Pyelolithotomy Workup

Updated: Oct 13, 2016
  • Author: Martha K Terris, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Workup

Laboratory Studies

See the list below:

  • 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

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  • 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 j Retrograde 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

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  • Perform an IVP or a renal scan to confirm function of the kidney in question.
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