What causes urinary stones? Causes of the formation of bladder stones in men: symptoms and treatment, preventive recommendations. Effect of gender and age on bladder stones

• An effective way to cleanse your kidneys at home

Urolithiasis occurs more often in men, but the risk of the disease is also observed in obese women. Nephrolithiasis is the occurrence of stones in the urinary tract, within the renal pelvis, ureters, bladder or urethra. These deposits are deposited from chemicals contained in the urine, given the right favorable conditions.

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There are several factors that contribute to the formation of gallstones in the bladder, these are:

• conditions associated with urinary stagnation;
• all urinary tract infections;
• dehydration;
• changing the optimal pH of urine;
• low magnesium concentration and the presence of so-called crystallization nuclei (for example, bacterial deposits).

Education mechanism

Human urine contains many dissolved substances, from which stones can form if their concentration is exceeded. Stones vary in their composition. Calcium oxalate stones make up about 85% of all stones. They form if a person has hypercalcemia, that is, an increased concentration of calcium in the blood, and hypercalciuria, that is, an increased concentration of calcium in the urine.
Uric acid stones make up approximately 5-10% of stones. They occur due to low urine pH, gout, and the use of certain medications. Stones made of apatite, that is, calcium phosphate, are about 10%. They occur in patients with renal urethral acidosis. Ammonium and manganese phosphate stones - 2 to 20% of stones are built from ammonium, magnesium and phosphate. They are typical for bacterial infections (for example Proteus, Klebsiella, Pseudomonas, Haemophilus). A general urine test almost always reveals leukocyturia and bacteriuria. Cystine stones - only 1% of all cases, occur in patients with genetic disorders of cystine transport. There is a decrease in the absorption of cystine in the intestines and kidneys, which leads to an increase in its concentration in the urine and to precipitation in the form of waste. For the formation of stones, so-called crystallization nuclei are necessary. The stone crystallizes around one core or several cores, they can connect. It may be that the crystallization core and the rest of the stone are composed of different components, for example the core is apatite and the rest is calcium oxalate.

Pathological manifestations

The risk of developing bladder stones increases with diseases such as:

• osteoporosis;
• gout;
• tumor formations;
• Crohn's disease;
• malabsorption syndrome.

Bladder stones can also develop after taking certain medications:

• vitamin D;
• large doses of vitamin C;
• Sulfonamide, Acetazolamide;
• antiviral drugs.

Stones can occur anywhere in the urinary tract, but most often they form in the kidneys, then move down through the ureters into the bladder. As a rule, if their diameter is small, they pass through the ureters and are finally expelled through the urethra. A larger stone may remain in the bladder, where it will gradually increase in size. The building block for stones in most cases is calcium phosphate or oxalate, much less often - uric acid compounds, cystine, xanthine.

Diagnosis of the disease

Bladder stones are usually diagnosed during an ultrasound of the abdomen and pelvis. The patient consults a doctor after he begins to experience signs of stones - painful colic in the kidneys. Other useful tests for making a diagnosis include pelvic x-ray, computed tomography, and urography. In addition to detecting the stone itself, these studies will help determine its composition, which is important in prevention. The location of damage to the urinary tract or blockage of urine outflow with the formation of hydronephrosis is determined. This situation may be caused by a stone in the bladder that is blocking the opening of the ureter or urethra.
In addition, symptoms of bladder stones are observed: frequent urination in small portions, an intermittent stream, inflammation of the urinary tract, pain or discomfort in the lower abdomen, usually extending to the perineal area. If there are stones in the bladder, men may have problems with erections. Women and men experience pain when urinating. Blood may periodically appear in the urine, or it may take on a dark, cloudy color.

Therapeutic measures

If the stone is very small and is located in the area of ​​the urethral opening, the doctor recommends the use of diuretics so that the patient can independently remove the deposits from the body. If there is no natural expulsion through the urinary tract and the stone is stuck in the bladder, it must be removed mechanically. Today, surgical treatment is used; the most common practice for removing stones is a procedure using a cystoscope inserted through the urethra. During the operation, the patient is under short-term general anesthesia. Removal of stones from the bladder is carried out on an outpatient basis and lasts 20-30 minutes. The procedure cannot be used on pregnant women or people with bleeding disorders.

The stone is removed as a whole or crushed into smaller fragments.

Treatment can be carried out using other methods: percutaneous lithotripsy and surgical methods. The first is to crush the stone using an endoscope inserted transdermally, while surgical removal of the stones is used in cases of failure of other methods. Both methods require the patient to be given general anesthesia. Treatment with such a less invasive procedure as extracorporeal lithotripsy is also used, that is, using electromagnetic waves that crush the calculus into small particles, which facilitates its further expulsion through the urinary tract. In addition to the removal itself, it is often necessary to treat the cause that causes the formation of stones (gout, metabolic disorders).

Possible complications

Even if a stone in the bladder does not cause any painful symptoms in the patient, which is not at all a rare situation, it is necessary to remove it due to possible complications. First of all, the patient is susceptible to blocking the outflow of urine at any time, developing hydronephrosis or pyonephrosis, and even kidney damage. The necessary treatment should be carried out immediately after confirmation of the diagnosis. You should not delay the operation, as this can lead to necrosis of the kidneys and ultimately to kidney failure.

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Frequent inflammation of the urinary tract can lead to progressive kidney dysfunction and the development of arterial hypertension. The presence of stones within the bladder can cause:

• constant irritation of its wall;
• the formation of abnormal structures, as well as cancer cells;
• a violation of the contractility of the muscles of the bladder with the occurrence of so-called atony or, conversely, its excessive contractility.

Prevention measures

To avoid urolithiasis, bladder stone prevention is necessary. First of all, one should never forget about urinary tract hygiene to avoid inflammatory processes, and if they occur, effective treatment. For recurrent urinary tract infections in women and men, one course of antibiotic therapy is not enough; sometimes constant prophylactic use of antimicrobial drugs is required. It is necessary to drink adequate amounts of fluid, especially during exposure to hot climates or heavy physical work. The diet used should not contain large amounts of compounds that are components of stones, primarily calcium, oxalates and animal protein. In addition, it is advisable to limit your salt intake. Legume seeds (eg beans, beans) and dark bread help reduce the risk of disease. As part of the prevention of urolithiasis, it is recommended to avoid spinach, rhubarb, beets, chocolate, strong coffee and tea. If the symptoms listed above, such as urinary disorders, occur, you should definitely consult a doctor.

nefrolab.ru

Urolithiasis is a pathology in which stones form in the bladder, kidneys, ureters and sometimes in the urethra. Bladder stones are the most common manifestation of this disease. Men over 45 years of age with problems with the prostate gland or urethral structures are most susceptible to this pathology. But this does not exclude the possibility that bladder stones can also occur in women.

Types of stones

The classification of bladder stones is as follows:

1. Chemical composition:

• Oxalate: brown stones with a rough surface that scratch the mucous membrane, thereby causing pain and discoloration of urea in a scarlet shade; the raw material for their formation is oxalic acid salts.
• Phosphate stones are fragile gray pebbles made from phosphate acid salts with a soft structure, due to which they are easily crushed, and appear due to a metabolic failure.
• Urate - smooth, non-traumatic for the mucous membrane, formed from uric acid salts, arising against the background of gout and dehydration.
• Struvite, which appears under the influence of bacteria that provoke an alkaline reaction with significant precipitation of such precipitation as magnesium, ammonium, carbonate and phosphate.
• Cystonic: they have the appearance of hexagons, the main reason for the appearance of which is cystinuria, which is a consequence of congenital changes in metabolism with a constantly increased content of cystine in urine.
• Mixed: formations with high hardness, created from several types of salts, due to which they have a pattern in the form of different layers.

2. By density:

• soft;
• solid.

3. Surface type implies fragments:

• with protrusions in the form of spikes;
• smooth, without a single protrusion.

4. Quantitative characteristics:

• single;
• multiple.

In addition, the formation of stones is primary or secondary. In the first case, stone formation occurs due to stagnation of urine in the bladder cavity. And in the second, formation occurs in the kidneys, and then the fragments travel through the ureter directly into the bladder. The types of bladder stones most commonly observed are of a mixed nature.

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Reasons for education

Metabolic failures provoke the appearance of oxalates.

Many experts are of the opinion that the formation and size of stones are hereditary. But there are several reasons for this process, the main ones include:

• disruptions in metabolism, resulting in the formation of salts that develop into oxalates, urates and phosphates;
• diverticula - protrusion of the mucous membrane and other defects of the muscular membrane from the inside;
• gastrointestinal diseases (for example, gastritis);
• injuries or pathologies of the skeletal system (osteoporosis);
• inflammatory processes in the bladder;
• inflammations affecting the genitourinary organs, kidneys (for example, cystitis);
• blockages in the urinary tract due to bladder outlet obstruction, which leads to impaired urination and stagnation of urine, and then the formation of salt crystals that transform into stones;
• if foreign bodies (catheters, contraceptives, etc.) enter the bladder;
• in the female population, a possible prerequisite is the prolapse of the bladder along with the vaginal wall;
• if a small stone comes out of the kidneys and enters the bladder through the ureter;
• eating large amounts of sour, spicy food, which increases acidity in the urine, which is fraught with salt deposits;
• operations to eliminate urinary incontinence by tissue transfer;
• lack of vitamins and ultraviolet rays;
• infections that cause water loss in the human body;
• the composition of the water that a person drinks, because in some countries it can be quite hard;
• when living in hot countries where there is increased sweating and salt concentration.

