bladder stones
Introduction
Introduction to bladder stones Bladder stones are stones formed in the bladder that can be divided into primary bladder stones and secondary bladder stones. The former refers to the stones formed in the bladder, mostly caused by malnutrition, and often occurs in children. With the continuous development of China's economy, children's bladder stones have shown a downward trend; the latter refers to the upper urinary tract or secondary. Bladder stones formed by lower urinary tract obstruction, infection, bladder foreign body or neurogenic bladder. In economically developed areas, bladder stones mainly occur in older men, and often suffer from benign prostatic hyperplasia or urethral stricture in poor areas. , more common in children, women are rare. basic knowledge The proportion of illness: 0.02% Susceptible people: no specific population Mode of infection: non-infectious Complications: cystitis
Cause
Bladder stone cause
Causes:
In addition to malnutrition factors, lower urinary tract obstruction, infection, bladder foreign body, metabolic diseases can be secondary to bladder stones, lower urinary tract obstruction such as benign prostatic hyperplasia, urethral stricture, bladder neck tumor, etc., are easy to stay due to urine Inducing the formation of bladder stones, bladder foreign bodies such as catheters, sutures, etc., can be used as the core, secondary to the formation of bladder stones, in addition, in the epidemic area of schistosomiasis in Egypt, bladder stones with egg as the core can be seen.
Pathogenesis:
Most of the bladder stones in our country are calcium oxalate, mixed stones of phosphate and urate. Stones often develop uric acid as the infective stone containing calcium phosphate and magnesium ammonium phosphate. The mechanical stimulation of the bladder wall can cause the bladder wall. Congestive edema or hemorrhage, and can form vesicular edema, ulcers and sticky pus. Intermittent or continuous obstruction of the bladder outlet can cause bladder muscle fiber hyperplasia, trabeculae, small diverticulum formation, leading to ureteral obstruction, stenosis or dilatation, causing upper urinary tract hydrops, long-term chronic stimulation of mucosal squamous metaplasia to scaly Cellular cancer, a small number of severe ulcer cases can be worn through the adjacent rectum, vaginal or anterior abdominal wall to form urinary fistula.
Prevention
Bladder stone prevention
Lower urinary infarction and infection must be eliminated, such as surgical treatment of prostatic hyperplasia and urethral stricture, radical urinary tract infections, especially those that break down urea, avoid bladder foreign bodies, and reduce stone formation.
1, usually should drink more water, develop drinking habits. Because drinking more water can increase the amount of urine, dilute the crystals in the urine, making it easy to excrete. At the same time, even if the fine stones have been formed, it can be washed out of the urine as soon as possible. Some scholars pointed out that it is best to drink more than 2,500 ml per day to keep the urine color light. If the local water source contains a high amount of calcium, it should be noted that it should be softened before drinking. It is best to drink magnetic water.
2, do not eat too much, limit excessive nutrition. Because eating and drinking is mostly high protein, high sugar and high fat diet, this will increase the risk of stone formation. Usually you should eat more coarse grains and vegetarian food.
3, if it is a stone patient, after the stone is cured, for patients with oxalate stone, in order to prevent the recurrence of stone, should avoid eating foods with higher oxalic acid, such as spinach, beets, mushrooms, potatoes, chestnuts, black tea, coffee Cocoa, chocolate, persimmon and bayberry; if it is a patient with urate, care should be taken to eat foods high in uric acid, such as animal offal, seafood, coffee, cocoa, black tea, chocolate and peanuts.
The main measures to prevent bladder stones in children are:
1. Improve maternal perinatal nutrition, especially protein intake, so that high-quality milk is fed to the baby after delivery.
2. Promote breastfeeding to prevent the replacement of breast milk with sugary foods.
3, baby food supplements should include enough dairy foods, including milk.
Complication
Bladder stone complications Complications cystitis
Bladder stones almost cause secondary infections, so patients may have pyuria, the original symptoms are aggravated when the infection is severe, a very small number of sputum can cause ureteral hydronephrosis or cause pyelonephritis, and even cause renal dysfunction, caused by stones Bladder irritation, secondary chronic inflammatory reaction can cause more serious complications such as squamous cell carcinoma of the bladder. It should be treated early and must be highly valued. Some patients may have a history of sulphate, and the elderly with a history of rectal fistula , abdominal paralysis.
