Litholapaxy Health Dictionary

Diseases of the URINARY BLADDER are diagnosed by the patient’s symptoms and signs, examination of the URINE, and using investigations such as X-RAYS and ULTRASOUND scans. The interior of the bladder can be examined using a cystoscope, which is a ?breoptic endoscope (see FIBREOPTIC ENDOSCOPY) that is passed into the bladder via the URETHRA.

Cystitis Most cases of cystitis are caused by bacteria which have spread from the bowel, especially Escherichia coli, and entered the bladder via the urethra. Females are more prone to cystitis than are males, owing to their shorter urethra which allows easier entry for bacteria. Chronic or recurrent cystitis may result in infection spreading up the ureter to the kidney (see KIDNEY, DISEASES OF).

Symptoms Typically there is frequency and urgency of MICTURITION, with stinging and burning on passing urine (dysuria), which is often smelly or bloodstained. In severe infection patients develop fever and rigors, or loin pain. Before starting treatment a urine sample should be obtained for laboratory testing, including identi?cation of the invading bacteria.

Treatment This includes an increased ?uid intake, ANALGESICS, doses of potassium citrate to make the urine alkaline to discourage bacterial growth, and an appropriate course of ANTIBIOTICS once a urine sample has been ana-lysed in the laboratory to con?rm the diagnosis and determine what antibiotics the causative organism is likely to respond to.

Stone or calculus The usual reason for the formation of a bladder stone is an obstruction to the bladder out?ow, which results in stagnant residual urine – ideal conditions for the crystallisation of the chemicals that form stones – or from long-term indwelling CATHETERS which weaken the natural mechanical protection against bacterial entry and, by bruising the lining tissues, encourage infection.

Symptoms The classic symptom is a stoppage in the ?ow of urine during urination, associated with severe pain and the passage of blood.

Treatment This involves surgical removal of the stone either endoscopically (litholapaxy); by passing a cystoscope into the bladder via the urethra and breaking the stone; or by LITHOTRIPSY in which the stone (or stones) is destroyed by applying ultrasonic shock waves. If the stone cannot be destroyed by these methods, the bladder is opened and the stone removed (cystolithotomy).

Cancer Cancer of the bladder accounts for 7 per cent of all cancers in men and 2·5 per cent in women. The incidence increases with age, with smoking and with exposure to the industrial chemicals, beta-napththylamine and benzidine. In 2003, 2,884 men and 1,507 women died of bladder cancer in England and Wales.

Symptoms The classical presenting symptom of a bladder cancer is the painless passing of blood in the urine – haematuria. All patients with haematuria must be investigated with an X-ray of their kidneys, an INTRAVENOUS PYELOGRAM (UROGRAM) and a cystoscopy.

Treatment Super?cial bladder tumours on the lining of the bladder can be treated by local removal via the cystoscope using DIATHERMY (cystodiathermy). Invasive cancers into the bladder muscle are usually treated with RADIOTHERAPY, systemic CHEMOTHERAPY or surgical removal of the bladder (cystectomy). Local chemotherapy may be useful in some patients with multiple small tumours.... urinary bladder, diseases of

n. (pl. calculi) 1. a stone: a hard pebble-like mass formed within the body, particularly in the gall bladder (see gallstone) or anywhere in the urinary tract (see cystolithiasis; nephrolithiasis; staghorn calculus). Calculi in the urinary tract are commonly composed of calcium oxalate and are usually visible on X-ray examination. Some of these stones cause pain if they are associated with obstruction and prevent urine flow in the ureter or kidney, or by direct irritation of the bladder. Stones passing down a duct (such as the ureter) cause severe colicky pain. Most stones pass spontaneously, but some need to be broken into smaller pieces, usually by extracorporeal *lithotripsy, and the remainder by endosurgical techniques (see litholapaxy) or rarely by open surgery. Calculi may also occur in the ducts of the salivary glands. 2. a calcified deposit that forms on the surface of a tooth that is covered with dental *plaque as a result of poor oral hygiene. Supragingival calculus forms above the *gingivae (gums), principally in relation to the openings of the salivary gland ducts. Subgingival calculus forms beneath the crest of the gingivae. Calculus hinders the cleaning of teeth and its presence contributes to *gingivitis and *periodontal disease. A link has been demonstrated between increased calculus levels and infective *endocarditis.... calculus

n. a surgical instrument used for crushing a stone in the bladder. See litholapaxy.... lithotrite

n. 1. the process of breaking calculi (stones) into smaller fragments by the application of shock waves. This will enable the stones to pass naturally or be removed more easily. In extracorporeal shock-wave lithotripsy (ESWL), used for breaking calculi in the upper urinary tract, the shock waves are generated and transmitted by an external power source. The specialized machine (a lithotripter) consists of a sophisticated radiological system to localize the stone accurately by biplanar X-ray and a shock head or transducer to produce and focus the energy source. The prototype machines required the patient to be anaesthetized and immersed in a water bath for treatment, but modern machines require neither water bath nor general anaesthesia. In electrohydraulic lithotripsy (EHL), used for breaking urinary calculi, an electrically generated shock wave is transmitted to the stone by a contact probe delivered via a *nephroscope or *ureteroscope. Laser lithotripsy has also been available since the 1980s. 2. see litholapaxy.... lithotripsy