Bladder stones – the display of an urolithic disease which is characterized by existence in a cavity of a bladder of salt or calcific concrements. Stones of a bladder are shown by a pain syndrome, frustration of an urination, availability of blood or pus in urine. Diagnose bladder stones by results of ultrasonography of uric ways, the general analysis of urine, a tsistoskopiya, a tsistografiya. The main treatment is a fragmentation and removal of stones of a bladder in the contact and remote way (lithotripsy) or in an operational way (during an open tsistolitotomiya).
Bladder stones (), along with stones in kidneys, mochetochnik and an urethra, are one of displays of an urolithic disease. Their education can be caused as violation of physical and chemical properties of urine (solubility of the organic and inorganic compounds which are contained in it), and physiological factors (the congenital or acquired exchange violations: metabolic, inflammatory, medicinal etc.).
Depending on the place and the mechanism of formation stones of a bladder can differ by the size, quantity, a consistence, surface type, a form, color and the chemical composition. Stones of a bladder can be single (solitary) and multiple, small (microlitas) and large (macrolitas), smooth, rough and fasetirovanny, soft and very firm; to contain uric acid, mochekisly salts, phosphates or oxalates of calcium.
Stones of a bladder are observed mainly at male population in children's (in the first 6 years of life) and advanced age (50 years are more senior). At adult patients stones of a bladder consist generally of uric acid, and at children – include crystals of uric acid, phosphates and oxalates of calcium.
The practical urology distinguishes bladder stones primary (are formed directly in his cavity) and secondary (are formed in kidneys and mochetochnik, then migrate in a bladder). Secondary stones, being in a bladder, can increase further in sizes.
Reasons of stones of a bladder
Infravezikalny obstruction – violation of free outflow of urine because of an obstacle in a neck of a bubble or an urethra is the most frequent reason of formation of stones of a bladder at adult patients. Obstruction of the lower uric ways can be caused by a bladder neck stenosis (Marion's disease), a giperplaziy prostate gland or a prostate cancer in men, urethra striktura (after a trauma, operation, an inflammation).
The mechanism of formation of stones is connected with the impossibility of full depletion of a bladder, stagnation and concentration of residual urine leading to loss of salt crystals. Kamneobrazovany is promoted by a neurogenetic bladder, its omission at women at a tsistotel, the available defects of an internal muscular cover, including diverticulums.
Sometimes in the presence of concrements in kidneys and the top uric ways migration of small stones on a mochetochnik with further emergence and their persistention in a bladder is observed. Presence of foreign matters (stent, ligatures, catheters and other foreign objects) at a bladder can cause adjournment on them of salts and formation of stones.
Stones of a bladder can be a consequence of reconstructive operations for a stressful incontience of urine and inflammatory changes at urinogenital infections, result of parasitic diseases (an urinogenital shistosomatoz) and radiation therapy. At children quite often leads available to emergence of stones of a bladder balanopostit, complicated fimozy and narrowing of an external opening of an urethra.
Symptoms of stones of a bladder
In certain cases existence of stones of a bladder, even enough big sizes, is not shown by any signs. Clinical symptoms arise at continuous contact of a stone with bladder walls, development of irritation of a mucous membrane or blocking of outflow of urine.
Symptoms of stones of a bladder are various, but not patognomonichna. It can be a pain syndrome in the bottom of a stomach, over a pubis, men have a discomfort, acute or dull ache in a penis. Insignificant at rest, pain become intolerable at the movement, change of position of a body of the patient and an urination, can irradiate in a crotch and external genitals, area of a hip.
Stones of a bladder cause violation of an urination with frequent, sharp desires at the movement, interruption of a stream of urine or a sharp delay of its outflow in case of migration of a stone in an urethra, and also an urine incontience at a nesmykaniye of an internal sphincter of a bubble because of got stuck in his narrowed stone neck. In case of large stones some patients can empty a bladder only in lying situation. At children the priapizm and enuresis sometimes develops.
Owing to accession of a microbic infection stones of a bladder can be complicated by cystitis and pyelonephritis. Gematuriya and a piuriya develop as a result of a travmatization and an inflammation mucous a bladder stones. At infringement of a stone in a neck of a bladder blood the last portion of urine can appear; at a trauma of expanded venous vessels of a neck the profuzny total gematuriya can develop.