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Signs of bladder stones

The cause of acute pain when urinating may be stones in the urinary system.

It happens that the disease is asymptomatic, but more often a bladder stone causes the patient to:

• painful urination;
• pain in the lumbar region;
• bloody discharge in the urine;
• bladder pain;
• cloudy urine, presence of an unpleasant odor;
• frequent urge, especially at night, to urinate, most often painful;
• incomplete emptying of the bladder;
• urinary incontinence;
• acute pain when changing body position or physical activity (if the fragment is in the canal);
• renal colic;
• Large stones, as they move towards the exit, can cause chills and fever.

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How do symptoms differ in women and men?

The disease is more often observed in males.

The general symptoms of bladder stones in women and men are not much different from each other, but it all depends on the location of the stone when it appears. Representatives of the fair sex are less likely to be susceptible to this disease. It can only arise due to the atypical anatomical structure of the urethra, or pebbles grow on the suture threads after surgical interventions. But they come out quickly and do not cause significant discomfort.

The male population may experience a painful erection, a sharp interruption of the flow until complete emptying.

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Diagnostics

An ultrasound examination of the urinary system is prescribed as part of a comprehensive diagnosis.

Stones in the kidneys and bladder can be identified already at the initial stages of pathology using basic and additional diagnostic methods. All of them require the use of special equipment and professional skills of medical personnel. Basic diagnostics include:

• determination of stones in urine through a general analysis;
• blood biochemistry and general analysis to detect inflammation and other changes;
• Ultrasound of the bladder area;
• insertion of a cystoscope for internal examination of the bladder.

Often, the above procedures are not enough to confirm the diagnosis, so doctors turn to auxiliary methods that can provide more accurate results:

• computed tomography;
• x-ray of the urinary tract using excretory urography;
• urography and x-ray of the kidneys;
• cystogram using contrast agent.

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Treatment of women and men: how to remove it?

Treatment of bladder stones depends on factors such as the parameters of the stones, their composition, existing complications, age and general condition of the body. The symptoms of the disease play an important role. The most effective methods are considered to be the following:

• drug therapy;
• diet;
• surgical intervention;
• folk remedies that help get rid of such inclusions.

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Treatment with drugs

The effect of medications will be positive if the stone has already passed into the urethra.

Removing stones from the bladder using drug therapy has two main goals - pain relief and basic therapy. Therefore, the following remedies are used for treatment:

• painkillers antispasmodics (for example, “No-shpa”, “Spazmalgon”);
• antibiotics for infections of the excretory tract, if the stone has passed and damaged their walls (“Ampicillin”, “Nevigramon”);
• stone-dissolving drugs;
• sometimes diuretics are prescribed to expel neoplasms with urine.

However, tablets will help if the stone has already passed into the urethra; in other cases, this method is ineffective. In addition, another drawback is selectivity, since its effectiveness is affected by the chemical composition of the formations. The doctor should also make sure that the passage of a stone in the urethra will not disrupt the outflow of urine. Therefore, not every drug is applicable in this case.

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Diet food

It is necessary to reduce the concentration of urine; for this it is important to adhere to the correct drinking regime.

To treat this disease, it is necessary not only to take the prescribed medications, but also to adhere to a diet. It will help restore normal well-being, prevent the development of new growths and stop the progression of old ones, helping the body create conditions unfavorable for stones to increase in volume. A mandatory rule is a satisfactory drinking regime (up to 10 cups of water per day), which will reduce the concentration of urine.

The patient’s diet is selected by the doctor strictly on an individual basis, taking into account the chemical structure of the formations, which an examination will help you find out:

1. The presence of calcium suggests a reduction in the amount of dairy products in the diet.
2. The oxalate base of the stones gives reason to refuse potatoes, sorrel and lettuce, milk, and oranges due to the content of oxalic acid in them.
3. In case of phosphate formations, fruits, vegetables, and dairy products should be replaced as much as possible with fish, meat, flour products and vegetable oil.
4. Detection of urate stones implies reducing the consumption of foods with uric acid (for example, liver), vegetable fats and fish, and for grapefruit lovers it is better to switch to lemon juice.

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Stone removal operations

To remove large stones, a surgical method is used.

Surgery is required if the stones are large and the medicine is not able to cope, there is urinary retention, and persistent pain. Contraindications include:

• acute infections of the bladder and urethra;
• presence of operations on the pelvic organs;
• poor urethral patency in men.

Today, surgery can be done in the following ways:

• crushing and removal using a cystoscope;
• crushing and removal with an endoscope;
• wave lithotripsy: crushing with ultrasound, X-ray control, then spontaneous release of fragments through the ureter;
• open surgery by opening the bladder wall and removing stones.

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How to dissolve stones in a bladder using folk remedies?

Tablets are not always acceptable to some patients. Dissolving bladder stones using folk remedies is an effective method if there are no significant complications or severe symptoms. To combat stones, you can use herbs and juices:

• a mixture of carrot and cucumber juice;
• beet juice;
• onion tincture: fill half a bottle with onion half rings and add vodka, letting it brew for at least 10 days, then take 1-2 tbsp 2 times a day. l. before meals;
• millet, both in the usual porridge form, added to soups, and in the form of a decoction (boil 0.5 tbsp in 1 liter of water, leave for 30 minutes and strain);
• natural birch sap, a glass three times a day;
• tincture of parsley leaves and roots, 1 tbsp. before meals 3 times a day, which will help remove stones;
• decoction of dried sunflower roots: chop them, pour 3 liters. water and cook for 5 minutes, then strain and cool, it is possible to reuse the boiled herb, drink the entire volume in 2 days and repeat after 2 weeks;
• herb St. John's wort, knotweed, dandelion rhizome, larkspur, violet, pour a liter of water, infuse and strain, drink 1 tbsp for a month. three times a day.

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Complications

Urolithiasis can cause infection of the genitourinary system.

Failure to see a doctor in a timely manner or self-medication can lead to urolithiasis causing complications such as:

• genitourinary system infections;
• blockage of the urinary tract;
• nephrogenic hypertension (uncontrolled surges in blood pressure);
• chronic inflammatory process;
• purulent processes that can cause anaphylactic shock and death of the patient.

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Prevention

1. For the male population over 45, an annual examination by a urologist and nephrologist is recommended, and for women such an examination is prescribed during pregnancy and the presence of pathologies of the genital organs.
2. Balanced diet.
3. Rejection of bad habits.
4. Exercise.
5. Always dress appropriately for the weather and avoid getting too cold.
6. Take all medications.
7. Contact specialists in a timely manner when the slightest signs of pathology appear.

Bladder stones in men and women are not a death sentence. Modern medicine offers a fairly wide range of methods to get rid of them; you should not avoid seeking medical help, and then a person will be able to regain his health and fully enjoy life, avoiding the recurrence of the disease with the formation of such formations.

EtoPochki.ru

How are bladder stones formed?

To form a calculus, one of the following conditions must be met:

1. 1Change in the chemical composition of urine, which will lead to precipitation and aggregation of insoluble salts. The composition of urine can change under the influence of diet (excessive consumption of vegetables, meat products), metabolic disorders (gout).
2. 2The presence of an inflammatory process in the urinary tract, foreign bodies (urinary catheter, stent, suture material). Inflammation is accompanied by the release of proteins into the lumen of the bladder, which serve as a trap for salt crystals. In addition, the physical and chemical characteristics of urine change.
3. 3 Presence of obstruction, dysfunction of the bladder wall and stagnation of urine inside the cavity. Stagnation of urine is accompanied by sedimentation and thickening of insoluble salt particles.

In some cases, stones initially form in the bladder cavity. Less commonly, they migrate from the upper sections: the ureter, the collecting system. Then they further increase in diameter due to the layering of insoluble salt deposits. At the initial stages of stone formation, the small size of the stone facilitates its spontaneous passage. An important role in their spontaneous elimination is played by the absence of barriers to the flow of urine. The chemical composition can indicate origin. Urates are more likely to indicate their initial formation in the lumen of the bladder. Oxalate stones (veddelites and wewellites) usually form in the calyces or pelvis of the kidney. Struvite, consisting of magnesium ammonium phosphate, is formed under the influence of bacteria that produce urease (Proteus mirabilis). Therefore, struvite indicates a chronic urinary tract infection. In adult patients, urate is most often detected (more than 50% of cases of urolithiasis). In pediatric patients, stones based on ammonium urate and calcium oxalates are more often diagnosed. In children, urolithiasis can occur with prolonged isolated breastfeeding and eating polished rice. These products are low in phosphorus. A lack of phosphorus in the diet leads to increased excretion of ammonium from the body. In addition, in children from areas where this pathology is endemic, the diet is dominated by vegetables rich in oxalates and meat products.

