What is the preferred entry point into the collecting system for PCNL for a 2.4 cm renal pelvis stone?
anterior lower pole calyx
posterior lower pole calyx
anterior upper pole calyx
posterior upper pole calyx
Correct Answer :
B. posterior lower pole calyx
posterolateral puncture directed at the lower posterior calyx would traverse through an avascular zone.
Related Questions
What could high dietary protein result in?
increase urinary calcium, oxalate, and uric acid excretion
decrease urinary calcium; but increase oxalate, and uric acid excretion
increased urinary calcium and uric acid; but decrease oxalate excretion
decreased urinary calcium, oxalate, and uric acid excretion
Which of the following factors, positively, affect lower calyceal stone clearance after ESWL?
short and wide infundibulum
large lower-pole infundibulo-pelvic angle
the adjunct usage of PCNL
all of the above
What is (are) true concerning ESWL?
a stone is fragmented when the force of the shockwaves overcomes the tensile strength of the stone
fragmentation occurs as a result of compressive and tensile forces, erosion, shearing, spalling, and cavitation
the generation of compressive and tensile forces and cavitation are thought to be the most important
all of the above
What is false concerning patient`s preparation for PCNL?
active UTI is an absolute contraindication
fluoroquinolone is the first choice for antimicrobial prophylaxis
withholding aspirin for only 10 days is enough
despite sterile urine, stone fragmentation might release hidden bacterial endotoxins and viable bacteria
What metabolic disturbances could result from renal tubular acidosis type I?
hypercalciuria and hypocitraturia
hypercalciuria and hypercitraturia
hypocalciuria and hypocitraturia
hypocalciuria and hypercitraturia
During pyelolithotomy for removing a staghorn urate stone; how to ensure a complete removal of calyceal branches?
by performing intra-operative ultrasonography
by performing radial nephrotomies
by performing adjunct PCLN
by taking a scout KUB film
In what kind of renal stones do antibiotics help most?
indinavir
magnesium ammonium phosphate
xanthine
matrix
A 24-hr urine collection of a recurrent Ca. oxalate stone former patient having Crohn`s disease might reveal:
high citrate, high oxalate
low citrate, low oxalate
high citrate, low oxalate
low citrate, high oxalate
Invasive intervention in stone patients is NOT indicated in the following condition:
stone size
unrelieved obstruction
infection and septicemia
recurrent stone formation
What is the treatment of choice for a 15 mm stone in the lower calyx with a narrow infundibulum?
ESWL
PCNL
radial nephrolithotomy
pyelolithotomy with ureteral stenting
What congenital anomaly is unlikely to result in stone formation?
left ureterocele
bifid right renal pelvis
neurogenic bladder
bilateral UPJ stenosis
What is the incidence risk of ureteral strictures following ureteroscopy?
3 6 %
12 15 %
0.4 0.8 %
0.09 0.14 %
What is false concerning primary bladder stones?
commoner in females than in males
in pediatrics, are of calcium oxalate and/or ammonium urate composition
caused by bladder outlet obstruction
might result in bladder cancer
Patients having what kind of stones should refrain from eating purines?
cysteine
urate
calcium
none of the above
What is a remarkable disadvantage of ultrasonic imaging for ESWL?
localization of stones in the ureter is difficult or impossible
inability to visualize stones breaking down in real time
c. patient`s position on ESWL table is uncomfortable
d. inability to visualize radiolucent stones
What does the treatment of hyperuricemia with urate stones include?
oral potassium sodium hydrogen citrate granules
increase hydration
allopurinol
all of the above
What is true concerning uric acid stones?
they are metabolic stones that form at high urinary pH
they score 800 1000 HU on CT
only 25% of affected patients have Gout disease
affected patients must stop eating animal protein
What kind of stones is most amenable to ESWL?
cystine
brushite
Ca.oxalate monohydrate
Ca.oxalate dihydrate
What is the treatment of choice for a 15 mm stone in a mid calyceal diverticulum?
ESWL
PCNL with fulguration of the diverticulum
ureteroscopy with fulguration of the diverticulum
pyelolithotomy with diverticulectomy
Which statement is false concerning renal stones related to hyperparathyroidism (HPT)?
renal stones are found in 20% of patients with primary HPT
acidic arrest promotes crystallisation of calcium phosphate stones related to HPT
HPT, vitamin D excess, and malignancy could lead to hypercalcemia and hypercalciuria
only surgery can cure primary HPT
What sequence of ureteral parts represents the most to least favorable stone response to ESWL treatment?
upper, lower, mid
lower, upper, mid
mid, upper, lower
mid, lower, upper
What is the preferred irrigation fluid during PCNL?
physiological saline 0.9%
glycine 1.5%
balanced salt solution
distilled water
Which event is unlikely to occur after placing a DJ ureteral stent?
can be forgotten in place
vesico-renal reflux
calyceal perforation
detrusor irritability and/or hematuria
Why do patients with cystic fibrosis form stones?
because urine and body secretions are highly concentrated
due to renal leak hypercalciuria
as a result of distal renal tubular acidosis type I
because of reduced or absent of oxalobacter formigenes colonization
What is the unfavorable stone characteristic for a rigid URS treatment?
size of 5 mm
location at the lower calyx
density of 400 HU
being recurrent
What does NOT appear as a filling defect in the renal pelvis on IVU?
fungal ball
radiolucent stone
urothelial growth
upper end of DJ ureteral stent
What parameter is NOT considered in the stone burden concept?
the surface area of the stones
the volume of the stones
the density of the stones
the number of the stones
What is false concerning neonatal nephrolithiasis?
frequently caused by loop diuretics
stones are often radiolucent
may be reversed by the use of thiazides
low calcium-to-creatinine ratio predicts stones resolution
What does nephrocalcin do?
dissolves cystine stones
enhances nephrocalcinosis process over old scared areas
inhibits Ca.oxalate aggregation and crystallization
plays a secondary role in metastatic calcification process
What is false concerning prostatic stones?
composed of calcium phosphate and calcium carbonate
the vast majority are asymptomatic
most of the calculi are found in the transitional zone
they dont affect PSA levels