Bladder calculi

Surgical intervention should be reserved for patients with severe lower urinary tract symptoms of benign prostatic hyperplasia or those with complications of disease (such as recurrent urinary tract infections, renal failure, and bladder calculi). 

Parsley piert is stated to possess diuretic and demulcent properties, and to dissolve urinary deposits. Traditionally, it has been used for kidney and bladder calculi, dysuria, strangury, edema of renal and hepatic origin, and specifically for renal calculus. 

Oral mucositis Choline deficiency Amyotrophic lateral sclerosis Renal and bladder calculi... 

No other tumors were observed. High doses of melamine cause bladder calculi. It is these calculi, through chronic bladder irritation, that result in the neoplasia. The compound is not a mutagen in a large variety of mutagenicity tests (23). 

Therefore, melamine appears to exert its effect via precipitation and chronic mechanical irritation. Since chronic irritation is a known promoting function, this is a likely hypothesis of the mechanism of toxicity. This hypothesis is further supported by the absence of carcinogenicity in doses below the dose which results in bladder calculi. The conclusions reached from this mechanism indicate that a threshold exists at the dose resulting in calculi and safe limits on exposure for melamine should be based upon the acceptable daily intake even though the compound by some definitions is a carcinogen. 

Figure 11. X-rays of female Scottish terrier (4 years) with clinical evidence of brushite bladder calculi. Treatment consisted of the incorporation of 0.5% Nag-NTA wt/wt, in the diet for a period of two weeks.

Approximately 10% of the human population (with regional differences indicating both genetic and environmental factors [33]) is affected by the formation of stones or calculi in the urinary tract. Urolithiasis is not only a painful condition, but also causes annual costs to the health system in the order of billions of dollars in the USA alone [34, 35]. Based on their composition, structure and location in the urinary tract, renal stones have been classified into 11 groups and their formation mechanisms have been discussed together with alterations in urinary parameters and metabolic risk factors for renal lithiasis [35]. Approximately 70% of these stones contain calcium oxalate monohydrate (COM) and dihydrate as major components, while other calculi are composed of ammonium magnesium phosphate (struvite), calcium phosphates (hydroxyapatite and brushite), uric acid and urates, cystine and xanthine. An accurate knowledge of the solubilities of these substances is necessary to understand the cause of renal or bladder calculi formation and find ways towards its prevention and treatment [36]. 

Melamine (2,4,6-triamino-l,3,5-triazine) is a relatively non-toxic compound with acute toxicity observed in rodents, with oral lethal doses (LD50) of 3100 mg kg and 3900 mg kg in male rats and male mice, respectively." In another study, a 125 mg kg oral dose of melamine showed only diuretic effects in dogs." Toxicity studies of cyanuric acid derivatives (e.g. sodium cyanurate) at 700 mg kg and 2200 mg kg doses in rats and mice, respectively, resulted in bladder calculi and bladder epithelial hyperplasia, with no other adverse effects." In other studies, it was observed that dietary monosodium cyanurate administered in dogs for 6 months at 0.8% concentration produced no adverse effects, although at 8% for a longer period of 16 to 24 months it produced kidney fibrosis and fical dilation. This was attributed to the low solubility of sodium cyanurate, due to which it precipitated at higher concentrations in urine, leading to renal dysfunction." ... 

Cystine was isolated from bladder calculi by Wolaston in 1810 and from horns by Moerner in 1899. Its content is high in keratins (9%). Cystine is very important since the peptide chains of many proteins are connected by two cysteine residues, i. e. by disulfide bonds. A certain conformation may be fixed within a single peptide chain by disulfide bonds. Most proteins contain 1-2% cystine. Although it is itself nonessential, cystine can partly replace methionine which is an essential amino acid. 

Indications for surgical intervention usually include azotemia, recurring hematuria, bladder calculi, recurrent large amounts of residual urine, recurrent infections, and incontinence. 

Two cases of bladder calculus have been reported in pregnant women who had vaginally administered pieces of slippery elm bark in an attempt to induce abortion. In both cases, the bark pieces had passed into the bladder and remained to form a stone while the pregnancy continued... 

Renal function is depressed by opioids. It is believed that in humans this is chiefly due to decreased renal plasma flow. In addition, opioids have been found to have an antidiuretic effect in humans. Mechanisms may involve both the CNS and peripheral sites. Opioids also enhance renal tubular sodium reabsorption. The role of opioid-induced changes in antidiuretic hormone (ADH) release is controversial. Ureteral and bladder tone are increased by therapeutic doses of the opioid analgesics. Increased sphincter tone may precipitate urinary retention, especially in postoperative patients. Occasionally, ureteral colic caused by a renal calculus is made worse by opioid-induced increase in ureteral tone. 

LUDUS LAPIS — A Stone Removed from the Bladder, a Remedy for all Species of Calculus. 

TARTARUS — is Calculus of Wine, called Wine-stone by similitude, the stone, or deposit, which cleaves to the sides of vessels. Paracelsus uses it for stone in the bladder or kidneys, or the albuminous deposit in the other members which causes gout. 

Acetazolamide may precipitate renal calculi formation in predisposed individnals. Therefore patients with bacterinria, previons bladder snrgery, or a history suggestive of previous calculus formation should not... 

Fig. 36.16 Giant gall-bladder staghorn calculus, dislocated into the right liver lobe and embedded in the parenchyma. (Probably the largest gallstone reported to date 12 x 5 cm, 120 g dry weight)...

In the urine, alkaline phosphates ai d magnesium salts are always present> and consequently when, by decomposition of urea, ilie urine comes alkaline, the conditions for the formation of this compound are fulfilled and being practically insoluble, especially in the presence of excess of phosphates and of ammonia, it is deposited in dystals, usually tabular, sometimes feathery and stellate in form. Wlien it is formed in the bladder, in tlie presence of some LkxIv to serve as a nucleus, the crystallization takes place upon the nucleus and a fusible calculus is produced. 

Fig. 1.82a,b. Calculus in the distal ureter. Longitudinal US scan through the right kidney shows a dilated collecting system produced by a calculus (arrow) in the right distal ureter (U). B, bladder... 

An Inquiry into the Nature and Treatment of Gravel, Calculus and other Diseases connected with a Deranged Operation of the Urinary Organs, London, 1821 (227 pp. and coloured illustration pref. dated 12 December 1820) 2 ed. 1825 (3 8 pp.), 3 ed.. On the Nature and Treatment of Stomach and Urinary Diseases Being an Inquiry into-the Connexion of Diabetes, Calculus, and other Affections of the Kidney and Bladder, with Indigestion, 1840 (483 pp.) 4 ed.. On the Nature and Treatment of Stomach and Renal Diseases, 1843 (593 pp.) s ed., 1848 (505 pp.) American ed. (from 2 ed., enlarged), Philadelphia, 1826. 

A tentative diagnosis of a right renal uric acid calculus was made. The patient was placed on intravenous fluids and parenteral analgesics. A CAT scan was performed, which showed a translucent calculus present in the lower right ureter close to its insertion into the urinary bladder. A serum uric acid was completed and was reported as above normal. His urine was continually monitored to note total output as well as to attempt to obtain the stone should it be passed. 

New data in this respect have become available (20, 21 -). Of the 3 patients reported upon, 2 developed calcium-phosphate stones and 1 a staghorn calculus composed of magnesium-ammonium-phosphate (the latter being the first of this composition reported). Two of the 3 patients had bladder anomalies, the third was hypercalciuric. 

---