Physical characteristics of stones

Concretions can be single or multiple. Their sizes vary: from small (3-7 mm in diameter) to large. Their consistency and shape also vary. Most stones are mobile, less often fixed in the area of ​​sutures (if there is a history of operations), tumor growths, or stents.

Causes of urolithiasis

In men, the main problem is an increase in prostate volume (hyperplasia). The prostate grows in the form of a ring surrounding and compressing the neck of the bladder, this leads over time to a pronounced disruption of its emptying. Stagnation of urine against the background of such a “blockade” contributes to the sedimentation of salts, their aggregation and stone formation. In women, urinary disorders and urinary stagnation are much less common. Typical anatomical prerequisites for urolithiasis in women are cystocele, enterocele, surgical interventions on the urethra, the anterior vaginal wall. A neurogenic bladder can also cause urolithiasis. Normally, nerve fibers carry an impulse from the brain to the muscle fibers of the bladder wall, leading to their spasm or relaxation. When they are damaged as a result of a stroke, spinal injury, diabetes mellitus and other pathologies, an imbalance occurs in the processes of contraction and relaxation of the muscles of the bladder wall. This imbalance leads to stagnation of urine in the bladder cavity. In order to divert urine, catheterization of the bladder is sometimes performed. The catheter itself is a foreign material and a source of chronic infection, which contributes to the formation of stones. It is the chronic infectious process that explains why struvite (consisting of magnesium ammonium phosphate) is more often detected in patients with spinal cord injury. For the formation of struvite, an alkaline environment is required, which is created by ammonium-producing microorganisms. Less commonly, urolithiasis can result from:

1. 1Inflammation (chronic persistent and recurrent cystitis).
2. 2Medical devices (ureteral stent, urinary catheter) can serve as a matrix for salt deposition.
3. 3Concretions formed in the pyelocaliceal system of the kidney can migrate along the ureter into the cavity of the bladder. Read how to deal with them here (follow the internal link).

Symptoms of the disease

Among patients with pathology, there is variability in the clinical picture: from the complete absence of any symptoms of the disease to severe pain and severe hematuria. The main manifestations of urolithiasis are:

1. 1Pain and discomfort above the womb. The pain can be dull and intensify with sudden movements and physical activity. Taking a position on the side or lying down by the patient leads to pain relief, sometimes to the passage of urine due to the removal of the stone from the neck of the bladder and the opening of the internal opening of the urethra.
2. 2Dysuric symptoms: pain, increased frequency of urination, intermittent urination. Sometimes the patient is bothered by the sudden cessation of the flow along with the appearance of pain above the pubis, in the scrotum, in the perineum, and in the lower back. This symptom is explained by the rolling of a stone into the triangle of the bladder, followed by muscle spasm and blockage of the proximal urethral opening. By changing body position, the delay and pain can be eliminated.
3. 3The appearance of blood clots in the urine, coloring it red (macrohematuria). With a slight increase in the number of red blood cells, the urine does not turn pink and red, in this case we are talking about microhematuria. Microhematuria is recorded by OAM or Nechiporenko's test.

Diagnostic measures

A conversation with the patient and collection of anamnesis are mandatory for diagnosing urolithiasis. First of all, the doctor asks the patient about the symptoms and their possible causes, clarifies the possibility of the hereditary nature of the disease, finds out the presence of concomitant diseases, and previous operations (including on the pelvic organs). When palpating above the womb, the doctor can determine the tension of the abdominal wall muscles; in case of acute urinary retention, a full, tense and painful bladder is palpated. Women should be examined for cystocele and enterocele.

General urine analysis

A general urine test is prescribed to all patients with suspected disease. Expected changes include:

1. 1Increased urine density.
2. 2Neutral or alkaline environment.
3. 3Increased number of red blood cells, leukocytes and casts in the urinary sediment.
4. 4Identification of crystals - urates, phosphates, oxalates.

Urine culture

Urine culture is performed to determine the main causative agent of secondary urinary tract infection. The study also evaluates the sensitivity of uropathogens to antibacterial drugs.

General blood test

With a pronounced inflammatory process in the CBC, an increased content of leukocytes, a shift in the leukocyte formula to the left (under the influence of pro-inflammatory factors, an increase in young forms of leukocytes occurs, which leads to a shift in the leukocyte formula), and an acceleration of the ESR.

Biochemical blood test

The analysis allows you to assess the functional state of the kidneys. In the presence of obstruction, biochemical analysis shows an increase in the level of creatinine and urea. Based on changes in other parameters, the cause of the disease can be suspected (for example, an increase in uric acid levels in gout can contribute to the deposition of urate).

Instrumental diagnostics

Figure 1 - Plain X-ray: multiple bladder stones. Illustration source - Medscape.com

• Plain radiography of the abdomen and pelvis, which includes the area of ​​the kidneys, ureters and bladder, allows the identification of radiopaque stones. Urates are X-ray negative, except when they have layers of calcium salts in their structure.
• Ultrasonography. If there are no changes on the radiograph, the patient is indicated for ultrasonography. The method is inexpensive, widely available and allows the differentiation of blood clots or tumors.
• Cystography, intravenous pyelography are methods based on the administration of contrast followed by a series of x-rays. With X-ray negative stones, filling defects are visualized on the image. A filling defect that shifts when the patient changes position is a typical radiological sign. A non-mobile filling defect may indicate a tumor or diverticulum.
• Computed tomography is a highly sensitive method for diagnosing pathology and allows you to diagnose radiopaque and radionegative stones. The use of contrast leads to a decrease in the accuracy of the method.
• Cystoscopy remains the main method for diagnosing the disease. The procedure allows the doctor to assess the size, shape, consistency of the formation, and its location. During the examination, you can also assess the condition of the urethra, prostate and bladder walls, determine the presence of strictures, obstructions in the outflow of urine, identify diverticula and tumors of the bladder wall. Cystoscopy can be supplemented with a biopsy. This is important, since long-term persistence of stones in the bladder cavity is associated with the risk of dysplasia and squamous cell carcinoma.

Figure 2 – Endoscopic picture of a stone with an uneven surface. In the background, a changed mucous membrane of the bladder is determined. Illustration source - Medscape.com

Features of treatment

The choice of type of surgical intervention is determined by the size of the stone, its composition and the presence of concomitant diseases.

Elimination of the main cause of stone formation (obstruction of the bladder outlet, infectious and inflammatory process, foreign bodies, errors in diet) is the basis for successful treatment and prevention of relapse of the disease.

Contraindications for stone removal are the unstable condition of the patient, asymptomatic disease in an elderly patient with a high surgical risk.

Non-invasive treatments

• Dissolving stones.

Dissolution of stones (lysis) can be used in the treatment of urate. To dissolve them, it is necessary to achieve alkalinization of the urine (pH level = 6.5 and higher). Potassium citrate is used for this purpose. It is worth noting that aggressive alkalization of urine can lead to the deposition of calcium phosphate deposits on the surface of an existing stone and negate all efforts to dissolve it. The method is ineffective and has a high probability of relapse, so it is not widely used.

• Extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy can break the stone into small fragments. The effectiveness of the method is determined by the size of the stone: the best results can be achieved with sizes not exceeding 2 cm. The method is the best choice in the treatment of small stones, as well as in patients with a high risk of surgical treatment. Complete fragmentation during the first crushing session is achieved in 77.7-88.4%; repeated sessions increase the effectiveness of treatment. In 17% of cases, cystoscopy is required to evacuate the resulting fragments. Advantages of this technique:

1. 1The method is non-invasive.
2. 2Allows you to crush small stones (up to 2 cm).

Its disadvantages:

1. 1Does not eliminate the cause of the disease.
2. 2The resulting fragments may not always come out on their own; cystoscopy using a basket evacuator may be required to remove them. To remove the remaining fragments, the patient can take antispasmodics (no-spa, papaverine), urological preparations, lingonberry and cranberry juices. The total volume of diuresis should be 1.5-2 liters/day (in the absence of contraindications). Alpha-blockers (tamsulosin) and nifedipine facilitate the removal of fragments with a diameter of up to 7-8 mm and prevent the development of renal colic.

Surgical interventions

For urolithiasis, the following types of surgical interventions can be used:

1. 1Transurethral cystolitholapaxy.
2. 2Percutaneous suprapubic lithotripsy.
3. 3Open suprapubic cystotomy.

