General Surgery
Kidney and Ureter
MBBS surgery notes on the kidney and ureter: urinary stones, obstruction, hydronephrosis and renal tumours, mapped to NMC codes SU29.1 to SU30.1.
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Kidney and Ureter
MBBS surgery notes on the kidney and ureter: urinary stones, obstruction, hydronephrosis and renal tumours, mapped to NMC codes SU29.1 to SU30.1.
This chapter covers surgical disease of the kidney and ureter. It focuses on urinary stones and their management, obstruction and hydronephrosis, and the renal and upper tract tumours.
High-yield: Kidney and Ureter
- Ureteric colic causes severe loin to groin pain that comes in waves, often with nausea and an inability to lie still.
- Most urinary stones are radio-opaque calcium oxalate stones, while pure uric acid stones are radiolucent.
- The non-contrast computed tomography of the kidney, ureter and bladder is the investigation of choice for a suspected stone.
- Stones commonly lodge at three sites of narrowing: the pelviureteric junction, the pelvic brim and the vesicoureteric junction.
- Small ureteric stones under about 5 mm often pass spontaneously with fluids and analgesia.
- Larger stones may need extracorporeal shock wave lithotripsy, ureteroscopy or percutaneous nephrolithotomy.
- A staghorn calculus fills the renal pelvis and calyces and is often a struvite stone associated with infection.
- An obstructed infected kidney, a pyonephrosis, is a urological emergency requiring urgent drainage.
- Renal cell carcinoma classically presents late with the triad of haematuria, loin pain and a loin mass.
- Renal cell carcinoma can produce paraneoplastic syndromes and can invade the renal vein and inferior vena cava.
- Transitional cell carcinoma of the renal pelvis and ureter presents with painless haematuria.
- A Wilms tumour, or nephroblastoma, is a common childhood renal tumour presenting as an abdominal mass.
- Pelviureteric junction obstruction causes hydronephrosis and can present with intermittent loin pain.
- Painless visible haematuria in an adult is urothelial cancer until proven otherwise and needs full urological assessment.
- Adequate hydration and dietary measures reduce the risk of recurrent stone formation.
Urinary stone essentials
- **Investigation:** Non-contrast computed tomography of the kidney, ureter and bladder is the first-line test.
- **Sites of impaction:** Pelviureteric junction, pelvic brim and vesicoureteric junction.
- **Small stone:** Under about 5 mm often passes with fluids and analgesia.
- **Larger stone:** Shock wave lithotripsy, ureteroscopy or percutaneous nephrolithotomy.
NMC competencies in this chapter
- **SU29.1:** Urinary tract stones: presentation and management
- **SU29.2:** Urinary tract obstruction and hydronephrosis
- **SU29.3:** Renal tumours in adults
- **SU29.4:** Haematuria and its evaluation
- **SU29.5:** Upper urinary tract infection and pyonephrosis
- **SU29.6:** Paediatric renal conditions and Wilms tumour
- **SU30.1:** Assessment of the urological patient
Frequently Asked Questions
What is the investigation of choice for a urinary stone?
A non-contrast computed tomography of the kidney, ureter and bladder, which detects stones of nearly all types and locations quickly and accurately.
Where do ureteric stones commonly lodge?
At the three natural narrowings: the pelviureteric junction, the point where the ureter crosses the pelvic brim, and the vesicoureteric junction where it enters the bladder.
What is the classic triad of renal cell carcinoma?
Haematuria, loin pain and a palpable loin mass, although this full triad appears late; many tumours are now found incidentally on imaging.
How should painless visible haematuria be treated?
As urothelial cancer until proven otherwise. It requires full urological assessment with imaging and cystoscopy to exclude a tumour of the kidney, ureter or bladder.
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