Professional Documents
Culture Documents
Khori Halimah
30101206653
Pembimbing :
dr. Ahmad Sulaiman Lubis, Sp.U
Surgical Anatomy
of Ureters
Anatomy
INTRINSIC
IDIOPATIC Heriditer
Age
Gender
EXTRINSIC
Geography: stone belt
Climate / temperature
Water / mineral intake
Diet: purine, oxalate
Work
Microscopic examination of urine sediment.
(Redrawn after Todd-Sanford-Davidson.)
Scanning electron micrographs
of various urinary crystals
CLINICAL MANIFESTATION
• Colic pain when the stone is down
Hematuri if the stone is down
• Urinalysis
• Physiological examination of the kidneys
• Abdominal radiograph / BNO
• PIV
• Ultrasound
DIFFERENTIAL DIAGNOSIS
• Urinary stones can mimic other retroperitoneal and
peritoneal pathologic states. A full differential diagnosis
of the acute abdomen should be made, including acute
appendicitis, ectopic and unrecognized pregnancies,
ovarian pathologic conditions including twisted ovarian
cysts, diverticular disease, bowel obstruction, biliary
stones with and without obstruction, peptic ulcer disease,
acute renal artery embolism, and abdominal aortic
aneurysm, to mention a few. Peritoneal signs should be
sought during physical examination.
MANAGEMENT
Conservative management for a patient with a ureteral stone smaller than 5
mm is appropriate because there is a high likelihood of stone passage.
Ureteral stones larger than 5 mm are unlikely to pass spontaneously
SWL and ureteroscopy are highly effective for patients with ureteral
calculi.
Location
Stone Burden
Stone Compositio
• Aberrant Anatomy
Technical Factors
ureteroscopy is the most cost-effective
treatment strategy for ureteral stones at all
locations, after observation fails.