• Transurethral fragmentation and removal of stones using endourological instruments (transurethral cystolitholapaxy): a cystoscope and working instruments are inserted through the lumen of the urethra to crush and evacuate fragments. The method is most applicable for stones up to 2 cm in diameter.

Fragmentation is achieved using mechanical/ballistic, ultrasonic, electro-hydraulic or laser energy. The holminium laser has the best effect.

Figure 3 – Laser fragmentation of stone. Illustration source - Medscape.com

Figure 4 - The picture on the left shows a diagram of cystoscopy, on the right - stone removal using a basket extractor. Source of illustration - www.drronaldfrank.com Most often, stone removal is performed using endoscopic methods through the urethra. Difficulties may arise when removing a large, high-density stone. In such a situation, urologists may resort to open surgery or minimally invasive percutaneous interventions.

• Percutaneous suprapubic lithotripsy. For this intervention, a suprapubic approach is used: a small skin incision is made above the pubis, through which the bladder is punctured and working endoscopic instruments are inserted into its cavity.

This operation option allows the use of larger caliber instruments, which ensures rapid fragmentation and the ability to evacuate stones of larger diameter (up to 4 cm). Urologists often resort to a combination of transurethral and suprapubic approaches to facilitate stone fixation during surgery and create adequate bladder irrigation. For suprapubic lithotripsy, the same energy sources are used as for transurethral lithotripsy.

• Open suprapubic cystotomy. During the operation, the stones are not fragmented, but are removed entirely from a wide skin incision above the pubis.

Figure 5 - A - Diagnosis of a stone (more than 7 cm in greatest diameter) in a patient during plain urography. B – Open cystotomy and stone evacuation. A 76-year-old patient with paraplegia and long-term catheterization of the bladder. Illustration source -

Indications for cystotomy:

1. 1Large stones (more than 4 cm in diameter).
2. 2Presence of indications for simultaneous surgery on the prostate and/or bladder: indications for open prostatectomy (prostate weight more than 80-100 g), the presence of wall diverticula.
3. 3 Lack of effect from minimally invasive treatment methods.

Advantages of cystotomy:

1. 1Fast execution.
2. 2It is easier to remove stones that have grown together with the mucosa.
3. 3Possibility of removing large and hard stones that cannot be fragmented.

The main disadvantages of cystotomy:

1. 1In the postoperative period, patients report more severe pain compared to minimally invasive techniques.
2. 2Longer rehabilitation and hospitalization.
3. 3Higher likelihood of postoperative complications.

Observation after surgery

A month after the intervention, the patient undergoes a survey urogram and ultrasonography to identify residual stones. If they are absent, a re-examination is scheduled after six months and a year. The patient remains under the supervision of a doctor, and pathological changes in a general urine test, biochemical analysis of blood and urine are assessed over time. A study of the chemical composition of the stone is indicated for patients with urate stones, stones of the upper floor of the urinary system, with a family history, recurrence of urolithiasis and its detection without the presence of risk factors.

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Image from the site lori.ru Without special equipment, bladder stones cannot be seen. But the disease manifests itself as painful symptoms, most often in the lower abdomen and above the pubis. The pain can radiate to the perineum, involve the genitals and internal genital organs. As a rule, pain appears when a person moves and intensifies when the patient urinates. Also, the presence of stones in the bladder may be characterized by an excessively frequent urge to urinate. The patient only needs to walk quickly, get into a shaking car, lift something heavy - and now he needs to look for the nearest toilet. A sign of stones in the bladder is also a specific type of urination disorder - the so-called symptom of an interrupted stream (“blocking”). The bladder has not yet been emptied, but the stream of urine has been interrupted, and the act of urination can only be completed after the position of the body has changed. If the disease is advanced and the stone has reached a significant size, urination becomes possible only in a supine position; Treatment of bladder stones should begin as early as possible. Reasons why stones appear in the bladder 1. The most common cause of the appearance of stones inside the bladder is called bladder outlet obstruction; this is a collective term that includes a variety of pathologies that lead to subvesical blockage of the urine outflow tract. As a rule, it is from the violation of free urination that occurs in the area of ​​the bladder neck or urinary canal that adults who have symptoms of bladder stones suffer. The mechanism of stone formation is simple: since the bladder, due to abnormal changes, is unable to perform its functions and empty itself properly, urine stagnates in large quantities, becomes concentrated, and salt crystals are formed, which later transform into stones. In male patients, this condition is often caused by intravesical growth of the prostate gland, as well as compression of the urethra in the prostate area. Also, as a reason that prevents the outflow of urine, there is a narrowing (stricture) of the urethra or Marion's disease (stenosis) - a sclerotic lesion of the bladder in the cervical area. 2. Disruption of the connection between the bladder and the central nervous system (innervation) also leads to the formation of stones. In patients with a neurogenic bladder (impaired urination due to damage to the nervous system) and an injured spinal cord, stones form in 35-36% of cases over 8 years. 3. Various inflammations affecting the bladder; the development of inflammatory processes can be observed after a person has been prescribed radiation therapy. 4. The presence of foreign bodies in the bladder. These may be remnants of suture material, stents, permanently present catheters, in women - mechanical anti-conception devices that have migrated into the bladder; or foreign bodies that the person himself, through oversight or on purpose, introduced there. 5. Defects of the inner muscular layer, protrusion of the mucous membrane (diverticula); 6. In women, prolapse (prolapse, prolapse) of the bladder together with the vaginal wall - cystostele. 7. Consequence of a reconstructive operation (with tissue transfer) performed to eliminate stress urinary incontinence. 8. Small kidney stones that travel through the tubular ureter into the bladder can also cause the formation of urinary stones. But this is not a necessary condition: in medicine there are many cases where, in the presence of kidney stones in patients, no signs of pathology were observed in the bladder. 9. A type of trematodiasis is genitourinary schistosomiasis. If a person whose urine flow is impaired has metabolic disorders, this is not a good reason for the appearance of stones in the bladder. Types of bladder stones Bladder stones are classified according to several criteria:

• Age dependence. In an adult, stones most often contain up to 50% uric acid, in children (according to statistics in areas for which this disease is typical) - uric acid in crystals, as well as calcium phosphates and oxalates.
• Quantity. There may be one stone (single), or there may be several stones in the bladder (multiple).
• Size. There are stones of a wide variety of sizes - from very small to formations comparable in size to the bladder itself.
• Hardness/softness. Urinary stones come in different consistencies, both soft and hard.
• Surface type. There are stones with a flat and smooth surface, like rounded pebbles, and others with spikes.

Main symptoms of bladder stones It happens that the patient does not have any external signs at all; therefore, accurate diagnosis of the presence of stones in the bladder is possible only with the use of special equipment. Most often, patients who have stones in the bladder complain of pain in the lower abdomen and pubic area; also characterized by sudden attacks of the desire to urinate, accompanied by painful sensations, the appearance of blood in the last portion of urine, night urges that force the patient to wake up. The following situation is also typical: urination suddenly stops, but pain occurs in the genitals (in men), lower back, abdomen and even in the thighs. Similar sharp or dull pains can also appear when a person exercises or simply changes body position. In some cases, intermittent urinary incontinence and painful erections (priapism) occur in children. Methods for diagnosing bladder stones Basic:

• urine test - general analysis;
• ultrasound diagnostics of the bladder area;
• internal examination of the bladder by inserting a cystoscope.

Additional:

• examination of the bladder using computed tomography;
• panoramic x-ray of the urinary tract;
• Rg study using a contrast agent (cystogram);
• examination of the problem area using a magnetic resonance imaging scanner.

Treatment of bladder stones In the case of conservative treatment, the goal is to alkalize the urine. Medicines and diet are prescribed to the patient depending on what type of salts are detected in the urine. Surgical treatment is possible.

A bladder stone is a fairly common diagnosis. The disease is associated with the deposition of small formations in the bladder cavity that interfere with the normal functioning of the genitourinary system. Interestingly, this problem is much more common among men.

The stones are usually composed of calcium oxalate and other minerals. They can be single or multiple, have different shapes, sizes and consistency.

Bladder stone: causes

Today there are many known reasons that lead to the formation of stones in the cavity:

The most common cause is the so-called bladder outlet obstruction, a phenomenon that is associated with partial blockage of the urine outflow tract. As a result of the current disruption, the bubble is not completely emptied. Urine stagnates and over time begins to crystallize, forming stones of various sizes. In men, blockage can be caused by an enlarged prostate gland, and in women, it can be caused by bladder lesions in the cervix.

In addition, a stone in the bladder can occur as a result of narrowing of the urethra, phimosis and other diseases that impede the outflow of urine.

In some cases, a similar problem is caused by a disruption of the connections between the bladder and the nervous system - these diseases are collectively called “neurogenic bladder.”

A stone in the bladder can form if there are foreign bodies in the cavity of the organ, including ligatures, stents, mechanical contraceptives (coil).

In women, this phenomenon can lead to a displacement of the bladder.

Reconstructive surgery on the bladder, which is performed for this purpose, can also cause the formation of stones.

