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Urolithiasis
Classification and external resources

KUB stone
ICD-10 N20.0-N22.0
ICD-9 592
DiseasesDB 11346
eMedicine ped/2371
MeSH D052878
Bladder stones incidentally found in a bladder diverticulum during transvesical prostatectomy (removal of the prostate via an incision in the bladder).

Urolithiasis (from Greek oûron, "urine" and lithos, "stone") is the condition where urinary calculi are formed[1] in the urinary tract.[2][3]

The term kidney stone (or "renal calculus") is sometimes used to refer to urolithiasis in any part of the urinary tract, however it is more properly reserved for stones that are actually in the collecting duct of the kidney itself.[4][5][6]

The term nephrolithiasis can be used to describe the condition of having kidney stones,[7] and ureterolithiasis can be used to describe the condition of having stones in the ureter.[8]

Obstruction of the ureter by the kidney stones causes a renal colic attack which is why intense pain is felt in groin and back.

The term bladder stone is more frequently associated with veterinary science.

Contents

Composition

Urinary stones may be composed of the following substances:[9]

Pathology

Bladder stones are small particles that can form in the bladder. In most cases bladder stones develop when the urine becomes very concentrated or when one is dehydrated. This allows for the minerals like calcium or magnesium to crystallize and form stones. Bladder stones vary in number size and consistency. In some cases bladder stones do not cause any symptoms of signs and are discovered as an incidental finding on a plain x ray. However, when symptoms do occur these may include severe lower abdominal and back pain, difficulty urination, frequent urination at night, fever, painful urination and blood in the urine. The majority of individuals who are symptomatic will complain of pain which comes in waves. The pain may also be associated with nausea, vomiting and chills.[10]

Bladder stones vary in their size, shape and texture- some are small, hard and smooth whereas others are huge, spiked and very soft. One can have one or multiple stones. Bladder stones are somewhat more common in men who have prostate enlargement. The large prostate presses on the urethra and makes it difficult to pass urine. Over time stagnant urine collects in the bladder and minerals like calcium start to precipitate. Other individuals who develop bladder stones include those who have had spinal cord injury, paralysis or some type of nerve damage. When nerves to the back are damaged, the bladder cannot empty and stagnant urine results.[11]

Causes

Bladder stones can also occur if the bladder gets inflamed or one has frequent insertion of urinary catheters. Some people who are paralyzed and unable to pass urine require small plastic tubes (catheters) placed in the bladder. These tubes are prone to infection which irritates the bladder resulting in stone formation. Finally kidney stones can travel down the ureter into the bladder and grow in to bladder stones. There is some evidence indicating that chronic irritation of the bladder by retained stones may increase the chance of bladder cancer.

Diagnosis

The diagnosis of bladder stone includes urine analysis, ultrasound, x rays or cystoscopy (inserting a small thin camera into the urethra and viewing the bladder). In the past a study called the intravenous pyelogram was frequently used to assess the presence of kidney stones. This test involves injecting a dye which is passed slowly into the urinary system. X ray images are then obtained every few minutes to determine if there is any obstruction to the dye as it is excreted into the bladder. Today, Intravenous Pyelogram has been replaced at most rural health centers by Ct scans. CT scans are more sensitive and can identify very small stones not seen by another other test.[12]

Treatment

The treatment of bladder stones is simple. One needs to start drinking a lot of fluids. While any fluids can be consumed, water is considered to be the ideal solution. Excess fluid can help pass the small stones. Large stones or those that fail to pass may require other methods of treatment.[13]

Breaking up of bladder stones is also done with a camera (cystoscope) which is inserted into the bladder. The surgeon visualizes the stone and use ultrasound or another mechanical device to break the stones into small pieces which are then flushed out. The procedure does require some type of anesthesia and may require admission to a hospital for several days. Complications of this treatment include infections, small tear of the bladder or bleeding in the urine.[14]

Surgery

Sometimes stones are just too large and may need open surgery. In such a case, the bladder is opened and the stones are removed. Surgery is usually the last step and is considered a major procedure.

Herbal remedies

In folk and alternative medicine, a number of herbs are used to treat bladder stones, such as gravel root, stone root and Hydrangea. Whether and how these herbs work is not known, since there are no scientific studies.[15]

Prevention

The best way to prevent bladder stones is to prevent them in the first place. This means drinking plenty of liquids. If you sweat a lot, exercise intensely or live in a hot environment, drink 6-10 glasses of water on a daily basis. One should avoid drinking excess tea as there is evidence that this beverage can stimulate formation of bladder stones. If one does develop bladder irritation or urgency to urinate, drink cranberry juice because it has been shown to prevent development of small stones. Finally men who have difficulty with urination and are found to have prostatic hypertrophy should seek treatment.[16]

References

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