F00574 017 f013
Stono in lower urcter
ESWL
Uteroscopic destruction Dornier basket extraction
Stone in renal pelvis or kidney
Stone in uppcr ureter
Stone in bladdcr
Extracorporeal shock wave lithotripsy (ESWL)
ESWL
Percutaneous nephrolithotomy Open surgery (very rarely)
ESWL
Uteroscopic destruction-laser or mechanical
Laparoscopic removal (rarely) Open surgery (very rarely)
Cystoscopic destruction-stone punch
Open removal-if largerthan hen's egg
Indications for intervention
• Obstructive anuria or severe infection (pyonephrosis) -> Emergency percutaneous nephrostomy only
• Severe pain or solitary kidney -» Urgent ESWL or surgery
• Pain and failure of the stone to move -> Elective ESWL or surgery
© Elsevier. Boon et al.: Davidson's Principles and Practice of Medicine 20e - www.studentconsult.com
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