Transcript diagnosis of bladder calculi (ppt)

‫الدكتور ‪ :‬جاسم عبد الحسن‬
‫اخصائي جراحة الكلى والمسالك البولية‬
FEMALE URINARY TRACT
MALE URINARY TRACT
Bladder lithiasis is believed to make up 5% of all
urinary calculi.
The majority of bladder calculi occur in adults,
particularly in elderly men with bladder outlet
obstruction. However, groups at risk for urinary stasis
and infection are also at risk for bladder stone
formation.

Unlike the rapid clearance rates of urine in the renal
tubules, the bladder is a reservoir for relatively
stagnant urine and its precipitates. The presence of
infection or poor bladder emptying may allow for the
supersaturation and heterogeneous nucleation around
a nidus. Subsequent aggregation results in crystal and
stone formation.
Vesical calculi can be classified as : migrant.
 primary idiopathic, or
 secondary calculi, which include calculi related to
urinary stasis, infection, and foreign bodies.
 Migrant bladder calculi are formed in the upper tracts,
pass into the bladder, and are retained there. Most
calculi that migrate out of the ureter into the bladder
are smaller than 1 cm and, in adults, are easily passed
per urethra especially in female.
 Endemic bladder stones form in children in the
absence of obstruction, local disease, neurologic
lesion, or known primary infection. it is rare in
developed countries. However, endemic bladder
calculi remain common in infants and children of
lower socioeconomic background in North Africa and
the Middle and Far East. Stone formation results from
dietary and nutritional deficiencies.
 These secondary bladder calculi are most often related
to urinary stasis or recurrent urinary tract infection
due to bladder outlet obstruction or neurogenic
bladder dysfunction. Patients with foreign bodies in
the urinary tract are also at risk for development of
calculi.
 The clinical presentation of bladder calculi varies
depending on stone size and location, as well as
patient characteristics.
 While they may be found incidentally in an
asymptomatic patient during imaging for other
reasons, calculi typically present with classic findings,
which may include dysuria, frequency, nocturia,
suprapubic pain, terminal gross hematuria,
intermittency and urinary retention
These symptoms may be relieved with a supine or
head-down position, which may change the position of
an obstructing stone at the bladder neck.
 Urinalysis
may reveal microscopic hematuria, pyuria, bacteriuria
and crystalluria, with urine cultures demonstrating
urea- splitting organisms.
 Due to the inaccuracies of plain film radiographs,
sonography and computerized tomography are the
imaging studies of choice for the diagnosis of bladder
calculi.
 Cystoscopy can be performed to:
-confirm radiographic findings.
- help determine causative factors and,
- plan for future operative intervention .
Plain film showing vesicle stone due to foriegn
body(retained ureteric stent)
CT scan showing large vessicle stone
Cystoscoic finding of vesicle stone
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