Urology Kidney Stone Review Note

HPI

• CT abdomen/pelvis without contrast (10/11/2023) demonstrates an 8 mm left lower pole renal calculus (1,150 HU, skin-to-stone distance 11 cm) and a 3 mm right interpolar renal calculus (650 HU, skin-to-stone distance 10 cm). No hydronephrosis.
• Currently experiencing intermittent, dull left flank pain. Denies gross hematuria, dysuria, urinary urgency, or fevers.

Past Stone History

• Calcium oxalate monohydrate (80%) and calcium phosphate (20%) on prior stone analysis.
• Right ureteroscopy with laser lithotripsy and stent placement (04/05/2019); left shockwave lithotripsy (12/10/2021).
• Renal ultrasound (15/05/2022) showed a 4 mm non-obstructing left lower pole calculus.

Past Medical History

• Hypertension, hyperlipidemia, type 2 diabetes mellitus, gout.

Assessment and Plan

• Symptomatic 8 mm left lower pole nephrolithiasis and asymptomatic 3 mm right nephrolithiasis.
• Non-contrast CT confirms 8 mm left lower pole stone (1,150 HU, SSD 11 cm) and 3 mm right interpolar stone (650 HU, SSD 10 cm) without collecting system dilation.
• Discussed observation vs. shockwave lithotripsy (SWL) vs. flexible ureteroscopy with laser lithotripsy (URS). Given stone density > 1,000 HU, SSD > 10 cm, and lower pole location, URS is favored over SWL. Patient elects to proceed with left URS, laser lithotripsy, and ureteral stent placement. Continue tamsulosin (Flomax®) 0.4 mg PO daily and diclofenac 50 mg PO BID PRN pain until surgery.

Instructions for Stone Prevention

I recommended drinking plenty of fluids, avoiding excessive animal protein and salt, and avoiding colas and cheese as much as possible.