1. КАМНИ МОЧЕВОГО ПУЗЫРЯ Подготовка слайдов: Доцент клиники урологии УО «ВГМУ» Жебентяев А.А. 2006

2. 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;

3.  Симптомы  Поллакиурия и императивность;  Дизурия;  Пиурия;  Терминальная гематурия;  Симптомы обструкции;  Боль в надлобковой области. Камни мочевого пузыря

4.  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);

6. DIVERTICULA OF THE BLADDER Acquired Diverticula (a) Pulsion Diverticula Causes: Herniation of mucous membrane of the bladder through the weakened trabeculated muscle coat obstruction, e.g. BNO, BPH & urethral stricture.

7. 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

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

9. DIVERTICULA OF THE BLADDER Acquired 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 cases micturation occurs twice, the 1 st specimen is clear & the 2 nd is cloudy.

10. DIVERTICULA OF THE BLADDER Acquired 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.

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

12. Acquired Diverticula (c) False Diverticulum Aetiology: 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