It can be noted that there are actually a lot of reasons for the formation of solid bodies in the cavity of the bladder.

Bladder stone: symptoms

Rarely, the disease may be asymptomatic. But in most cases, patients complain of severe pain in the lower abdomen. The urge to urinate becomes more frequent, but during this process severe pain occurs, radiating to the genitals. Patients also complain of frequent urges at night. Sometimes there are traces of blood in the urine. Sexual intercourse becomes painful.

Bladder stone: diagnosis and treatment

If you experience the symptoms described above, you should immediately consult a doctor. First, you need to take a urine test - a laboratory test usually reveals an increased level of salts. In addition, the patient is prescribed an ultrasound examination of the bladder, which allows one to determine the size and consistency of the stones. Much less often, an internal examination of the bladder is carried out with the introduction of a special device - a cytoscope.

As for treatment, as a rule, conservative methods will be sufficient for a complete cure. The main goal of therapy is to dissolve stones and remove salts from the body. Therefore, patients are prescribed various drugs that destroy the structure of deposits. The choice of medicine here depends on the mineral of which the stone is composed. But sometimes surgical removal of the formations is still required.

Bladder stones (cystolithiasis) are one of the types of urolithiasis, characterized by the presence of calcified or saline stones in the organ cavity. Mineral hard formations inside the bladder are most often observed in older men. They are also found in women, and sometimes in preschool children.

General information about bladder stones

Acids and salts (urates, phosphates and oxalates) are found dissolved in the urine of any healthy person. Normally, their quantity is insignificant, but when favorable conditions for the occurrence of urolithiasis appear, the concentration of these substances increases and they begin to crystallize, forming stones. First, small grains of sand appear in the bladder - so-called microliths (up to 3 mm in diameter). Gradually, accumulating, they connect with each other and turn into macrolites (the size of a duck egg).

The process of urinary stone formation can take years.

The occurrence of the disease is promoted by:

• disturbances in the body's water-salt metabolism;
• changes in the acid-base balance that occurs during infectious diseases and intoxications;
• sedentary work;
• frequent experiences and neuropsychic disorders;
• abuse of alcohol, smoking and certain medications.

The formation of stones is favored by factors that make it difficult for urine to exit the bladder. These include:

• swelling or narrowing (stricture) of the urethra;
• hyperplasia (enlargement) of the prostate gland;
• phimosis (narrowing of the foreskin);
• bladder atony;
• narrowing of the external entrance to the urethra;
• diverticula of the bladder (bag-like protrusions of its walls);
• tumors or foreign bodies inside an organ.

The incidence in men is caused by the fact that urinary stagnation often occurs due to benign growth (hyperplasia) or sclerosis of the prostate, as well as urethral stricture. In women, cystolithiasis is quite rare.

Types and origin of bladder stones

Stones are classified according to their origin:

• primary, formed in the bladder initially due to stagnation of urine, stones of this type are found mainly in men;
• secondary, formed in the kidney and later descending through the ureter into the cavity of the bladder, that is, being a consequence of urolithiasis in the upper urinary tract.

Due to the slower passage of urine in the vesicourethral segment, it gradually becomes thicker. A precipitate begins to form in the bubble, and then these salt or acid elements combine together and form conglomerates. Stones can also grow around foreign objects: rubber, metal and glass parts of instruments accidentally left in the organ during medical procedures, or bone fragments trapped in the bladder after a complex pelvic fracture.

There are also stones called ligature, formed from suture material. In case of injuries or operations on the bladder, as a rule, self-absorbing catgut sutures are applied, since salts are deposited on stitches made of any other material, eventually forming a calculus. Stones of ligature origin grow when, for some reason, during urological or gynecological operations, material that does not dissolve was used for sutures. This is practically the only reason why stones of the primary type are formed in women; in addition, prolapse of the bladder (cystocele) also predisposes to the formation of stones.

Stones can form after surgery for urinary incontinence, when the neck of the organ is attached to the pubic symphysis and the entire thickness of the bladder wall is mistakenly captured in the suture.

According to their chemical composition, formations are:

• oxalate, consisting of oxalic acid lime and having a brownish-brown color and a spiky surface;
• phosphate, formed by crystals of calcium phosphate, white in color with a smooth surface;
• urate, consisting of particles of uric acid, yellow in color, flat in shape or similar to an egg;
• mixed - solid conglomerates created from several types of salts or acids with a layered texture.

Concretions are found single and numerous, and their number ranges from 1 to 100 pieces. They can have any shape, but are usually represented by round formations with a smooth surface ranging in size from 0.3 to 7 cm in diameter. But there are also rough stones with long processes.

Table: types and composition of bladder stones

Photo gallery: types of stones in the bladder

Larger urate stones are formed from individual small granules Multiple irregularly shaped phosphates are often formed against the background of chronic cystitis Oxalates are usually single stones Large phosphates can form huge conglomerates in the bladder, which are quite difficult to eliminate using minimally invasive methods Urate stones are often formed during inflammation and hyperemia of the bladder mucosa Large phosphates are often formed during inflammation of the bladder with elements of hemorrhage. One large stone of a mixed type can be crushed inside the bladder into several smaller stones

Clinical picture of the disease

Clinical symptoms of the presence of stones in the bladder are quite uniform and typical. Stones cause pain in the lower abdomen and above the pubis, which intensifies with physical stress and movement of the patient. At the same time, the person feels a frequent urge to urinate. The pain in men radiates to the penis and groin, in women - to the perineum and thighs.

But sometimes even large stones do not make themselves felt and do not bother the patient. The patient begins to feel discomfort when urination is impaired, constant friction of the rough stone against the walls of the bladder, irritation and inflammation of the inner surface of the latter. If a stone gets into the neck of the organ and prevents the internal sphincter from closing, urinary incontinence develops.

Pain occurs due to the traumatic effect of the stone on the mucous membrane of the bladder, its inflammation or compression of the nerve endings by the stone. These sensations are especially strong when a stone is pinched in the urethra. In this case, acute urinary retention is observed: a person tries to empty the bladder, but when straining, only a few drops are released, and an intermittent stream is also characteristic. Urination is restored only when the body position is changed. Having realized this, the patient begins to look for a suitable position: lies on his side, on his back, men urinate in a feminine way - squatting. After the strangulation is eliminated, blood appears in the urine. Subjective unpleasant sensations stop only at night, in a calm state.

If cystitis occurs, the course of the disease and the person’s well-being worsen. Urination becomes frequent and painful, especially at the end of the act, and the patient is forced to visit the toilet several times a night. This condition is characterized by high leukocytosis, a large number of bacteria and a noticeable admixture of blood and pus in the urine. A complication of cystitis that occurs due to urolithiasis in the bladder can be pyelonephritis.

Video: bladder stone

Diagnostics

Detection of stones in the bladder usually does not cause difficulties for an experienced urologist. Diagnosis is based on clinical symptoms, as well as on the results of cystoscopy, ultrasound and X-ray excretory urography.

Diagnostic cystoscopy involves examining the bladder from the inside using a special device inserted through the urethra - a cystoscope. During the procedure, one or more stones are identified. The appearance and color of the formations can suggest their chemical composition.

In the case when the presence of stones is accompanied by cystitis, corresponding changes are visible on the mucous membrane lining the bladder: its redness (hyperemia), swelling. If a diverticulum is present, the entrance to the pocket is determined. Cystoscopy is especially informative when detecting urates - stones of this type do not give a visible shadow on x-rays.

X-ray methods

If the presence of stones in the bladder is suspected, the patient is offered an ascending (retrograde) x-ray examination - cystography. A series of images is taken after the organ is filled with a contrast agent from the bottom up, using a catheter inserted through the urethra. After the examination is completed, the bladder is emptied. This method allows you to determine the size, number and shape of stones, their placement in the diverticulum. In the latter case, a small shadow is visible on the urogram slightly to the side of the border of the bladder.

If it is impossible to insert a catheter into the organ (when the patient has a urethral stricture, tumor occlusion of the lumen of the bladder neck, acute urethritis, etc.), descending (antegrade) cystography is performed. A contrast agent is injected into the patient's vein, which travels through the bloodstream to the kidneys. 45–50 minutes after the injection, the colored biological fluid appears in the bladder. At this time, photographs of the organ are taken in the anteroposterior, axial and semi-lateral positions. With an antegrade study, they turn out to be somewhat less clear than with an ascending study. Together with excretory intravenous urography, cystographic examination is the most informative and popular method for diagnosing urinary tract diseases.

Another type of this method is pneumocystography, when the bladder is filled with oxygen as a contrast agent. Gas is administered not only through the urethral catheter, but, if necessary, using suprapubic drainage of the organ or by puncture.

