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Struvite Stones: Treatment – Nephrolithiasis

by Amy Sussman, MD

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    00:01 How about struvite stones? What do we need to consider in that particular patient population? So struvite stones are also called triple phosphate stones or infections stones.

    00:12 They are large in size, they're difficult to eradicate and they oftentimes will form a staghorn calculus meaning that they fill up the entire renal pelvis in those calyces.

    00:23 They are composed of magnesium ammonium phosphate and triple phosphte and calcium carbonate apatite.

    00:30 They are associated with urease-producing bacteria, that includes Proteus, Pseudomonas, Klebsiella, Serratia, Ureaplasma and Citrobacter.

    00:42 So some of the risks of forming struvite stones are going to be when patients have urinary tract infections.

    00:49 There's an increase in propensity to form these struvite stones particularily with those urease-producing organisms that we talked about.

    00:56 Women tend to have more struvite stones than men and having a high urinary pH, again with those urease-producing organisms really puts that patient at risk.

    01:08 How do we treat struvite stones? Antibiotic therapy is key, remember these are infection-related stones so we have to eradicate that infection.

    01:17 Oftentimes unfortunately, that is not enough and our patients will actually require urological intervention.

    01:24 So we call our urology colleagues and they can do a complete stone removal.

    01:29 For small stones, they can come in and they can do extracorporeal shock wave lithotripsy.

    01:34 So basically, they can actually use a shock wave to break up those stones and let them pass or if it's a larger stone, particularly staghorn calculi or others, they can do a percutaneous nephrolithotomy.

    01:48 That's what's shown in this image over here.

    01:50 This patient actually has multiple tracks where they've entered percutaneously right into the renal pelvis in order to retrieve the stone.


    About the Lecture

    The lecture Struvite Stones: Treatment – Nephrolithiasis by Amy Sussman, MD is from the course Nephrolithiasis (Kidney Stones).


    Included Quiz Questions

    1. Antibiotic therapy is crucial in the management of struvite stones.
    2. Acidic urinary pH increases the risk of struvite stone formation.
    3. Urologic intervention is not usually required in the management of struvite stones.
    4. Struvite stones are associated with oxidase-producing bacteria.
    5. Struvite stones are more common in male than in female patients.

    Author of lecture Struvite Stones: Treatment – Nephrolithiasis

     Amy Sussman, MD

    Amy Sussman, MD


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