May 6, 2008

Bladder calculus

Bladder stone is one of the common diseases children suffer from. The causes for this condition are many. The most important factor is infection. The stasis of infected urine gives rise to stone formation. The symptoms are dysuria, pain in lower abdomen, sometimes blood in urine, urinary retention etc. When one examines the child there will be slight tenderness in the suprapubic region i.e. lowermost central part of abdomen. This is because of bladder inflammation associated with bladder calculus.

Urine routine and microscopy shows pus cells indicating urinary tract infection. Plain X-ray abdomen shows bladder calculus in pelvic region if the calculus is radio opaque but if the calculus is radiolucent then X-ray will not show it. Ultrasonography of the pelvic region picks up these types of stones. It also shows the presence of cystitis & if there is any bladder outlet obstruction. Bladder outlet obstruction convincingly ruled out by doing micturating cystourethrogram (MCU). The dye is injected into the bladder by passing a small infant tube or bladder catheter. After injecting dye to fill up the bladder, the tube is taken out. The child is told to void and pictures are taken. If there is any bladder outlet obstruction like posterior urethral valves, it is immediately diagnosed. If it present, one has to deal with it along with removal of calculus.

Bladder calculus is removed by endoscopically (if the stone is soft and small) but majority of times it is removed surgically. The procedure is called as cystolithotomy. Through a small incision over the lower abdomen, the bladder is approached (after filling up with saline through bladder catheter), bladder is then opened, stone removed & bladder stitched back. The catheter is kept for 3-5 days after procedure.