Sexually Transmitted Diseases - I. I. Mavrov 2005

Diseases of the genital organs of various etiologies
Bladder stones

Bladder stones are relatively common. They occur predominantly in men and are rare in women; in children, they are found almost exclusively in boys and occasionally in girls. Bladder stones may form primarily within the bladder or descend from the Kidneys or Ureters. They can be single or multiple, varying in shape, size, and weight. Chemically, they are composed of urates, phosphates, and oxalates, though most commonly they are of mixed composition.

Factors promoting bladder stone formation include inflammatory processes, chronic urinary outflow obstruction, complete urinary retention, parasitic diseases (Schistosomiasis), and foreign bodies.

Bladder stones are most frequently observed in elderly men. Their formation is caused by conditions leading to chronic urinary outflow obstruction, such as urethral strictures, diverticula, prostate adenoma and Cancer, tumors, bladder and urethral injuries, and bladder atony. Foreign bodies residing in the bladder can also lead to stone formation.

In women, bladder stones are associated with Diseases of the bladder neck resulting from radiation cystitis or vesicovaginal fistulas. Their formation is frequently caused by surgical sutures (ligatures) accidentally penetrating the bladder during gynecological Procedures. Foreign bodies within the bladder may also serve as a Nucleus for stone formation.

In children, bladder stones typically originate in the renal pelvis. After descending into the bladder, they are often spontaneously expelled. However, if there is an obstruction to urinary outflow from the bladder, the stones are retained and continue to grow through the deposition of new layers of salts.

In a small percentage of patients, bladder stones develop primarily. This occurs under conditions that promote the stasis of infected urine. In boys, stones develop due to relative urethral narrowness and phimosis.

Clinical presentation. The primary symptom of the disease is impaired urination resulting from stone irritation of nerve endings in the bladder mucosa. Infected stones are accompanied by cystitis, with pain occurring at the end of urination. Bladder pain is exacerbated by movement, physical exertion, and body jarring, radiates to the Perineum, testicle, and glans Penis, and subsides at rest.

Urination becomes more frequent during the day due to the shifting of the stone. Small, highly mobile stones with rough surfaces cause more pronounced dysuric symptoms. A characteristic symptom of bladder stones is the sudden interruption of the urinary stream during urination, which can only resume after changing body position. Some patients can only urinate in specific postures, such as squatting or lying on their side. When a stone partially enters the posterior Urethra, sphincter closure becomes impossible, leading to Urinary Incontinence.

Bladder stones are frequently accompanied by alterations in urine characteristics, such as gross and microscopic Hematuria and pyuria. Hematuria is typically of a mild, traumatic, or inflammatory nature and intensifies with strain or movement. In some cases, it presents as terminal hematuria, explained by the stone shifting toward the bladder neck at the end of urination and traumatizing the mucosa.

Diagnosis. The primary diagnostic Methods for bladder stones are cystoscopy, X-ray imaging, and ultrasound. Stones may also be detected by introducing a metal catheter (bougie) into the bladder, a Procedure performed when the bladder is full. Palpation is largely ineffective for diagnosing bladder stones, as only very large stones can be felt through the rectum or Vagina.

Treatment. Bladder stones require removal. Two main methods exist: lithotripsy (stone crushing) and lithotomy (stone incision/removal). Contraindications for lithotripsy include urethral strictures, inflammatory bladder processes, reduced bladder capacity, stones located in bladder diverticula, large hard stones, stones with foreign bodies as their core, prostate adenoma, renal failure, and febrile states.

In cases where lithotripsy is contraindicated, stones are removed surgically via high suprapubic cystostomy. The prognosis is favorable, and working capacity is restored. Recurrence is observed in 6-7 % of cases.

When treating bladder stones in children, most urologists remove calculi using high lithotomy. Even in the absence of contraindications, lithotripsy is used in children only in exceptional cases.