КАМНИ МОЧЕВОГО

ПУЗЫРЯ

Подготовка слайдов:Доцент клиники урологии УО «ВГМУ»

Жебентяев А.А.2006

КАМНИ МОЧЕВОГО ПУЗЫРЯ

Этиология Мужчины > женщины; Стаз мочи (инфравезикальная

обструкция); Инородные тела;

Описание Обычно большие, одиночные камни; Множественные при наличии

остаточной мочи или дивертикулов мочевого пузыря;

Симптомы Поллакиурия и императивность; Дизурия; Пиурия; Терминальная гематурия; Симптомы обструкции; Боль в надлобковой области.

Камни мочевого пузыря

Камни мочевого пузыря Типы камней Оксалат/фосфат кальция; Струвит (инфицированная моча); Мочевая кислота; Исследования Обзорная урография; УЗИ; Цистоскопия; Лечение Трансуретральная литотрипсия и

литолапаксия; Устранение инфравезикальной

обструкции – рецидив! (ТУР простаты или рассечение стриктуры);

DIVERTICULA OF THE BLADDER

Acquired Diverticula

(a) Pulsion DiverticulaCauses: Herniation of mucous membrane of the bladder through the weakened trabeculated muscle coat obstruction, e.g. BNO, BPH & urethral stricture.

Acquired Diverticula

Pathology: - Usually the mouth of the diverticulum is situated above and to the outer side of one ureteric orifice;- It is lined by the bladder mucosa and the wall is composed of fibrous tissue only, so not contractile leading to stasis and complications;- It enlarges in a downward direction & sometimes may obstruct a ureter.

DIVERTICULA OF THE BLADDER

DIVERTICULA OF THE BLADDER

Acquired Diverticula

Complications:(1) Recurrent cystitis;(2) Vesical calculus;(3) Hydroureter, hydronephrosis & pyonephrosis(4) Neoplasm arising in a diverticulum(7-8%)

DIVERTICULA OF THE BLADDERAcquired Diverticula(a) Pulsion Diverticula. Clinical Picture:By an uninfected diverticulum there are no symptoms and no pathognomonic symptoms:- Symptoms of the cause: BNO, BPH;- Symptoms of complications: frequency, pyuria- Micturation symptoms:“Double micturation” - in a few casesmicturation occurstwice, the 1st specimenis clear & the 2nd

is cloudy.

DIVERTICULA OF THE BLADDERAcquired Diverticula

Investigations:(1) Urine analysis & serum creatinine;(2) Plain X-ray, IVP & ascending cystography;(3) Cystoscopy;

Treatment:(1) Small uninfected diverticula: remove the cause.(2) Large, narrow neck, complicated diverticula: remove the cause + diverticulectomy.

DIVERTICULA OF THE BLADDERAcquired Diverticula(b) Traction Diverticulum (glancing hernia of the bladder)Rare. The condition is relatively frequent in femoral and direct hernia.

Acquired Diverticula(c) False DiverticulumAetiology: Rupture of a pelvic abscess in the bladder, with creeping mucous membrane of bladder to cover the inside of the abscess cavity forming a false diverticulum.

Treatment: Diverticulectomy. Which may prove to be very difficult from adhesions.

DIVERTICULA OF THE BLADDER