Ultrasound in the diagnosis of cystolithiasis

In the case when the patient is contraindicated for the insertion of a catheter or cystoscope, as well as when there are urates in the bladder that are invisible to x-rays - stones composed of uric acid crystals, ultrasound comes to the rescue. Ultrasound is used to diagnose cystolithiasis in young children, for whom cystoscopy can only be performed under anesthesia, and in elderly patients with benign prostate enlargement. Inserting an instrument into the urinary organs of such patients can cause them to develop acute pyelonephritis.

On an echogram, a calculus with a bladder filled with urine is visualized as an echo-positive formation with clear contours.

Video: bladder stone on the ultrasound machine screen

Differential diagnosis

Bladder stones are differentiated from pathologies that have similar symptoms:

• cystitis;
• urethral strictures;
• prostate tumors.

The presence of a stone is indicated by a specific symptom - “blocking” of the urinary stream, when during the act of urination there is a sudden cessation of the secretion of this biological fluid. Other distinctive signs of cystolithiasis:

• spraying a stream of urine in different directions;
• increased pain in the suprapubic region when moving and lifting heavy objects;
• the appearance of blood in the urine after any physical activity.

How to remove stones from the bladder

With a small diameter (up to 0.5 cm), stones are sometimes washed out with copious and intense urination without any action on the part of the patient. Secondary type stones, that is, those that descended into the bladder through the ureters from the kidneys, have a greater chance of spontaneous passage.

But more often you have to resort to medical procedures and various means to get rid of stones. It should be remembered that even if it was possible to remove them from the bladder, this does not relieve the patient of urolithiasis. As long as anatomical or physicochemical conditions favorable for the formation of stones exist in the body, a relapse of this pathology can occur at any time.

Medicines

To prevent the formation of new stones and the growth of existing stones, in the absence of contraindications, the patient is prescribed drugs that prevent the formation and promote the dissolution of stones (Rovatinex, Uralit-U, Fitolysin) and vitamin C to acidify urine. If cystitis is complicated, therapy with antibiotics and uroseptics is recommended (including, for example, Furamag, Palin, 5-NOK) along with plenty of fluids.

To prevent urine from stagnating in the bladder, causing an increase in existing stones, the patient may be prescribed diuretics (diuretics), for example, Furosemide. Sometimes there is a need for analgesics: to relieve painful spasms, the patient is recommended Papaverine, Baralgin, Spazgan.

Photo gallery: drugs for the treatment of urolithiasis

Spazgan will relieve pain and spasm Phytolysin - a herbal preparation with an anti-inflammatory effect Furomemide will help flush out small stones from the bladder

Folk remedies

Traditional medicines can occupy a worthy place in the complex of therapeutic measures and are used as natural diuretics and uroseptics that prevent the development of infection in the bladder. Diuretics can only help expel stones when they are in the form of sand or microlites. With a large stone, they, alas, are powerless. But if herbal remedies do not completely eliminate this disease, they at least alleviate the suffering of the patient. Before using any product, you should consult your doctor.

In order to prepare a healing cranberry drink, you need:

1. Pour 2 cups of fresh ripe berries into a bowl and crush them with a special puree spoon to form juice.
2. Transfer the resulting pulp into a vessel with boiling water (1 l).
3. Cover with a lid, turn off the heat and let sit for 15 minutes.
4. Strain the infusion through a fine sieve.
5. Crush the berries remaining in the sieve so that they release all their juice.
6. Pour the product back into the vessel, put on low heat, add sugar to taste, stir and bring to a boil.
7. With the drink boiling, turn off the heat and let it sit for 1-2 hours.

Cranberry juice is a storehouse of vitamins and an excellent antiseptic for the bladder.

Knotweed infusion

An infusion of knotweed, a herb that grows everywhere, perfectly counteracts stone formation in the lower urinary tract. To prepare the product you need:

1. 2 tbsp. l. plants, pour 0.5 liters of boiling water.
2. Place in a water bath and heat for 10 minutes.
3. After this, let it brew for 1 hour.
4. Strain and add boiling water to the drink so that the liquid volume becomes 0.5 liters.

Drink 0.5 glasses three times a day before meals.

Juice mixture against urinary stones

It will be useful to mix the juice of two lemons with a glass of warm water and drink several times throughout the day. At the same time, you need to take a third of a glass of a mixture of carrot, cucumber, tomato and beet juice 5-6 times a day for a week or two, until the sand is completely released from the bladder.

Decoction of rosehip seeds

For stones in the bladder, a decoction of rosehip seeds will be useful. To prepare it you should:

1. Pour 0.5 liters of boiling water 1 tbsp. l. rosehip seeds.
2. Boil over low heat for 15 minutes.
3. Let cool, strain.

You need to take the resulting decoction ¼ cup three times a day before meals.

Medicinal infusion

You need to prepare an equal amount:

• adonis herbs;
• rose hips;
• juniper fruits;
• steelhead roots.

You need to pour 4 tbsp. l. collect 1 liter of boiling water, let stand for 3 hours, then strain. The product should be drunk in small portions throughout the day.

Rice breakfasts

To remove sand and small stones from the bladder, you can try the folk method of rice breakfasts. How to do it:

1. Prepare 5 clean glass jars of 0.5 liters each.
2. Pour 2 tbsp into the first jar. l. dry rice, cover with cold water and let stand for 24 hours.
3. On the second day, drain the water, rinse the rice, fill it with new water in the same jar and leave it to soak for 5 days.
4. At the same time, pour another 2 tbsp into the second jar. l. rice and also add water.
5. The next day, rinse the rice from the second jar, add fresh water again and leave for 5 days.
6. Do the same with the other three banks.
7. After 5 days, all 5 jars will be filled with rice, and in the first one it will be ready.
8. Boil the rice from the first jar without salt and eat it without oil in the morning for breakfast. Do not drink or eat anything for the next 4 hours.
9. Pour 2 tbsp into the empty first jar again. l. rice and add water. Then repeat these steps every day.

You need to eat this rice for breakfast for at least two months.

Decoction of cornflower and horsetail

The decoction is prepared as follows:

1. Mix an equal amount of cornflower flowers and horsetail grass.
2. Pour boiling water over the raw materials at the rate of 2 cups of water per 2 tbsp. l. plants.
3. Cook for 15 minutes.
4. The broth is filtered.

It should be drunk hot in small sips; it acts as a diuretic. While drinking, you can massage the lower abdomen in the area of ​​the bladder, and then lie down and apply a poultice filled with hot boiled horsetail herb to the problem area.

Diet food

The diet for a patient with bladder stones does not play such an important role as for kidney stones, but still some rules should be followed. The diet of a patient with cystolithiasis should be adjusted in such a way that water-salt metabolism in the body is normalized. To do this, you need to limit your consumption of table salt and generally reduce your daily diet.

If you have urates, you should avoid the following foods:

• broths;
• chocolate;
• cocoa;
• coffee;
• liver;
• kidney;
• fried and spicy foods.

For oxalate stones, a diet low in oxalic acid is needed. It is necessary to limit in the diet:

• tomatoes;
• sorrel;
• spinach;
• green salad;
• potato;
• carrot;
• dairy products;
• oranges and grapefruits;
• chocolate;
• meat broths;
• fats;
• meat of young animals.

If the stones have a phosphate composition, then the patient needs nutrition that promotes the oxidation of urine. To do this, you need to diversify your menu with fish, meat, flour products, lard, and vegetable fats.

To prevent the formation of new stones, it is necessary to reduce the concentration of urine; for this it is important to adhere to the correct drinking regime. It is recommended to drink as much fluid as possible, preferably mineral water. For uric acid stones, the patient is prescribed Borjomi, Essentuki and others. For phosphates and oxalates - “Izhevsky Spring” or “Narzan”. The patient should drink at least 2–2.5 liters of mineral water per day.

Surgical intervention

The most effective treatment is surgical removal of bladder stones. Modern gentle techniques make it possible to perform interventions even on elderly patients who have suffered serious illnesses such as myocardial infarction and others in the near past. In most cases, stone removal procedure (lithotripsy) is performed endoscopically - as patients say, “without cuts and blood.” In other words, access to the surgical field is through the urethra. Transurethral extraction (extraction through the urethra) of a single small stone in its entirety is possible.

Both with open and endoscopic destruction and removal of stones, spinal anesthesia is used, during which the sensitivity of the lower half of the patient’s body is turned off for several hours.

Contraindications to all types of endoscopic lithotripsy:

• acute cystitis;
• urethritis;
• prostatitis;
• small bladder capacity;
• obstruction of the urethra and the inability to insert a cystoscope into the bladder;
• age up to 6 years.

After endoscopic crushing and removal of stones in the patient’s bladder, a catheter is left in place for 24 hours to drain urine. After removing the instrument, the patient spends another 4–5 days in the hospital under the supervision of doctors, then he is sent home.

Contact pneumatic lithotripsy

A special instrument (operational cystoscope) is passed through the urethra into the bladder. First, the stone is destroyed and its grains are washed out, and then, using the same endoscopic method, the patient is relieved of prostatic hyperplasia, which in most cases causes a violation of the outflow of urine.