Diagnostics of stones of a bladder
Diagnostics of stones of a bladder includes the analysis of data of the anamnesis and complaints of the patient, results of tool and laboratory inspection. It is necessary to specify the nature of pain, extent of manifestations of a dizuriya and a gematuriya, to reveal cases of an otkhozhdeniye of sand and stones, existence of associated diseases: giperplaziya and prostate cancer, striktura of an urethra, diverticulum, tumor of a bladder, neurogenetic dysfunction.
Only very large stones of a bladder can be found at a vaginal (bimanualny) or rectal research. The rectal palpation of a prostate gland at men allows to reveal its increase. With bladder stones in the general analysis of urine it is possible to find leukocytes and erythrocytes, bacteria, salts in patients. Bakposev of urine allows to identify microflora and its sensitivity for selection of antibacterial therapy.
At ultrasonography of a bladder it is possible to see stones as giperekhogenny educations with an acoustic shadow which move to bladder cavities at change of position of the patient. Tsistoskopiya – one of the main methods allowing to study internal structure of a bladder (a state mucous, existence of diverticulums, tumors, ) to define presence of stones at his cavity, their quantity and size.
By means of a tsistografiya and excretory urography it is possible to give an assessment to a condition of uric ways, to reveal an urolithic disease, existence of rentgenpozitivny concrements, a prostate giperplaziya, bladder diverticulums. The Rentgenkontrastnost of stones of a bladder depends on their chemical composition, first of all, of existence and percent of contents in them a calcic component. At spiral, multispiral KT - one of the most sensitive methods of detection of various stones of a bladder - it is possible to distinguish very small and rentgennegativny concrements, and also the accompanying pathology.
Treatment of stones of a bladder
Sometimes small stones of a bladder depart independently through an urethra with urine. In lack of complications at the small size of stones of a bladder conservative treatment which consists in observance of a special diet (depending on mineral structure of stones) and reception of medicines for maintenance of alkaline balance of urine is carried out.
In expeditious removal of stones from a bladder apply an endoscopic litoekstraktion, lithotripsy (a contact transurethral tsistolitotripsiya, a chrezkozhny nadlobkovy litolapaksiya, a remote tsistolitotripsiya) and a kamnesecheniye (an open nadlobkovy tsistolitotomiya).
The transurethral lithotripsy is carried out to adult patients during a tsistoskopiya, at the same time the found stones under visual control split up the special device (an ultrasonic, pneumatic, electrohydraulic or laser litotripter), and their fragments delete with method of washing and suction via the cystoscope. The transurethral tsistolitotripsiya can be the independent procedure or is carried out together with other endoscopic operations, for example a transurethral resection of a prostate. The transurethral tsistolitotripsiya is contraindicated at the small volume of a bladder, during pregnancy, in the presence of a pacemaker.
The remote lithotripsy is carried out by a shock and wave method at absence at the patient of infravezikalny obstruction and increase in a prostate, and also at secondary stones of a bladder and the burdened background when contraindicated transurethral intervention. The Chrezkozhny nadlobkovy litolapaksiya is shown to patients of children's age as allows to fragment quickly and safely a stone of a bladder and to remove its parts.
In lack of result from medicamentous therapy and lithotripsy, at a sharp delay of urine, a resistant pain syndrome, a gematuriya, a recurrence of cystitis and at large stones of a bladder carry out an open vnebryushinny nadlobkovy tsistolitotomiya. For the postoperative period in a bladder establish a catheter, appoint antibacterial medicines.
The biopsy and histologic research of tissues of bladder is carried out after operation in case of noticeable changes from its wall at is long the existing and not lechenny urolithic disease. Observation within 3 weeks after a kamnesecheniye is supplemented by ultrasonography of kidneys and a bladder for an exception of the remained splinters of stones.
The infection of uric ways, fever, trauma of walls of a bladder, giponatriyemiya, bleeding can be complications of expeditious treatment of stones of a bladder.
The forecast after removal of stones of a bladder
Further observation of the urologist, metabolic inspection and ultrasonography of kidneys and a bladder once in half a year is necessary.
At elimination of a background disease the forecast after treatment of stones of a bladder favorable. At not removed causes of a kamneobrazovaniye the recurrence of formation of concrements in a bladder and kidneys is possible.