UROLITHIASIS IDOKO JOY ANULIKA MA1901B Urolithiasis is the formation of urinary calculi in the bladder or urinary tract resulting from various factors such as diet, water intake, biochemical metabolism, and genetic risk factors. Urolithiasis occurs when crystals that the stone is composed of supersaturate the urine due to being present in a high concentration and begin to collect and crystallize within the parenchyma of the kidney, forming the renal calculi. These crystals will aggregate together and continue to enlarge with the potential to migrate into the ureter and become symptomatic. If the stone causes an obstruction and does not allow for the passage of urine through the ureter, hydronephrosis can occur secondary to upstream dilation of the ureter and renal pelvis. The most common location for a stone to obstruct is near the ureteropelvic junction (UPJ) because in this region the diameter of the ureter is very narrow. Endemic bladder stones Malnutrition in developing countries causes bladder stones in children without the presence of bladder emptying disorders. Affected areas are North Africa, the Middle and Far East. Boys under 10 years suffer more often from bladder stones, since girls may pass better sandy precursors via the short urethra. The cause of urinary bladder stone formation in children is a diet low in animal proteins, which consists mainly of cereals. Other factors include dehydration and a dietary phosphate deficiency. Pediatric bladder stones most commonly consist of ammonium acid urate with or without calcium calcium oxalate or calcium phosphate. Signs and Symptoms of Bladder Calculi Childhood Symptoms in Endemic Bladder Stones: Symptoms due to Secondary Bladder Stones: Abdominal pain Recurrent urinary tract infections Interrupted urine flow Dysuria, alguria, frequency Need to manipulate the penis Dysuria, alguria, frequency Interrupted urinary flow or urinary retention The majority of bladder stones cause no additional problems in addition to the underlying bladder disorder. Diagnostic Work-Up of Bladder Calculi * Abdominal Radiograph: * Computed Tomography: * Many bladder stones are radiopaque, but some are obscured by overlying bowel gas shadows or are not radiopaque. * CT without contrast media is a very accurate method in * Cystography: * Cystoscopy: * Non-radiopaque urinary bladder stones can be detected by cystography by causing a filling defect of the contrast media * Cystoscopy is a reliable method in the diagnosis of bladder stones and is also necessary for treatment planning of the underlying disease (prostate size? urethral stricture? bladder diverticula?). the diagnosis of urinary bladder stones. Treatment of Urinary Bladder Stones The majority of bladder stones can be treated endoscopically. Treatment options are influenced by the anatomy, etiology, concomitant diseases and stone size.
