Bladder and urethral stones
Introduction
Introduction to bladder and urethra stones Urinary calculi are common and frequently-occurring diseases. They have been recorded since ancient times. Traditional Chinese medicine refers to it as Shilin or sand drench. The disease is closely related to the environment, systemic diseases and other diseases of the urinary system. Primary bladder stones are rare, more common in children, secondary bladder and urethra stones are more common in older men, common causes are upper urinary tract stones discharged into the bladder, lower urinary tract obstruction to make urine retention, infection, foreign bodies and so on. Urethral calculi are rare, most of which are caused by stones in the kidneys and bladder through the urethra or in the urethra. There are also a few primary urethral stones that occur in urethral strictures, foreign bodies, or diverticulum that opens into the urethra. Urethral calculi occur mainly in men. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: pyelonephritis, renal empyema, periarthritis
Cause
Bladder and urethra stones
Bladder stone formation (30%):
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.
Primary and secondary (30%):
(1) Primary urethral stones: refers to stones that are formed in the urethra, urethral stricture, infection, retention cysts, mucosal damage, diverticulum and foreign bodies.
(2) secondary urethral stones: refers to the formation of stones in the urinary system above the urethra, the posterior urethra into the urethra and stay in the urethra, more in the urethral physiological expansion and the proximal side of the stenosis, so urethral stones are more common in The urethra is at the prostate, the ball, the penis, the scaphoid, and the urethra.
Pathogenesis
Although there are some differences in the formation mechanism of upper urinary tract and lower urinary tract stones, there are also some commonalities. There are several basic theories about the formation of stones, such as local lesions of the kidney; excessive sedimentation theory of urinary components; lack of theory of inhibition factors; Free granules and fixed granules; the role of matrix components and matrix; orientation epiphysis and immune mechanism theory, etc. Most of the upper urinary calculi are calcium oxalate stones, and the ammonium magnesium phosphate stones in bladder stones are more than the upper urinary tract. See, infectious stones are caused by the urease-producing bacteria decomposing urea in the urine to produce ammonia, causing the urine to be alkalized, and the urine urinary phosphate and ammonium urate are in a relatively supersaturated state, resulting in deposition, bacteria, Infected products and necrotic tissue are also the core of the formation of stones. In short, urine supersaturation is the energy source of urinary stone formation. The chemical kinetics of its formation are roughly nucleation, growth, aggregation and solid phase transformation. The urethral calculi are formed in the urinary system above the urethra, and then enter the urethra and stay in the physiologically enlarged and stenotic sites in the urethra, causing obstructive changes. Series of clinical symptoms.
Prevention
Bladder and urethra stone prevention
The formation of stones is related to diet. It is caused by excessive intake of related ingredients that can form stones in the diet. To prevent the occurrence of stone disease, it is necessary to pay attention to the food mix, and all kinds of foods are eaten in moderation, even if it is checked out. When the body lacks certain nutrients and needs certain foods to supplement it, it is not suitable to eat in large quantities at once. Because the body's digestion and absorption functions are limited, the nutrients that are digested and cannot be absorbed are excreted through the excretory organs, which also increases the urinary system. The burden, even if it does not suffer from kidney stone disease, is also harmful to health, especially when the examination confirms that it is a urinary calculi, during the illness, the patient should be restricted from eating foods that are prone to stone formation. The specific method is as follows:
1. Drink more water, increase urine output, dilute urine, and the amount of urine per adult should be >2000ml every 24 hours.
2. According to the stone composition, patients with oxalate stones should eat less spinach, potatoes, tea, etc., taking vitamin B6 can reduce the excretion of oxalate, those with calcium stones should limit milk, white flour, chocolate If you have uric acid stones, you should not use foods with high sputum (such as animal internal organs), and you can take alkaline drugs to keep the urine pH at 7 to 7.5.
3. Disarm the urinary tract obstruction in time, control the urinary tract infection, remove or replace the catheter left in the urinary tract in time, remove the foreign body in the urinary tract, and encourage the long-term bedridden to perform functional exercise.
Complication
Bladder and urethra calculi complications Complications, pyelonephritis, renal empyema, periarthritis
1. Infection of urine stasis is easy to cause infection, stone as a foreign body to promote the occurrence of infection, invasion and reproduction of pathogens, such as up-regulation of kidney infection, pyelonephritis, renal parenchymal abscess, renal empyema and periarteritis, obstruction Both the infection and the infection can increase the stones rapidly, so the stones, obstruction and infection are mutually causal and aggravate the urinary damage.
