- Management
- Noninvasive medical management includes rehydration, correction of electrolyte and acid–base imbalances, promotion of urolith migration toward the bladder (eg, CRI mannitol to induce diuresis, prazosin, glucagon, amitriptyline).
- Pain management
- Ureteral stent placement
- Nephrostomy tube placement
- Surgery (ureterotomy)
- Ureteral stricture is a common complication.
- Surgery is contraindicated if the ureterolith is migrating, azotemia is decreasing, or the kidney is already dysfunctional.
Cystouroliths
- Common clinical signs include pollakiuria, dysuria/stranguria, hematuria, and periuria.
- Can be subclinical
- Most common cystouroliths are struvite, calcium oxalate, urate, calcium phosphate, cystine, and silicate.
- Determining urolith type helps guide management options (Figure 1, above; Table).
- Complications of cystouroliths may include UTI, polyps, and obstructive uropathy.
- Management
- Medical dissolution (struvite, urate, cystine)
- Cystotomy
- Voiding hydropulsion (depends on urolith size, shape)
- Catheter retrieval (depends on urolith size, shape)
- Basket retrieval (depends on urolith size, shape)
- Lithotripsy
Figure 1. Uroliths are often composed of a nidus or nucleus, body, shell, and possibly surface crystals. In urolith analysis, all components should be considered when directing treatment and prevention. For example, a calcium oxalate nidus and body may later develop a struvite shell and struvite surface crystals secondary to a complicating UTI; in this case, after the stone has been removed and the UTI eradicated, treatment strategies should target prevention of calcium oxalate urolith recurrence.