During contact crushing of a calculus, the latter is destroyed by the tool into several small fragments. Lithotripsy occurs in a gas environment. These fragments are then washed out of the bladder using the same cystoscope.

The working surgical instrument is so thin and delicate that all the action takes place inside the organ cavity, maintaining its integrity and without disturbing the structure.

Video: endoscopic contact crushing of a stone in the bladder

Laser crushing

Laser surgical aid allows you to crush the calculus into even thinner and smaller fragments than the previous method. To completely rid the patient of stones, one procedure is sufficient. In this case, a flexible cystoscope is used, inserted into the organ through the patient’s urethra, which is equipped with a special laser beam. The latter turns solid conglomerates almost into dust, after which they easily leave the bladder with a stream of urine.

The intervention is absolutely painless for the patient, while he sees and hears everything that is happening and even has the opportunity to watch the progress of his operation on a special video monitor.

Open abdominal surgery

If it is impossible to fragment and remove stones using the transurethral method, it is necessary to resort to open surgery with cutting of the bladder (cystotomy). Such intervention is carried out in the following order:

1. The patient lies on his back with his pelvis slightly elevated.
2. In the center of the lower abdomen, along a line running from the pubis to the navel, an incision 9–11 cm long is made, cutting through the skin and its base.
3. The abdominal muscles are pulled apart, opening the prevesical tissue.
4. By pushing the fold of peritoneum upward, access to the bladder is opened.
5. Two holders are placed on the front wall of the organ and it is cut lengthwise or crosswise between them.
6. Using an instrument, the stone is removed; if there is a diverticulum, then that is also removed.
7. The incisions on the bladder and abdominal wall are sutured in layers.
8. A catheter is inserted into the bladder and left for several days.

In the postoperative period, provide constant irrigation of the bladder with antiseptic solutions. If there is an obstacle to urination and a strong inflammatory process in the organ, a polyethylene drainage tube is left, which, if the healing process is favorable, is removed on days 7–11.

Video: extraction of oxalate from the bladder using cystotomy

Rehabilitation in the postoperative period

It should be remembered that the recovery period after surgery lasts about two months. Even if no incisions were made during the intervention, the inner surface of the bladder is a fairly extensive wound.

Restoration of the mucous membrane occurs within 1–1.5 months. Throughout this period, the patient takes prescribed anti-inflammatory drugs, which prevent the development of infection and speed up the healing process. Water load is recommended: the amount of pure or mineral water drunk in the postoperative period should not be less than 2 liters per day.

Consequences, complications and prognosis of treatment

In the absence of timely treatment, the disease continues to develop. The size of the stones and their number increase, and infection occurs. First, chronic inflammation of the bladder (cystitis) develops, followed by pyelonephritis - inflammation of the renal pelvis and cups. In the future, all this can lead to chronic renal failure, which is often fatal.

Timely treatment allows the patient to return to normal life, completely restore natural bladder emptying and get rid of pain. In the future, he needs regular monitoring by a urologist and an ultrasound examination of the urinary organs twice a year.

If the causes that led to stone formation in the bladder are eliminated, the prognosis is good. However, with ongoing disorders in the body that caused urolithiasis, sand and stones may reappear.

Prevention

Every man over 50 years of age must be examined by a urologist at least once a year. By preventing problems with the prostate gland, the formation of stones in the bladder can be avoided.

An excellent remedy for preventing the appearance of stones in the urinary organs is strong green tea. You need to drink it without sugar, and at least four glasses a day.

Of great importance for the prevention of stone formation is the fight against urinary tract infections and urodynamic disorders, as well as diseases of the endocrine system. When working sedentarily, you need to get up every hour and do a warm-up to prevent stagnation in the pelvis.

The topic of anatomy, physiology and human health is interesting, loved and well studied by me since childhood. In my work I use information from medical literature written by professors. I have extensive experience in treating and caring for patients.

In this article we will look at the symptoms and treatment of bladder stones. What kind of illness is this?

Urolithiasis is a pathology characterized by the formation of stones in the kidneys, bladder, ureters, and in some cases in the urethra. Stones localized in the bladder are the most common form of the disease.

It often happens that they come out of the bladder. The symptoms are very unpleasant.

Men over 45 years of age are at highest risk of developing urolithiasis, especially those who have problems with the prostate and the functioning of the urethral structures. However, women may also develop bladder stones. The symptoms are presented below.

Types of stones by chemical composition

There is a certain classification according to which stones in the bladder are divided into several types according to different characteristics. Depending on the chemical composition, the following variations are distinguished:

1. Oxalate. These are brown stones that have a rough surface and tend to scratch the mucous membrane, which causes severe pain and turns the urine red. Such stones are formed from salts of oxalic acid.
2. Phosphate. They are fragile gray stones that are formed from salts of phosphoric acid. They have a soft structure, which makes them easy to crush. The most common cause of phosphate stones is a metabolic disorder.
3. Urate. They have a smooth surface, do not injure the mucous membrane, are formed from uric acid salts and occur as a complication of dehydration or gout.
4. Struvite. This type of stone appears as a result of the negative impact of microorganisms, which cause an alkaline reaction and lead to significant precipitation, such as ammonium, magnesium, phosphate and carbonate.
5. Cystonaceae. Presented in the form of hexagons, their appearance is usually caused by cystinuria - a consequence of inborn errors of metabolism, which leads to a regular increase in the level of cystine in urine.
6. Mixed type. These formations have a high degree of density, arise from several types of salts and have a layered pattern.

When you have any type of bladder stone, the symptoms can be very unpleasant.

Other classifications

Based on density, the following types are distinguished:

1. Solid.
2. Soft.

According to the type of surface, stones can be:

1. Spike-shaped.
2. Smooth, without any protrusions.

According to the number of formations, stones are:

1. Multiple.
2. Single.

By nature of origin:

1. Primary. Their formation provokes a violation of the outflow of urine from the bladder.
2. Secondary. They are formed in the kidneys, and only then descend into the bladder.

If symptoms of bladder stones appear, you cannot ignore them; you must immediately contact a specialist.

Causes of stone formation

Most medical specialists are confident that the occurrence and size of stones are determined by the presence of a genetic predisposition. However, there are other reasons why bladder stones can form. The most common ones are the following:

1. Metabolic disorder, which leads to the formation of salts that gradually turn into urates, oxalates and phosphates.
2. Diverticula are protrusions of the mucous membrane and other disorders of the muscular layer.
3. Gastrointestinal diseases such as gastritis and ulcers.
4. Pathologies of bone structures, such as osteoporosis, as well as their injury.
5. Development of the inflammatory process in the bladder.
6. Inflammatory process in the genitourinary system and kidneys, for example cystitis.
7. Blockage of the urinary tract as a result of bladder outlet obstruction, which leads to urinary dysfunction and stagnation, after which salt crystals form, which later turn into stones.
8. Foreign bodies entering the bladder, such as catheters, contraceptives, etc.
9. A prerequisite for the formation of stones in the bladder in a woman may be prolapse of the organ along with the vaginal wall.
10. The passage of a small stone from the kidneys, passing through the ureter into the bladder.
11. Excessive consumption of sour, spicy foods and other foods that can increase acidity and, as a result, provoke salt deposits.
12. Performing surgery to relieve urinary incontinence through tissue transfer.
13. Deficiency of ultraviolet rays and vitamins.
14. Infectious diseases that lead to dehydration of the body.
15. Hard water, which is used to quench thirst.
16. If we are talking about hot countries, then hyperhidrosis and the accumulation of salts can provoke the appearance of stones in the bladder.

Symptoms of bladder stones

Quite rarely, urolithiasis occurs in a latent form; most often, the presence of stones in the bladder leads to the development of the following symptoms:

1. Pain when urinating.
2. Pain syndrome in the lumbar back.
3. Blood-colored spots in the urine.
4. Bladder pain.
5. Urine darkens and acquires a sharp, unpleasant odor.
6. The urge to urinate frequently, especially during sleep.
7. Incomplete emptying of the bladder.
8. Urinary incontinence.
9. When changing body position or increasing physical activity, sharp pain occurs.
10. Colic in the kidneys.
11. When moving towards the exit, large stones can cause increased body temperature and chills.

Symptoms of bladder stones in women and men are almost identical. They depend on the location of the stone and its size. Sometimes the disease occurs as a result of an abnormal structure of the urethra.

Symptoms of bladder stones in men may vary slightly. Pain is localized in the lower abdomen or at the pubic level. The process of urination may suddenly stop. In this case, the man suffers from pain in the perineum, genitals or lower back. Sometimes patients feel nothing when there is particulate matter in the bladder.

Diagnostics

Stones in the bladder and kidneys can be detected even at the earliest stage of the disease. Both basic and additional diagnostic procedures are carried out. This requires the use of special equipment and special professional skills of medical personnel.