2. Combined polyps or malignant tumor stones are incarcerated in the urethra for a long time, causing damage to the local mucosa and chronic mechanical stimulation, resulting in limited inflammatory hyperplasia of the urinary catheter. Some patients form benign polyps, polyps including inflammatory polyps and fibrosis Polyps, some polyps have tumor structural features, called polypoid tumors, and stones can cause malignant transformation in the bladder for a long time.
Symptom
Bladder and urethra stones symptoms Common symptoms Male urinary tingling urgency turbid urine bladder stones urinary pain dysuria and urinary retention urinary flow interrupt urinary frequency urinary foreign body sensation acute urinary retention
1. Clinical manifestations of bladder stones
(1) Sudden interruption of urination: as a typical symptom, the urinary line is suddenly interrupted due to the movement of stones when urinating to block the bladder outlet, and the urination can continue after changing the position.
(2) dysuria: caused by stones in the urinary bladder caused by local irritation and damage to the bladder, can be radiated to the head of the penis and the distal urethra, sometimes accompanied by frequent urination, urgency and other urinary tract irritation.
(3) difficulty in urinating: the stone is located in the triangle area of the bladder, close to the neck of the bladder, increasing the resistance to urinating, and the stone is embedded in the neck of the bladder, which may cause difficulty in urinating.
(4) Hematuria: gross hematuria may occur due to stone rubbing of the bladder mucosa or combined with urinary tract infection.
(5) urinary tract infection: can show frequent urination, urgency, dysuria and pyuria.
2. The main symptoms of urinary calculi are dysuria, laborious, urination and pain in the drip, and acute urinary retention occurs when the stone completely blocks the urethra.
Examine
Examination of bladder and urethra stones
1. Urine routine examination, discharge fresh urine, centrifuge immediately, find crystal in the sediment, do not use cold storage method to preserve urine, because the cooling itself can make normal urine crystallize, microscopic examination can see red blood cells, crystals, such as co-infection, visible a lot of white blood cells or Pus cells, urine routine examination before and after exercise have a diagnostic significance.
2. 24 hours continuous 24h urine test for calcium, phosphorus, chlorine, sodium, potassium, magnesium, citrate, oxalate, pH, uric acid, urine creatinine, urine output, 24h urine to observe whether there is stone discharge, and analysis Its ingredients.
3. Low calcium, low sodium diet (calcium: 400mg, sodium: 100mmol) for 1 week, after the end, leave the empty urine to measure calcium, to find the renal calcium leakage, calcium load (take 1g calcium) and then stay in the urine to find intestinal absorption of calcium Amount, urine test cystine, jaundice, aminobenzoquinone, adenylate.
4. Urine bacterial culture and drug susceptibility test The intermediate urine is used for bacterial culture, which helps to identify and select effective antibiotics for infected bacteria.
5. Determination of blood calcium, phosphorus, chlorine, sodium, potassium, alkaline phosphatase, parathyroid hormone levels, uric acid, creatinine and protein, combined with 24h urine urinary calcium, uric acid, creatinine, oxalic acid content analysis to understand the metabolic status, There is no endocrine disorder.
6. Renal function test blood creatinine, urea nitrogen to understand the state of renal function.
7. B-ultrasound can show the sound and shadow of the stone, and can also find prostate hyperplasia.
8. X-ray examination of the abdominal plain film most of the stones can be developed, and at the same time pay attention to whether there is renal ureteral stones, if necessary, can do urography to understand the urinary tract.
9. Cystoscopy can be confirmed by cystoscopy when the above method can not be diagnosed.
10. CT examination has a diagnostic value for the location of stones in the bladder diverticulum.
Diagnosis
Diagnosis of bladder and urethra stones
diagnosis
1. The diagnosis of bladder stones can be based on the history of urinary flow interruption, urinary pain and hematuria and other typical symptoms, physical examination of the hands can sometimes touch the stone, combined with laboratory tests and other auxiliary examination assistance, not difficult diagnosis.
2. Diagnosis of urethra stones
(1) The palpation of the urethra can touch the anterior urethra stones, and the rectal examination can touch the posterior urethra stones.
(2) Metal urethral probe inspection is blocked and has a special feeling and sound.
(3) X-ray and B-ultrasound can show posterior urethra stones that can not be found in rectal examination.
Differential diagnosis
Lower urinary tract stones should be differentiated from pelvic vein stones, bone islands, intestinal contents, and gynecological diseases.
