Diagnosis and management of urinary tract stone in family practice
- Author:
Noel L. Espallardo
- Publication Type:Other Types
- Keywords:
Prevention and management
- MeSH:
Urinary Calculi;
Humans;
Urinalysis;
Family Practice
- From:
The Filipino Family Physician
2018;56(4):190-204
- CountryPhilippines
- Language:English
-
Abstract:
Background:Urinary tract stones or calculi are low-density crystals in any part of the urinary tract that result from either excessive excretion or precipitation of salts in the urine or lack of substances to inhibit its formation. Prevention and management of urinary tract stones is also now medically feasible and recommended.
Objectives:This clinical pathway was developed to guide family and community physicians on the diagnosis and initial
management of urinary tract stone in terms of: 1) clinical history and physical examination; 2) laboratory and ancillary procedures to be requested; 3) pharmacologic interventions; 4) non-pharmacologic interventions; and 5) patient outcomes to expect.
Methods:The PAFP Clinical Pathways Group reviewed the previous guidelines for the treatment of urinary tract stones,
published medical literature (PubMed and HERDIN) to identify, summarize, and operationalize the clinical content of diagnostics, interventions and clinical indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice.
Recommendations:Family physicians should elicit patient history of flank pain, tenderness, dysuria and hematuria. They must be described in detail in terms of, characteristics, date of onset and severity. Other patient history to elicit should include stone passage, recurrent UTI, dietary history, fluid intake, recurrent UTI, medications and family history of being a stone former or some metabolic disorder. The laboratory should include ultrasound of kidney, ureter and bladder (plain CT is second line imaging study), urinalysis and blood chemistry (BUN, creatinine, calcium and uric acid). Symptomatic treatment with non-steroidal anti-inflammatory drugs or opioid analgesic in severe pain should be started even before the definitive diagnosis. Anti-spasmodic therapy may also be given. If stone is present, medical dissolution therapy for all stone sizes (alone or as complementary to medical expulsion, lithotripsy or surgery), medical expulsion therapy for stone size 5-10 mm and lithotripsy or surgery if greater than 10 mm. Non-pharmacologic treatment includes patient education, increased fluid intake to achieve at least 2-2.5 liters of urine per day and limit sodium intake (no evidence to limit calcium or protein intake). Family intervention to adjust family diet preference to low sodium is also recommended.
Implementation:To promote rational management of urinary tract stone in family practice, outreach visits to individual family physician’s clinic have been identified as an intervention that may improve the practice of health care professionals. This type of ‘face to face’ visit has been referred to educational detailing or academic detailing. Organizational activities such as quality improvement activities will also be encouraged.
- Full text:Diagnosis.pdf
