days offers a suitable alternative to dilation.

Hydrophilic coated ureteral access sheath (UAS), can be placed through a guide wire, with the tip placed in the proximal ureter. In patients with large stone mass UAS promotes improved stone-free rate and reduced OR-time.

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The goal of endourological intervention is to achieve complete stone removal, as the ‘break and go’ strategy leaves patients with a higher risk of stone recurrence and postoperative complications.

The nitinol basket preserves the deflection of the flexible ureterorenoscope tip, and the tipless design reduces the risk of mucosal injury.

Pre-stenting facilitates the ureteroscopic management of stones, improves the stone-free rate, and reduces the complication rate. Stents should be placed in patients at higher risk of complications.

Most complex (staghorn) stones should be approached primarily with PNL or a combination of PNL and ESWL. Open surgery may be a valid primary treatment option in selected cases.

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Laparoscopic or open surgical stone removal may be considered in rare cases where ESWL, URS, and percutaneous URS have failed or are unlikely to be successful.

When expertise is available, laparoscopic surgery should be the preferred option before proceeding to open surgery. An exception will be a complex burden of kidney stones and/or side stones.

For generally asymptomatic gallstones, active surveillance with an annual follow-up assessment of symptoms and stone status by appropriate means (KUB, ultrasonography [US], NCCT) is an option for a reasonable period (the first 2-3 years). years), whereas intervention should be considered after this period if patients are well informed.

If stone removal intervention is essential and salicylate therapy should not be interrupted, retrograde URS is the preferred treatment of choice.

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Radiolucent uric acid stones, but not sodium urate or ammonium urate stones, can be dissolved by oral chemolysis. Determination is done by urinary pH. Careful monitoring of radiolucent stones during/after therapy is imperative. (GR*:A)

Patients should be informed that URS is associated with a better chance of achieving stone-free status with a single procedure, but has a higher complication rate.

Recommendation: Percutaneous antegrade removal of ureteral stones is an alternative when ESWL is not indicated or fails, and when the upper urinary tract is not amenable to retrograde URS.

Steinstrasse occurs in 4% to 7% of ESWL cases, the major factor in the formation of steinstrasse is stone size.

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Identification of biochemical risk factors and appropriate stone prevention is particularly indicated in patients with residual fragments or stones.

Patients with residual fragments or stones should be followed regularly to monitor their disease course.

After ESWL and URS, adjunctive treatment with tamsulosin can improve fragment clearance and reduce the probability of residual stones.

For well-disintegrated stone material residing in the lower calyx, inversion therapy during large diuresis and mechanical percussion facilitate stone clearance.

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Indications for active stone removal and selection of the procedure are based on the same criteria as primary stone treatment and also include repeat ESWL.

Spontaneous passage of a stone and fragment after ESWL is more likely to occur in children than in adults (LE: 4). For pediatric patients, the indications for ESWL and PNL are

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