The main methods for diagnosing urolithiasis are:

1. Conducting a urine test.
2. Biochemical blood test and passing a special test to identify the inflammatory process and other changes.
3. Ultrasound examination of the bladder and kidneys.
4. Examination of the bladder through the introduction of a cytoscope.

Other diagnostic methods

Symptoms of stones leaving the bladder appear quite clearly, but there are cases when all these diagnostic methods are not enough, so additional manipulations are used, such as:

1. CT scan.
2. X-ray examination of the urinary tract.
3. X-ray of the kidneys and urography.
4. Cystogram through injection of contrast agent.

How to get rid of the symptoms of kidney and bladder stones?

Treatment

Treatment of urolithiasis is prescribed depending on several factors, such as the nature of the stone formations, the presence of complications, the general condition of the patient and his age. The nature of the symptoms is also of great importance in therapy.

Drugs

Drug therapy for urolithiasis is aimed at solving several problems - relieving pain and eliminating stones. To accomplish these tasks, the following drugs are used:

1. Antispasmodic drugs such as Spazmalgon, No-shpa, etc.
2. If the disease is caused by a urinary tract infection, antibacterial drugs are prescribed. The main condition is the passage of the stone through the ureter without damaging its walls.
3. Preparations aimed at dissolving stones.
4. Diuretics, the purpose of which is to provoke the passage of stones in urine.

If the stone has passed into the urethra, then drug treatment will be effective, otherwise conservative therapy will not give the expected result. In addition, it assumes selectivity, that is, the composition of the stones influences the effectiveness of therapy.

Nutrition

Another important aspect of the treatment of urolithiasis is nutritional therapy. It will help normalize the patient’s general condition, prevent the formation of new stones and stop the development of already formed stones. The main rule of a therapeutic diet is compliance with the drinking regime. This helps reduce urine concentration.

The diet is prepared by the attending physician individually, taking into account the composition of the stones. Based on the results of a comprehensive examination, the doctor may exclude certain foods and prescribe a diet:

1. With calcium formations, as a rule, doctors recommend reducing the consumption of dairy products.
2. Oxalate stones mean avoiding sorrel, lettuce, potatoes, oranges, milk and others.
3. Phosphate stones indicate the need to give up fruits, vegetables and dairy products in favor of meat, fish, baked goods and vegetable oil.
4. Urate stones suggest reducing the amount of consumed foods containing uric acid: liver, fish, grapefruit and vegetable fats.

Operation

In some cases, symptoms of bladder stones in women and men may require surgery. As a rule, this happens when the stones are too large and drug treatment does not work. Contraindications to the operation are:

1. Infectious diseases of the urethra and bladder in acute form.
2. Surgeries performed on the pelvic organs.
3. Urethral obstruction in men.

Surgical intervention today can be carried out in different ways:

1. Cytoscopic grinding followed by removal.
2. Endoscopic method of crushing and removing stones.
3. Lithotripsy. This is the crushing of stones using ultrasound.
4. Surgical opening of the bladder wall and removal of stones.

Folk remedies can help relieve the symptoms of bladder stones. However, you should not blindly rely on the experience of your ancestors; any therapy must be agreed with a doctor.

Complications

Urolithiasis can lead to infection of the genitourinary system. Self-medication and untimely contact with a specialist can provoke the following complications:

1. Obstruction of the urinary canals.
2. Nephrological hypertension.
3. Chronic inflammation.
4. Purulent processes that can lead to anaphylactic shock and death.

Prevention

In most cases, provided that all rules and regulations are followed, urolithiasis is successfully cured. However, a relapse is possible; the following preventive measures will help avoid it:

1. Men are required to undergo an examination by a urologist and nephrologist every year.
2. Stick to a balanced diet.
3. Quitting smoking and drinking alcohol.
4. Moderate physical activity.
5. Avoid hypothermia and dress appropriately for the weather.
6. Contact a specialist promptly when the first symptoms of the disease appear.

Conclusion

Modern medicine has learned to remove stones successfully and with minimal risk of complications. Therefore, such a diagnosis should not be taken as a death sentence. The main thing is not to put off going to the doctor if you have stones in your bladder. You now know what symptoms indicate their presence.

Bladder stones (cystoliths) form when minerals coalesce into small, hard formations. Suitable conditions arise when the bladder is not completely emptied, causing the urine to become concentrated - this leads to crystallization of the dissolved minerals it contains.

Sometimes these stones come out (while they are small in size), sometimes they are fixed to the wall of the bladder or urethra, gradually increasing in size.

Cystoliths often remain in the bladder for a long time without causing any symptoms and are discovered accidentally while undergoing examination for other health problems.

Causes of bladder stones

Since cystoliths begin to form in residual urine, which is not completely eliminated from the bladder, the search for the causes of stone formation is associated with certain diseases that interfere with complete emptying. These pathologies include:

• Neurogenic bladder – occurs when the nerves connecting the bladder to the spinal cord and brain are damaged (for example, after a stroke or spinal injury).
• Enlarged prostate – an enlarged prostate gland puts pressure on the urethra.
• Medical devices – catheters, sutures, stents, foreign bodies in the bladder, contraceptive devices.
• Cystitis.
• Kidney stones – these can migrate through the ureters into the bladder and increase in size.
• Bladder diverticula – urine accumulates and stagnates in them.
• Cystocele – in women, the bladder wall may prolapse into the vagina, impairing bowel movements.

Types and composition of stones

Not all stones are made of the same minerals. Their different types include:

• Calcium stones are composed of calcium oxalates, phosphates and hydroxyphosphates.
• Uric acid stones are the most common type in adults.
• Struvite – This type of stone is found most often in women with urinary tract infections.
• Cystines - occur in patients suffering from the hereditary disease cystinuria, in which the amino acid cystine passes from the kidneys into the urine.

Cystoliths have different sizes and textures - they can be single or located in groups, have a round shape or have outgrowths.

The largest stone found in the bladder weighed 1899 g and measured 17.9 x 12.7 x 9.5 cm.

Sometimes the symptoms of bladder stones do not appear for a long time. But as soon as they begin to irritate the walls, characteristic signs appear. So, the symptoms of a stone in the bladder may be as follows:

• Discomfort or pain in the penis in men.
• More frequent urination or intermittent urine flow.
• Slow onset of urination.
• Pain in the lower abdomen.
• Pain and discomfort during urination.
• Blood in urine.
• Cloudy or abnormally dark urine.

Features in women

The cause of the formation of cystoliths in women may be cystocele (prolapse of the urinary tract into the vagina), contraceptives that have migrated into the bladder, or operations to reconstruct the vagina.

Cystocele is manifested by the sensation of a foreign body in the vagina, discomfort during sex.

Because women's urethra is shorter than men's, infectious inflammation of the urethra (urethritis) is more likely to progress to cystitis (inflammation of the bladder). Recurrent cystitis is a risk factor for the formation of cystoliths and a sign of their presence in women.

Diagnostics

The presence of cystoliths is detected using the following methods:

• Urinalysis - detects the presence of blood, bacteria and mineral crystals.
• CT scan.
• Ultrasonography.
• X-ray (with this examination, not all types of cystoliths can be seen).
• Intravenous pyelography - a special contrast is injected intravenously, which is released through the kidneys into the bladder.

With small stones, their natural removal to the outside is facilitated by increased water consumption. If they are too large to pass through the urethra, treatment is divided into two groups: crushing the stones and surgical removal.

It is important to note that there is no scientific data confirming the effectiveness of folk remedies.

Crushing stones

Cystolitholapaxy (crushing stones) consists of inserting a thin tube with a camera at the end through the urethra into the bladder, with the help of which the doctor sees the stones and can crush them.

This is done using laser, ultrasound or mechanical crushing, after which the debris is washed out or sucked out. This procedure is performed under local or general anesthesia.

Surgical removal

If the stones are so large that they cannot be broken up by cystolitholapaxy, surgery is another treatment option. The surgeon makes an incision in the abdominal wall and bladder, through which the cystolitis is removed.

Possible complications

Despite the fact that some cystoliths do not cause any complaints, they can still lead to the development of a number of complications:

• Chronic bladder dysfunction (frequent urination, associated pain and discomfort). Over time, the cystolitis can completely block the opening of the urethra, blocking the flow of urine from the bladder.
• Urinary tract infections.

Since the formation of stones is usually caused by the presence of some kind of disease, there are no fail-safe and specific methods of prevention.

However, if a person experiences any problems with the urinary tract (for example, pain when urinating, change in urine color), it is advisable to immediately seek medical help. Drinking enough fluids also helps dissolve minerals.

If a person has a urinary tract infection and does not empty their bladder completely, they should try to urinate again 10-20 seconds after the first attempt. This technique is called “double emptying” and helps prevent the formation of cystoliths.

It is believed that sitting while urinating helps patients with an enlarged prostate to completely empty the bladder. This, in turn, prevents or slows down the formation of cystoliths.