Pyelolithotomy Workup

  • Author: Martha K Terris, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS   more...
 
Updated: May 9, 2011
 

Laboratory Studies

  • The usual surgical profile includes the following:
    • CBC count
    • Blood type
    • Activated partial thromboplastin time and prothrombin time
    • Electrolytes
    • Blood urea nitrogen
    • Creatinine
  • Perform a urinalysis (with culture and sensitivity).
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Imaging Studies

  • Confirmation is usually based on radiological findings.
    • Radiograph of the kidneys, ureters, and bladder (KUB): Ninety percent of stones are radiopaque.
    • CT scan provides information to quantify stone mass. This also shows uric acid stones, which are radiolucent.
    • Intravenous pyelogram (IVP) provides the most information on collecting system anatomy, demonstrating filling defects where stone burden is located. This also shows uric acid stones. See the image below. Intravenous pyelogram demonstrating ureteropelvic Intravenous pyelogram demonstrating ureteropelvic junction obstruction with dilatation of the collecting system and lack of excretion of contrast.
    • Cystoscopy and retrograde pyelogram offer similar information as IVP and is performed when patients have renal failure, usually with a creatinine level of more than 1.8 g/24 h. See the image below. Retrograde pyelogram demonstrating ureteropelvic jRetrograde pyelogram demonstrating ureteropelvic junction obstruction secondary to annular stricture.
    • Plain renal tomograms may be helpful.
    • Renal scintigraphy should be considered in patients with a large stone burden and long-standing obstruction. The kidney function in this clinical scenario can be extremely poor, and, if confirmed on functional study, a nephrectomy may be more appropriate.
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Diagnostic Procedures

  • Perform an IVP or a renal scan to confirm function of the kidney in question.
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Contributor Information and Disclosures
Author

Martha K Terris, MD, FACS  Professor, Department of Surgery, Section of Urology, Director, Urology Residency Training Program, Medical College of Georgia; Professor, Department of Physician Assistants, Medical College of Georgia School of Allied Health; Chief, Section of Urology, Augusta Veterans Affairs Medical Center

Martha K Terris, MD, FACS is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Institute of Ultrasound in Medicine, American Society of Clinical Oncology, American Urological Association, Association of Women Surgeons, New York Academy of Sciences, Society of Government Service Urologists, Society of University Urologists, Society of Urology Chairpersons and Program Directors, and Society of Women in Urology

Disclosure: Nothing to disclose.

Coauthor(s)

Subbarao V Cherukuri, MD  Consulting Staff, Department of Urology, St Joseph Regional Health Center

Subbarao V Cherukuri, MD is a member of the following medical societies: American Urological Association and Ohio State Medical Association

Disclosure: Nothing to disclose.

Richard H Jadick MD  Staff Physician, Section of Urology, Medical College of Georgia

Richard H Jadick MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Osteopathic Association, and American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Martin I Resnick, MD †  Former Lester Persky Professor and Chair, Department of Urology, Former Professor, Department of Oncology, Case Western Reserve University School of Medicine

Martin I Resnick, MD † is a member of the following medical societies: American College of Surgeons, American Federation for Medical Research, American Institute of Ultrasound in Medicine, American Medical Association, American Society for Bone and Mineral Research, American Society for Reproductive Medicine, American Society of Andrology, American Surgical Association, American Urological Association, Association for Academic Surgery, Endocrine Society, National Kidney Foundation, Ohio Urological Society, and Pan American Medical Association

Disclosure: Nothing to disclose.

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

References

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Intravenous pyelogram demonstrating ureteropelvic junction obstruction with dilatation of the collecting system and lack of excretion of contrast.
Retrograde pyelogram demonstrating ureteropelvic junction obstruction secondary to annular stricture.
 
 
 
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