The bladder stones

The bladder stones or descend into the bladder from the kidneys and ureters, or are formed in the bladder.
The formation of stones in the bladder contribute, in addition to the General reasons of stone formation, poor outflow of urine from the bladder. So the females bladder stones occur many times less often than men (after a short, wide urethra of women of small stones easily stand out from the bladder with a jet of urine). Occurring in women stones are usually fixed on the silk seams, which accidentally flashed bladder, gynecological operations, or on prorezalsya in a bubble silk ligature.
In men bladder stones are found mainly in children (on the soil relative narrowness of the urethra boys) and in the elderly (due to prostatic hypertrophy).
The stones of different sizes - from small gravel to male fist. Often the bladder stones single, but often found 2-3 tens, hundreds and even thousands of small stones; a form of round or oval. Multiple stones are cut together, adjacent surfaces are formed smooth facet (many-faceted stones). Surface, color, texture and chemical composition the same as at stones of kidneys.
In the absence of urinary infection of the mucous membrane of the bubble may remain unchanged. Infected stones are accompanied cystitis with subsequent development of pyelitis, pyelonephritis or apostatizing jade.
The stones lying behind BPH and small stones, which formed on the ligature may long does not manifest itself. Oxalates as a result of their subulate surface, sooner cause urination disorders and pain.
For cystitis to more frequent attached pain in the end of urination. For stone bubble is characterized by greater dysuric phenomena when walking, bumpy ride.
Typical stone of the bladder is a sudden interruption of the urine stream during urination and resume it when changing body position (the stone rolled back from the neck of the bladder). Some patients may urinate only in a certain position - squatting on the side.
The injury stone nerve endings, which are particularly rich in the neck of the bladder that causes while walking and jolting ride pain radiating to the head of the penis, perineum, the testicle.
Microscopic hematuria occurs when the bladder stones in most cases. Gross hematuria usually occurs after movements, it is not very intense and fast ends in a tranquil position of the patient.
The bladder stones can be detected by probing them with a metal probe with a short beak (kampikathakal, see Fig. 39), introduced into the bladder. It gives the feeling of friction against a stone, and with solid stones - oxalates and urates - you can hear the sound of the instrument of it.
The main method of the research is cystoscopy. During cystoscopy can not only detect the stone, but to get an idea of bladder capacity, the condition of the mucous membrane, the number, size and composition of the rocks, on the availability of BPH (Fig. 96). It's important to choose a method of treatment.
During cystoscopy can not detect a stone if the latter is located in the diverticula. In addition, it is not possible when narrowing of the urethra, small capacity of the bubble, when it inflammation.

stone bladder - lithate cystoscopy
Fig. 96. Stone bladder - lithate. Next to him is seen jutting out into bubble territory of prostate adenoma. Cystoscopy.
stone bladder radiograph
Fig. 97. A stone in the bladder. Overview radiograph.

In these cases, the diagnosis of bladder stone is made on the basis of the review x-ray detecting the shadow of stone (Fig. 97). At stones, little delay x-ray (urates, cystine stones)use the cystography with oxygen or weak (3-5%) a solution of sergazina. Filling defect indicates the presence of stone. Cystography, in addition, gives an idea of the size of BPH.
The bladder stones, as a rule, are subject to removal. Infected stones, accompanied by anesthetic, pielit or pyelonephritis, require urgent removal.
The most common way to remove stones in the bladder is kamnedrobilniy POI using lithotripter. The latter consists of two long branches, one of which moves century longitudinal groove other. Each of the branches arched at the end of the beak. In structure of the bill distinguish gear (fenestrated) and spoon lithotripters (Fig. 98). By means of the screw on the handle lithotripter possible and to shift the branches so that they densely adjoined to each other, and push them.
Grasping and crushing of stone lithotripter is blind. After anesthesia urethra by instillation solution dikaina 3:1000 bladder fill with a solution oxycyanides mercury or rivanol 1 :3000 and enter the lithotripter. When turned upwards, i.e. in the cavity bladder, the bill lithotripter left hand raise up the handle of the instrument and lightly touches the end of it in nizhnezadnimi the wall so that the beak of the tool was at the lowest point of the bubble. Then the right hand open and close the beak lithotripter, and the left hand at the same time, produce a slight concussion of his, gently turn it left and right. Because of this stone into force of gravity is adjudged to be in an open beak lithotripter.
The branches of the tool's pull together and turns of the screw produce stone. Shards of stone capture and crushed in the same way into small pieces and sand, which are removed by washing bladder through entered into the urethra evacuation catheter using Janet's syringe or suction rubber cylinder (see Fig. 28).
A cystoscope-lithotripter (see Fig. 26) can be kamnedrobilniy under the control of the eyes. This tool is applicable only when the stones that does not exceed 2-3 cm diameter
Kamnedrobilniy has several advantages: it does not require opening of the bladder, and after a successful lithotripsy patient in 2-3 days can be issued. When relapse kamnedrobilniy can be repeated.
However, in some cases, kamnedrobilniy contraindicated or technically unfeasible. These include stones, exceeding 5-6 cm in diameter, which cannot be captured by the lithotripter, and oxalates, 's hardness is not susceptible to fragmentation.
In these cases recently crushing of stones in the bladder so-called electro-hydraulic shock - high-voltage electric discharge generated inside the liquid that fills the bladder. Special generator of high-voltage discharge is passed to the stone at the moment of touching him head of the probe is introduced into the bladder through operational cystoscope. The stone falling to pieces, crushing them in the same ways.
At stones located in the bladder diverticulum, when the rocks formed around a foreign body in the narrowing of the urethra, with small capacity (less than 50-75 ml) bubble, with bleeding of mucous membrane lithotripsy impossible.
In these cases, the stone is removed by high vnebrachnogo section bladder (sectio alta). In entering the bladder 200-250 ml of 0.1% solution of rivanol. Make a cut on the middle line of the abdomen with a length of 6-8 cm, some distance 2 cm from the upper edge of the symphysis. Dissect the aponeurosis, direct abdominal muscles in pushing the blunt side by hanging skladku abdomen push back up. On the sides from the median of the front wall of the bubble stitch two long strands, with the help of which slightly tighten it, and cut parallel to the skin incision. The stone removed. When infected with the stones is introduced into the bladder drainage, removal of which the wound heals spontaneously. When uninfected stones and the free flow of urine, especially in children, the bubble can be sewn tightly.