SurgeNote

10 mm → Time to Scope 🔍💎

Mnemonic to remember ESWL contraindications: “B-PUS” 💥 B = Bleeding disorder P = Pregnancy U = Ureteric obstruction (stenosis) S = Severe infection (added for completeness)

11th rib = 1 pleural leak → Hydrothorax 💧🫁

PCNL (Percutaneous Nephrolithotomy) Via the 11th intercostal space risks pleural injury because the 11th rib is close to the pleural cavity. Puncture may allow fluid from irrigation or urine to enter the pleural space, causing hydrothorax.

Drain First, Fix Later💧➡️🔧 💧 Drain → relieve obstruction (stent/PCN) 🔧 Fix → definitive stone removal once kidney stabilizes

A 50 years old female is admitted with abdominal pain and anuria. Radiological studies revealed bilateral impacted ureteric stones with hydronephrosis. Urine analysis showed RBCs with pus cells in urine. Serum creatinine level was 10 mg/dl and urea level was 200 mg/dl.

Calcium Oxalate 🧊💥 – Small, hard, hurts like ice cubes in your kidney. ❄️ Small, radiopaque ⚡ Causes sharp recurrent colic 👨‍🦰 Mostly adults, idiopathic Struvite 🦠🏰 – Infection castle stone. 🦠 Associated with Proteus infection. 🏰 Forms staghorn, fills the renal pelvis like a fortress 💧 Often in women with recurrent UTIs. مهممممممم جدا Important: Pain + no infection → think Calcium Oxalate 🧊💥 Big staghorn + UTI → think Struvite 🦠🏰

Most adult colic stones = Calcium oxalate – Visible on X-ray 💎

Calculi composed of cystine, callium oxalate monohydrate are known to be resistant to fragmentation (ESWL)

Monohydrate = Mono strong 💪, Di = easier to break 🪨✨

Small pelvic stones in kids → ESWL rocks them! 🪨✨

💡 No calcium, no X-ray shadow.

🟦 Uric acid hides on X-ray. it’s the sneaky one that’s radiolucent, others show up.