Foreign matter of a bladder
Foreign matter of a bladder – the foreign object which got into a bladder cavity in the retrograde, descending way or through the damaged walls. At a foreign matter of a bladder there can be pains in the bottom of a stomach, a dizuriya, a gematuriya, a piuriya; sometimes alkaline cystitis, pyelonephritis, an urolithic disease develops, formation of fistulas is possible. The diagnosis is confirmed when performing ultrasound examination of a bladder, a viewing tsistoskopiya and X-ray contrast tsistografiya. The foreign matter of a bladder is deleted by means of endoscopy in the transurethral way or at open surgery.
Foreign matter of a bladder
Foreign matter of a bladder - a problem which the urology meets rather often. As foreign matters of a bladder find household objects (thermometers, pencils and pens, plastic and metal tubes, hairpins for hair), medical accessories (tampons, catheters and drainages, sutural material), shells (bullets, splinters of grenades), osteomiyelitny sequesters. The foreign matter gets into a bladder from below up more often, i.e. through an urethra (retrogradno), is more rare - from surrounding fabrics and at bubble wound, is rather rare – from kidneys and urinary tract.
The foreign matter can get into a bladder for various reasons. It can occur owing to efforts of the most sick: as a result of childish prank, masturbation or mental deviations of the patient. Foreign matters of a bladder in bigger number of cases come to light at women; it is connected with the fact that a female urethra shorter and wide.
Yatrogenny hit of foreign matters in a bladder is caused by unsuccessful carrying out tool researches and bladder and urethra operations, use of faulty endoscopic devices, drainages, catheters, leaving of medical material. The foreign matter in a bladder can be found owing to the fire and getting stomach wounds. In rare instances there is a migration in a bladder of foreign matters from an abdominal cavity and the next bodies (when opening it is purulent - the necrotic center, advance of small foreign matters on a mochetochnik from a kidney, urinogenital fistula etc.).
Development of clinical symptoms is defined by the size and a form of a foreign matter, its chemical composition and duration of stay in a bladder. Not infected, chemically and biologically inert foreign matters of a bladder cause weak inflammatory reaction of fabrics and are practically not encapsulated. At the moderate immune answer of an organism foreign matters of a bladder gradually become covered by the fibrous capsule and have a long asymptomatic current.
At biologically alien foreign matters of a bladder allergic fabric reaction can develop; at chemically active - a necrosis of surrounding fabrics, and at poisonous - the general intoxication. The pains in the bottom of a stomach amplifying at the movement, frustration of an urination (painful frequent or faltering, it is frequent - an ishuriya), a gematuriya (total or terminal), a piuriya can be symptoms of a foreign matter of a bladder. At inflammatory changes in a bladder the phenomena of alkaline cystitis develop.
Long stay of a foreign matter in a bladder promotes development of inflammatory process and can be complicated by pyelonephritis. Over time on a foreign matter of a bladder salts are laid and stones with formation of decubituses, uric zatek, paracystitis, puzyrno-vaginal fistulas are formed.
Clinical picture in combination with data of the anamnesis can cause suspicion on existence of a foreign matter of a bladder. Performing ultrasonography of a bladder, a tsistoskopiya, tsistografiya (pnevmotsistografiya) allows to confirm the diagnosis of a foreign matter. In certain cases at women the foreign matter of a bladder can be revealed at a vaginal research (a bladder palpation through a vagina).
Ultrasonography of a bladder defines existence of additional inclusions and signs of inflammatory changes. Tsistoskopiya helps to establish existence of a foreign matter, behind an exception is long the objects which are and already inlaid with salts giving a picture of usual stones of a bladder ("the emerging concrements").
The bladder X-ray analysis (tsistografiya) gives the image of a foreign matter, reveals secondary character of uric stones and the defect of filling of a bubble appearing at the same time. At X-ray negativity of a foreign matter (a piece of a gauze, sutural material, etc.), it is found in a bladder only after an incrustation salts or during a pnevmotsistografiya.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
At the small sizes and a smooth surface the foreign matter can be independently brought out of a bladder at an urination, otherwise – hospitalization in urological or surgical office for its extraction is obligatory. In case of severe pains at a foreign matter of a bladder as emergency aid stop a pain syndrome promedoly or pan-top this, at rise in temperature - appoint antibacterial therapy.
In most cases the foreign matter is taken from a bladder endovezikalno through an urethra; at its incrustation at first carry out by salts crushing of a stone, and then delete a subject. The exception is made by foreign matters of the big size, irregular shape, with the sharp ends for which removal the high section of a bladder (an open epitsistostomiya) is carried out.
In the post-operational period carry out drainage of a bladder: young women and men after a deaf ushivaniye have bubble walls - a constant urethral catheter; at elderly patients and at the expressed inflammatory and necrotic changes in a bladder leave a temporary nadlobkovy tsistostoma. The forecast after extraction of a foreign matter of a bladder favorable.