VESIKOLITIASIS

Mayang Ameilia Putri

1610211009
  Bladder (vesical) calculi are stones or calcified materials that are
present in the bladder (or in a bladder substitute that functions as a
urinary reservoir).

DEFINISI
  Bladder outlet obstruction remains the most common cause of
bladder calculi in adults. Prostatic enlargement, elevation of the
bladder neck, and high postvoid residual urine volume cause
stasis, which leads to crystal nucleation and accretion. This
ultimately results in overt calculi. In addition, patients who have
static urine and develop urinary tract infections are more likely to
form bladder calculi.
 In a study of patients with spinal cord injuries (SCIs) who were
ETIOLOGI monitored for more than 8 years, 36% developed bladder calculi.
 Bartel and colleagues found that indwelling catheters were
associated with a higher risk of developing bladder stones and a
higher risk of recurrence of bladder stones than intermittent
catheterization or reflex micturition.
 Other etiologic factors for bladder stone formation include foreign
bodies in the bladder that act as a nidus for stone formation.
These may be iatrogenic or noniatrogenic in origin.
  Dewasa > anak-anak
 In the Western hemisphere, vesical calculi primarily affect men
who are usually older than 50 years and have associated bladder
EPIDEMILOGI outlet obstruction.
 The incidence of bladder calculi in less developed countries and
areas such as Thailand, Burma, Indonesia, the Middle East, and
North Africa remains relatively high.
  suprapubic pain
 dysuria
 intermittency
 hesitancy
 nocturia
GEJALA
 and urinary retention.
KLINIS  Parents of children with vesical calculi may notice priapism and
occasional enuresis
 Other common signs include terminal gross hematuria and
sudden termination of voiding with some degree of associated
pain referred to the tip of the penis, scrotum, perineum, back, or
hip
  On laboratory studies, less specific signs of vesical calculi include
the following:
 Microscopic or gross hematuria
 Pyuria
 Bacteriuria
 Crystalluria
 Urine cultures positive for urea-splitting organisms
DIAGNOSIS
 Abdominopelvic planar radiography is commonly used to identify
radiopaque bladder stones.
 Cystoscopy, noncontrast computed tomography (CT), and
ultrasonography are other diagnostic methods commonly used to
confirm the presence of bladder calculi
  Urinalysis is usually inexpensive and rapid and provides useful
information in this setting
 bladder calculi can be associated with test results positive for
nitrite, leukocyte esterase, and blood.
 Adults with uric acid bladder calculi are expected to have an acidic
DIAGNOSIS pH.
(URYNALISIS)  Because bladder calculi usually cause dysuria and pain, patients
may reduce daily fluid intake, which raises urine specific gravity
 In patients with outlet obstruction and infection, the white blood
cell (WBC) count may be elevated, with a left shift.
 The creatinine level may be elevated in outlet obstruction.
  The initial imaging study of choice is
plain radiography of the kidneys,
ureters, and bladder (KUB), which is
the least expensive and easiest
radiologic test to obtain.
 Alone or as the first film of
intravenous pyelography (IVP), KUB
detects radiopaque stones.
DIAGNOSIS  Pure uric acid and ammonium urate
(RADIOGRAPHY) stones are radiolucent but may be
coated with a layer of opaque calcium
sediment.
 If the clinical suspicion remains high
and the initial KUB reveals no stones,
the next step is bladder
ultrasonography, which may be able
to differentiate a calculus from tumor
or clot
  Sonograms typically show a classic hyperechoic object with posterior
shadowing, and they are effective in identifying both radiolucent and
radiopaque stones.

DIAGNOSIS
(ULTRASONOGRA
PHY)
  Cystoscopy remains the most commonly used test for confirming the
presence of bladder stones and planning treatment. This procedure
allows the examiner to visualize the stones and assess their number,
size, and position

DIAGNOSIS
(CYTOSCOPY)
PROGNOSIS??
  Terapi medikamentosa ditujukan untuk batu yang berukuran lebih
kecil yaitu dengan diameter kurang dari 5 mm, karena diharapkan
batu dapat keluar tanpa intervensi medis.
 Analgesik  meredakan nyeri dan mengusahakan agar batu
TATA dapat keluar sendiri secara spontan
LAKSANA  antibiotik  apabila terdapat infeksi saluran kemih atau pada
(Medikamentosa) pengangkatan batu untuk mencegah infeksi sekunder
 Setelah batu dikeluarkan, BSK dapat dianalisis untuk mengetahui
komposisi dan obat tertentu dapat diresepkan untuk mencegah
atau menghambat pembentukan batu berikutnya
TATA
LAKSANA
(Transurethral  In transurethral cystolitholapaxy, cystoscopy is performed to
visualize the stone, an energy source is used to fragment it, and
cystolitholapaxy) the fragments are then removed through the cystoscope.
 Unlike renal and most ureteral calculi, bladder calculi have not
been effectively treated with electrohydraulic shock-wave
lithotripsy (ESWL) in most centers
  Merupakan tindakan non-invasif dan tanpa pembiusan, pada
tindakan ini digunakan gelombang kejut eksternal yang dialirkan
melalui tubuh untuk memecah batu.

TATA  ESWL dapat mengurangi keharusan melakukan prosedur invasif

LAKSANA
ESWL (Extracorporeal
Shockwave
Lithotripsy)
  Bladder Outlet Obstruction
KOMPLIKASI  Infeksi Saluran Kemih