BLADDER STONES

BLADDER STONES 2 د.عبدالرزاق السلمان
A primary bladder stone is one that develops in sterile urine; it often originates in the kidney.
A secondary stone occurs in the presence of infection, outflow obstruction, impaired bladder emptying or a foreign body.
Composition and cystoscopic appearance
Most vesical calculi are mixed.
1-An oxalate calculus is a primary calculus that grows slowly; usually, it is of moderate size and solitary, and its surface is uneven.
2- calcium oxalate: Although is white, the stone is usually dark brown or black because of the incorporation of blood pigment.
3-Uric acid calculi are round or oval, smooth and vary in colour from yellow to brown . They occur in patients with gout but are also found in patients with ileostomies or with bladder outflow obstruction.
4- A cystine calculus occurs only in the presence of cystinuria and is radio-opaque because of its high sulphur content.
5-A triple phosphate calculus is composed of ammonium, magnesium and calcium phosphates and occurs in urine infected with urea-splitting organisms. It tends to grow rapidly. In some instances it occurs on a nucleus of one of the other types of calculus; more rarely it occurs on a foreign body.
It is dirty white in colour and of chalky consistency. A bladder stone is usually free to move in the bladder and it gravitates to the lowest part of the bladder. Less commonly, the stone is wholly or partially in a diverticulum, where it may be hidden from view.
Clinical features
Men are affected eight times more frequently than women. Stones may be asymptomatic and found incidentally.
1-Frequency, may be a sensation of incomplete bladder emptying. 2-Pain (strangury) is most often found in patients with a spiculated oxalate calculus. It occurs at the end of micturition and is referred to the tip of the penis or to the labia majora; more rarely it is referred to the perineum or suprapubic region. The pain is worsened by movement. In young boys, screaming and pulling at the penis with the hand at the end of micturition are indicative of bladder stone.
3-Haematuria is characterised by the passage of a few drops of bright-red blood at the end of micturition.
4-Interruption of the urinary stream is due to the stone blocking the internal meatus.
5-Urinary infection is a common presenting symptom.