1. DEFINITION PRIMARY Develops in sterile urine SECONDARY Occurs in presence of infection ,outflow obstruction impaired bladder emptying or a foreign body

2. Types 1. Mixed - most common 2. Calcium Oxalate stones primary stones Moderate size Solitary , uneven surface Dark brown 3. Types 3. Uric acid stones Round to oval Smooth Yellow to brown Occur in patients with gout ileostomies or with bladder outflow obstruction 4. 3. TRIPLE PHOSPHATE composed of ammonium, magnesium and calcium phosphates CALCULUS - Infected urine with urea splitting organisms Grows rapidly Dirty white Chalky in consistency 5. Types 4. Cysteine calculus Presence of cystinuria Radio-opaque High sulphur content A bladder stone is usually free to move in the bladder May cause erosions and haematuria Gravitates to the lowest part of the bladder 6. Clinical features Men >women. 8:1 Symptoms 1. Frequency : sensation of incomplete bladder emptying. 2. Pain (strangury) occurs at the end of micturition refered to tip of penis 1. Pain is worsened by movement 7. 4. Haematuria drops of bright-red blood at the end of micturition, 5.Interruption of the urinary stream stone blocking the internal meatus. 6. UTI 8. Examination 1. Per abdomen : large calculus is palpable in the female in suprapubic region 9. Investigations 1. urine reveals 1. microscopic haematuria, 2. pus or crystals that are typical of the calculus, 2. Ultrasound abdomen 3. Radiogram 10. Treatment Treat the cause Bladder outflow obstruction Incomplete bladder emptying in patients with neurogenic bladder dysfunction. Modalities Lithotripsy Per cutaneous suprapubic litholapaxy Removal of retained foleys catheter 11. Different modalities optical lithotrite, electrohydraulic lithotrite, Holmium laser or ultrasound probe stone punch, which is useful to crush small fragments further so that It can be evacuated with an Ellik evacuator. 12. Ultrasound lithotripsy is extremely safe but appropriate only for small stones. Percutaneous suprapubic litholapaxy This is the best method to use if it is not possible to carry out litholapaxy per urethram because of a narrow urethra. 13. Laser lithotripsy with the holmium laser can deal with most large stones. Once small fragments are produced, the optical lithotrite can be used to finish the job. For evacuation of the fragments, fluid (200 ml) is introduced into the bladder. By evacuator the returning solution carries with it fragments of stone. 14. Contraindications To perurethral litholapaxy are extremely rare: Urethral stricture that cannot be dilated sufficiently; In patient is aged below 10 years; Contracted bladder; A very large stone. 15. Thank you REF BAILEY AND LOVE 25 ED