Vesical calculus.pptx

Lecture notes for medical students

1. Tips on using my ppts . You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Etiology ) > Ask students what they already know about etiology of todays’s topic. > Then show next slide which enumerates etiologies . At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibiliography .

2. Learning Objectives

3. Learning Objectives Introduction & History Relevant Anatomy, Physiology Aetiology Pathophysiology Pathology Classification Clinical Features Investigations Management Prevention Guidelines Take home messages

4. Introduction & History.

5. Introduction & History. Bladder ( vesical ) calculi are stones or calcified materials that are present in the urinary bladder. The presence of upper urinary tract calculi is not necessarily a predisposition to the formation of bladder stones.

6. Relevant Anatomy

7. Relevant Anatomy Most vesical calculi formed de novo within the bladder, but some initially may have formed within the kidneys. Stones composed of calcium oxalate usually originate in the kidney.

8. Aetiology

9. Aetiology Idiopathic Congenital/ Genetic Nutritional Deficiency/excess Traumatic Infections /Infestation Autoimmune Neoplastic (Benign/Malignant) Degenerative / lifestyle Iatrogenic Psychosomatic Poisoing / Toxins/ Dtug induced

10. Aetiology Idiopathic Congenital/ Genetic Nutritional Deficiency/excess Traumatic Infections /Infestation Autoimmune Neoplastic (Benign/Malignant) Degenerative / lifestyle Iatrogenic Psychosomatic Poisoing / Toxins/ Dtug induced

11. Predisposing Factors

12. Predisposing Factors Bladder outlet obstruction  Neurogenic bladders Indwelling catheters Radiation cystitis Schistosomiasis Congenital or acquired vesical diverticula  Sliding inguinal hernias containing the urinary bladder. Bladder augmentation Foreign bodies in the bladder Medications (eg, viral protease inhibitors)  Renal stone disease and gout 

13. Predisposing Factors A diet deficient in animal protein, Poor hydration Recurrent diarrhea . 

14. Predisposing Factors Males- Benign prostatic hyperplasia Urethral stricture Neurogenic bladder Diverticula Ureterocele Ladder neck contracture. Females- Incontinence repair that is too tight Cystoceles Bladder diverticula.

15. Pathology

16. Pathology The most common composed of uric acid.  Less frequently calcium oxalate calcium phosphate ammonium urate Cysteine magnesium ammonium phosphate (when associated with infection ). In many cases, the core consists of one chemical, and layers of different chemicals form around this core.

17. Pathology In children- ammonium acid urate , calcium oxalate, mixture of ammonium acid urate and calcium oxalate with calcium phosphate. In patients with spinal cord injuries, composed of struvite or calcium phosphate .

18. Pathophysiology

19. Pathophysiology Bladder outlet obstruction>Stasis>crystal nucleation and accretion> overt calculi.

20. Pathophysiology The factors that promote uric acid stone formations are Persistently low urinary ph Dehydration leading to low urinary volume High uric acid production.

21. Classification

22. Classification A primary bladder stone is one that develops in sterile urine it often originates in the kidney. A secondary stone occurs in the presence of infection outflow obstruction impaired bladder emptying foreign body.

23. Chemical composition

24. Chemical composition Most vesical calculi are mixed. Oxalate calculus Uric acid Cystine Triple phosphate

25. Clinical Features

26. Clinical Features Demography Symptoms Signs Prognosis Complications

27. Demography

28. Demography Incidence & Prevalence Geographical distribution. Age Sex Socioeconomic status Temporal behaviour

29. Demography Incidence & Prevalence -

30. Demography Incidence & Prevalence- 5% of urinary tract stones.

31. Demography Geographical distribution.

32. Demography Geographical distribution. The incidence of bladder stones is higher in developing countries.

33. Demography Age

34. Demography Age The age distribution has two peaks: 3 years 60 years.

35. Demography Sex

36. Demography Sex common in males, with male:female ratios between 10:1 and 4:1

37. Demography Temporal behaviour

38. Demography Temporal behaviour Since the 19th century, the incidence of primary bladder calculi in the United States and Western Europe has been steadily and significantly declining as a consequence of improved diet, better nutrition, and infection control.

39. Demography In regions where vesical lithiasis is endemic in children, stone formation is more common among boys younger than 11 years people from low socioeconomic backgrounds, is not usually associated with renal calculi less likely to recur after treatment (in comparison with upper urinary tract calculi)

40. Symptoms

41. Symptoms Asymptomatic Suprapubic pain Dysuria Intermittency Frequency Hesitancy Nocturia Urinary retention. Priapism Enuresis.   Terminal gross hematuria and sudden termination of voiding with pain

42. Signs

43. Signs None Suprapubic tenderness Fullness Palpable distended bladder Cystoceles in women Stomal stenosis Neurologic deficits in patients with neurogenic bladder.  Van buren sounds.  

44. Complications

45. Complications Squamous cell carcinoma of the bladder

46. Investigations

47. Investigations Laboratory Studies Routine Special Imaging Studies Tissue diagnosis Cytology FNAC Histology Germline Testing and Molecular Analysis Diagnostic Laparotomy.

48. Investigations Laboratory Studies Microscopic or gross hematuria Pyuria Bacteriuria Crystalluria Urine cultures positive for urea-splitting organisms

49. Diagnostic Studies

50. Diagnostic Studies Imaging Studies X-Ray USG CT Angiography MRI Endoscopy Nuclear scan

51. Diagnostic Studies Imaging Studies X-Ray- uric acid stones are radiolucent. USG CT Angiography MRI Endoscopy Nuclear scan

52. Diagnostic Studies

53. Diagnostic Studies

54. Cystogram

55. Differential Diagnosis

56. Differential Diagnosis Clot Fungal ball Papillary urothelial carcinoma

57. Management

58. Management Transurethral cystolitholapaxy Percutaneous suprapubic cystolitholapaxy Open suprapubic cystotomy ESWL

59. Management The energy sources mechanical device (ie, a lithoclast [pneumatic jack hammer ]) ultrasonic device electrohydraulic device manual lithotrite laser .

60. Prevention

61. Prevention Eat less than hunger Drink water more than thurst .

62. Get this ppt in mobile Download Microsoft PowerPoint from play store. Open Google assistant Open Google lens. Scan qr code from next slide.

63. Get this ppt in mobile Download Microsoft PowerPoint from play store. Open Google assistant Open Google lens. Scan qr code from next slide.

64. Get this ppt in mobile Download Microsoft PowerPoint from play store. Open Google assistant Open Google lens. Scan qr code from next slide.

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