DEFINITIONPRIMARY

Develops in sterile urineSECONDARY

Occurs in presence of infection ,outflow obstruction impaired bladder emptying or a

foreign body

Types 1. Mixed - most common2. Calcium Oxalate stones

primary stonesModerate size Solitary , uneven surfaceDark brown

Types 3. Uric acid stones –

Round to ovalSmooth Yellow to brownOccur in patients with gout ileostomies or with bladder outflow obstruction

3. TRIPLE

PHOSPHATE composed of

ammonium, magnesium and calcium phosphates

CALCULUS -Infected urine with urea splitting organismsGrows rapidlyDirty white Chalky in consistency

Types 4. Cysteine calculus

Presence of cystinuria Radio-opaque High sulphur content

A bladder stone is usually free to move in the bladder May cause erosions and haematuriaGravitates to the lowest part of the bladder

Clinical featuresMen >women. 8:1Symptoms

1. Frequency : sensation of incomplete bladder emptying.

2. Pain (strangury) occurs at the end of micturition refered to tip of penis

1. Pain is worsened by movement

4. Haematuria drops of bright-red blood at the end of micturition,5.Interruption of the urinary stream stone blocking the internal meatus. 6. UTI

Examination

1. Per abdomen : large calculus is palpable in the female in suprapubic region

Investigations

1. urine reveals1. microscopic haematuria,2. pus or crystals that are typical of the

calculus,

2. Ultrasound abdomen 3. Radiogram

Treatment Treat the causeBladder outflow obstructionIncomplete bladder emptying in

patients with neurogenic bladder dysfunction.Modalities LithotripsyPer cutaneous suprapubic litholapaxyRemoval of retained foleys catheter

Different modalitiesoptical lithotrite, electrohydraulic lithotrite, Holmium laser orultrasound probestone punch, which is useful to crush small fragments

further so thatIt can be evacuated with an Ellik evacuator.

Ultrasound lithotripsy is extremely

safe but appropriate only for small stones. Percutaneous suprapubic litholapaxyThis is the best method to use if it is not

possible to carryout litholapaxy per urethram because of a

narrow urethra.

Laser lithotripsy with the holmium laser can deal with most large stones.

Once small fragments are produced, the optical lithotrite can be used to finish the job. For evacuation of the fragments, fluid (200 ml) is introduced into the bladder. By evacuator the returning solution carries with it fragments of stone.

Contraindications

To perurethral litholapaxy are extremely rare:

Urethral stricture that cannot be dilated sufficiently;

In patient is aged below 10 years;Contracted bladder;A very large stone.

Thank you

REF BAILEY AND LOVE 25 ED