Algorithm for Treatment of Urate Urocystolithiasis - Flowchart
Algorithm for Treatment of Urate Urocystolithiasis - Flowchart Algorithm for Treatment of Urate Urocystolithiasis Algorithm for Treatment of Urate Urocystolithiasis
«Flowchart»

Dysuria, pollakiuria, hematuria

Dysuria, pollakiuria, hematuria

Dysuria, pollakiuria, hematuria

4 weeks:


Urinalysis
Double contrast cystography

4 weeks:


Urinalysis
Double contrast cystography

4 weeks:


Urinalysis
Double contrast cystography


Urinalysis
Double contrast cystography

End

End

End

Less than distended urethral diameter


Voiding urohydropropulsion

Less than distended urethral diameter


Voiding urohydropropulsion


Voiding urohydropropulsion Less than distended

Urocystoliths greater than distended urethral diameter

Urocystoliths greater than distended urethral diameter

Urocystoliths greater than

All uroliths retrieved


Refer to prevention algorithm

All uroliths retrieved


Refer to prevention algorithm


Refer to prevention algorithm All uroliths retrieved

All uroliths not retrieved

All uroliths not retrieved

All uroliths not retrieved

Dissolution treatment:


Diet: restricted purine and urine alkalinizing
Allopurinol 15 mg/kg PO q12h

Dissolution treatment:


Diet: restricted purine and urine alkalinizing
Allopurinol 15 mg/kg PO q12h


Diet: restricted purine and urine alkalinizing
Allopurinol 15 mg/kg PO q12h Dissolution treatment

Cystotomy and postoperative double contrast cystography

Cystotomy and postoperative double contrast cystography

Cystotomy

Urocystolith size and number

Urocystolith size and number

Urocystolith size and number

Dissolution treatment:


Diet: restricted purine and urine alkalinizing
Allopurinol 15 mg/kg PO q12h

Dissolution treatment:


Diet: restricted purine and urine alkalinizing
Allopurinol 15 mg/kg PO q12h


Diet: restricted purine and urine alkalinizing
Allopurinol 15 mg/kg PO q12h Dissolution treatment

All uroliths not retrieved

All uroliths not retrieved

All uroliths not retrieved

All uroliths retrieved


Refer to prevention algorithm

All uroliths retrieved


Refer to prevention algorithm


Refer to prevention algorithm All uroliths retrieved

Urocystoliths not present


Refer to prevention algorithm

Urocystoliths not present


Refer to prevention algorithm


Refer to prevention algorithm Urocystoliths not present

Urocystoliths present

Urocystoliths present

Urocystoliths present

No change or increase in size and/or number

No change or increase in size and/or number

No change or increase

Decrease in size and/or number


Continue therapy

Decrease in size and/or number


Continue therapy


Continue therapy Decrease in size

Urocystoliths not retrieved


Cystotomy
Double contrast cystography

Urocystoliths not retrieved


Cystotomy
Double contrast cystography


Cystotomy
Double contrast cystography Urocystoliths not retrieved

Urocystoliths retrieved and analyzed

Urocystoliths retrieved and analyzed

Urocystoliths retrieved

Uroliths

Uroliths

Uroliths

No uroliths


Refer to prevention algorithm

No uroliths


Refer to prevention algorithm


Refer to prevention algorithm No uroliths

Xanthine

Xanthine

Xanthine

Urate


Increased allopurinol dose by 10-25%

Urate


Increased allopurinol dose by 10-25%


Increased allopurinol dose by 10-25% Urate

Urocystoliths not retrieved


Cystotomy
Double contrast cystography

Urocystoliths not retrieved


Cystotomy
Double contrast cystography


Cystotomy
Double contrast cystography Urocystoliths not retrieved

Stop allopurinol, continue diet, wait 1-2 months, repeat double contrast cystogram, retrieve uroliths and analyze.
If urate, begin allopurinol at 25% dosage reduction

Stop allopurinol, continue diet, wait 1-2 months, repeat double contrast cystogram, retrieve uroliths and analyze.
If urate, begin allopurinol at 25% dosage reduction


Stop allopurinol

Urocystolith size and number

Urocystolith size and number

Urocystolith size and number

No urethral obstruction


Double contrast cystography
Urethrography

No urethral obstruction


Double contrast cystography
Urethrography

No urethral obstruction


Double contrast cystography
Urethrography


Double contrast cystography
Urethrography

Dissolution treatment:


Diet: restricted purine and urine alkalinizing
Allopurinol 15 mg/kg PO q12h

Dissolution treatment:


Diet: restricted purine and urine alkalinizing
Allopurinol 15 mg/kg PO q12h

Dissolution treatment:


Diet: restricted purine and urine alkalinizing
Allopurinol 15 mg/kg PO q12h


Diet: restricted purine and urine alkalinizing
Allopurinol 15 mg/kg PO q12h

No urethral obstruction


Double contrast cystography
Urethrography

No urethral obstruction


Double contrast cystography
Urethrography

No urethral obstruction


Double contrast cystography
Urethrography


Double contrast cystography
Urethrography

No urethral obstruction


Double contrast cystography
Urethrography

No urethral obstruction


Double contrast cystography
Urethrography


Double contrast cystography
Urethrography No urethral obstruction

Urethral obstruction


Retrograde urohydropropulsion

Urethral obstruction


Retrograde urohydropropulsion


Retrograde urohydropropulsion Urethral obstruction