Symptom
Bladder stones symptoms Common symptoms Urinary urgency Urinary waiting for dysuria Suprapubic pain Severe pain Urinary calculi Acute urinary retention Bladder diverticulum Purulent bladder irritation
Bladder stones can have no special symptoms, especially in children, but typical symptoms are more common in children.
1. Pain in the urinary pain can be caused by the stimulation of the bladder mucosa by stones. It is characterized by dull pain in the lower abdomen and perineum. It can also be obvious or severe pain. The symptoms of pain increase after exercise, and the pain can be relieved after changing the position. Often accompanied by frequent urination, urgency, symptoms of dysuria, increased pain at the end of urination, children often pull the penis due to severe pain during urination, crying, sweating, children in order to avoid pain during urination Will take a special position to urinate, that is, standing knee flexion forward, the trunk back 30 °, once the urinary line is thin or the flow of urine is interrupted, immediately change the position to continue to urinate after the stone is removed.
2, urinary dysfunction stones embedded in the neck of the bladder can appear obvious dysuria, and there is a typical urinary interruption, can also cause acute urinary retention, patients with benign prostatic hyperplasia, there are symptoms of dysuria, such as the prostate The volume is huge, it protrudes into the bladder and raises the position of the urethra. The stone is not easy to block the urethral opening, so there is no interruption of urination.
3, hematuria is mostly terminal hematuria, bladder stones with infection, bladder irritation and pyuria.
According to clinical manifestations, B-ultrasound, X-ray examination, cystoscopy if necessary, generally can diagnose bladder stones, such as unconditional B-ultrasound, X-ray and cystoscopy, can be taken into the bladder by metal urethra exploration, left and right swing can be detected The special feeling and sound of impacting stones, this method should be used in children.
In short, the key issue in diagnosis is to find the primary cause of bladder stones.
Examine
Examination of bladder stones
No specific laboratory examination of bladder stones, protein, white blood cells and red blood cells in the urine. If accompanied by infection, urine culture can be positive, and red blood cells (RBC) can increase after activity.
Ultrasound diagnosis of bladder stones is simple and effective, the stones are special sound and shadow, and move with the body position change. X-ray examination requires the whole abdominal plain film to understand the size, position, number and shape of the stones. The stones in the bladder cavity are on the X-ray. The flat piece appears on the abnormal part and is relatively fixed, which should attract attention.
Cystoscopy is the most reliable method for diagnosing bladder stones. It can not only diagnose stones, but also find other problems, such as benign prostatic hyperplasia, bladder diverticulum, and cancer.
Diagnosis
Diagnosis and diagnosis of bladder stones
1, bladder foreign body: bladder foreign body can cause dysuria, frequent urination, urgency, dysuria and hematuria, a history of bladder foreign body implantation, but often concealed, X-ray film has diagnostic value for X-ray foreign bodies, bladder Mirror examination is the main means of identification.
2, benign prostatic hyperplasia: mainly manifested as poor urination and frequent urination, increased number of nocturia, but also urination pain and hematuria, but mainly in the elderly, a long history, progressive development, anal finger examination can be found in prostate enlargement Large, B-ultrasound showed that the prostate volume increased and protruded into the bladder; there was no strong echo group in the bladder, cystoscopy showed that the prostate protruded into the urethra or bladder, and the bladder neck was elevated; there was no stone in the bladder. .
3, urethral stones: urethra stones can be manifested as dysuria, dysuria, urinary interruption and other symptoms, easy to be confused with bladder stones, physical examination of male anterior urethra stones in the penis or perineum can touch induration and tenderness, posterior urethra stones Through the rectum, female patients can be touched by the vagina. The urethral probe can detect the friction and sound of the stone. The urethra X-ray film can also show the dense shadow of the urethra. The urethroscopic examination can confirm the diagnosis and find out. Other urethral lesions present at the same time.
4, urethral stricture: manifested as dysuria, thinning of the urinary tract, more urinary tract trauma, urethral inflammation, transurethral examination or operation, indwelling catheterization and other medical history, the urethra is blocked when the probe is blocked, urethrography can show the narrow part and To the extent, urethroscopic examination showed that the inner diameter of the urethra suddenly became thin and small.
5, posterior urethral valve: common in children, may have difficulty urinating, no opaque shadow in the plain area of the bladder, but urinary tract urography during the urination, see urethral dilatation above the valve, growth, normal urethra below the valve, urethroscopic examination, can be The urethra sees the valve, which is a flap-like diaphragm, mostly located in the anterior wall, cystoscopy, and no stones in the bladder.
