Next, the second most common type of kidney stone
or nephrolithiasis is going to be a huge one.
This one’s called a M-A-P, MAP, it’s Magnesium-Ammonia and Phosphate.
Two of the substances here or two of the components or ingredients
of what’s known as a staghorn type of stone
actually will give you a pH that is alkaline, are we clear?
Once more, few of the components or ingredients of this struvite, staghorn,
all the same thing, is then going to be what’s known as your ammonia phosphate.
It will give you an alkaline type of pH.
That’s important for you to know and many of you noticed to what I’m getting at.
Next, alkaline urine precipitation, pH increases,
and that type of infections that you’re worried about
include things like well, a urinary tract infection with Proteus mirabilis.
Now, this is a huge stone.
Staghorn, it’s going to be radiopaque no doubt, you can’t miss it.
It’s just a large, solid abnormality that might be in your renal pelvis.
Please put yourself in the renal pelvis, good.
And they have a huge stone there, and it’s radiopaque.
Now, here, be careful.
I don’t want you to get your envelope -
And that’s what I - the part that I’m not so comfortable with
is the fact that the shape of the stones.
What you wanna know and with certainty is that if it’s a dumbbell like, it’s calcium,
well, that’s going to be calcium, and then if it’s a box shaped, be careful.
In your head and in the picture that you see here,
do not get your coffin confused with an envelope.
I mean, for the most part, they’re both boxed shape or maybe more rectangle, is that clear?
So really, ladies and gentlemen, apart from that type of crystals
that you’re going to find which is going to be more rectangular and square like
in both calcium phosphate and also here with struvite,
do take a look at the history of your patient.
If there’s anything about urinary tract infections,
if there’s anything about those huge structures in the pelvis,
then you’re going with your obviously struvite.
Now, accounts for 15% known as a struvite or staghorn,
synonymous urinary tract infection.
What kind of urine do you have here? Alkaline.
What kind of urine did you have with calcium oxalate?
Good, that was more of your acidic type of urine
whereas calcium phosphate will be more alkaline.
So be careful with the type of urine pH.
You once again want to confirm your finding with the history.
Proteus mirabilis, the saprophyticus, and then klebsiella
would be those organisms that would take advantage of such an alkaline environment.
Management, what do you wanna do?
Includes eradication of urinary tract infection
and what’s known as percutaneous nephrolithotomy.
That’s the big one. Okay?
You wanna note that as being part of our current day practice
apart from treating the urinary tract infection,
you try to do a nephrolithotomy as well.