Bladder stones

Description:

Stones of a bladder represent one of clinical displays of a mochekamyanny disease. This disease is generally observed at males in children's (first of all, boys in the first 6 years have lives) and advanced age (to 96-97%).

Symptoms of Stones of a bladder:

The clinical picture is various, however there is no symptom which can be considered pathognomonic.

Pain in a bladder projection (suprapubic area) at rest insignificant, however amplifies at the movement and an urination with irradiation in a balanus, a small egg and a crotch.

Dysuria. The urination becomes frequent when walking, jolty driving, but remains normal at rest therefore increase of desires on an urination in the absence of their night is characteristic in the afternoon of a stone of a bladder (in the absence of clinical displays of a hyperplasia of a prostate). During an urination the symptom of interruption ("mortgaging") of a stream of urine which disappears at a body postural change (at large stones some patients can urinate only in a prone position) is quite often observed.

At a stone vklinivaniye in a neck of a bladder or at its migration in an urethra development of an acute ischuria is observed. At large stones also the urine incontience is possible.

The hamaturia results from traumatizing mucous a bladder and development of inflammatory process. Infringement of a stone in a bladder neck sometimes leads to a terminal hamaturia, and in the presence of a prostate hyperplasia (in view of injury of expanded veins in a bladder neck) the total gross hematuria is possible.

Reasons of Stones of a bladder:

Primary stones are formed against the background of infravezikalny obstruction. Factors of infravezikalny obstruction: hyperplasia and prostate cancer, urethra stricture, diverticulum, tumor, neurogenic bladder, etc. At children quite often lead a phymosis, a balanoposthitis, narrowing of an outside opening of an urethra to emergence of a stone of a bladder (меатостеноз), the urethra valve. The lithogenesis at women is observed at bladder neck diseases owing to beam cystitis, at a vesical vlagalishnykh fistulas etc.

Foreign bodys (ligatures etc.) can serve in a bladder as the lithogenesis reason.

Secondary stones are the migrating stones from a kidney and most often occur at men with a prostate hyperplasia (15%).

Stones of a bladder have various form, the sizes, and chemical composition and color same, as at kidney stones. Stones can be single and multiple, be located only in a bladder or be combined with stones of other localization.

Treatment of Stones of a bladder:

In treatment of patients two main methods are used: lithotripsy (lithotripsy) and lithotomy (lithotomy). Lithotripsy is method of the choice and is carried out with use of contact, remote litotripter or mechanical tsistolitotripter (now, as a rule, are not used).

Contact cystolithotripsy. After performance of a tsistoskopiya and visualization of a stone (stones) of a bladder, their fragmentation with use of various litotripter (pneumatic, electrohydraulic and ultrasonic) and a tsistolitolapaksiya (washing and suction of splinters) is carried out.

The contact cystolithotripsy can be carried out as independent operation, and in a combination with various endoscopic operations that allows not only to remove a bladder stone, but at the same time to carry out necessary treatment of a basic disease (a transurethral resection at a prostate hyperplasia etc.).

Remote cystolithotripsy. The remote cystolithotripsy can be recommended at the stones of a bladder which are not followed by infravezikalyy obstruction, a benign hyperplasia of a prostate of the I stage and secondary stones of a bladder at patients with the burdened intercurrent background when performance of transurethral operation is accompanied by high risk of complications. Tsistolitotomiya (lithotomy). The most widespread way of surgical treatment is the suprapubic extra peritoneal tsistolitotomiya. The transabdominal tsistolitotomiya is applied extremely seldom, and perineal - by way of exception.