VESIKOLITHIA

SIS
ANATOMI
DEFINITION
Bladder stones are a common form of urolithiasis of the lower urinary
tract with formation of calculi in the bladder.
 EPIDEMIOLOGI
Kasus batu kandung kemih pada orang dewasa sekitar 5% dan terutama
diderita oleh pria, sedangkan pada anak-anak insidensinya sekitar 2-3%

masih banyaknya kasus batu endemik yang disebabkan diet rendah

protein, tinggi karbohidrat dan dehidrasi kronik
ETHIOLOGY
Idiopathic
Voiding dysfunction
Urethral stricture
Fimosis
Benign prostate hyperplasia
Bladder neck contracture
Neurogenci bladder

Endocrine Disease
hyperparathyreoidism;
hyperthyroidism;
hypopituitaric diseases;
Foreign body
Foley catheters
RISK FACTOR
Family history
endogenous Gender
Metabolism disorder

Climate
Diet
Foreign bodies
exogenous

Occupation
Drugs
Micturition disorder
Urinary tract infection
Theories of Stone Formation
A. Nucleation Theory
B. Stone Matrix Theory
C. Inhibitor of Crystallization Theory
Patogenasa
Calsium
Stone-Formation
 PATOGENESIS
Infected
Urinary
NH4+ Stone-Formation
CaP and MAP
supersaturation
Urinary
pH
Urinary
tract
infection Nucleation
with a Urinary Abnormal Infection
and crystalluria
urea- mucoprotein stone
agglomeration
splitting
organism
Urinary
citrate
Inhibitory
activity
Urinary
phosphate
 PATOGENESIS
Age Uric Acid
Sex (M > F) Stone-Formation
Genetic disorders
Metabolic disorders
Dietary purine Urinary
uric acid

Renal NH3 Urinary Uric acid Abnormal Uric acid

production pH supersaturation stone
crystalluria
Dietary acid

Urinary
volume
Fluid intake
Fluid loss
Ambient
temperature
 PATOGENESIS Cystine
Stone-Formation
Tubular
reabsorption
of cystine

Urinary Cystine Abnormal Cystine

cystine supersaturation crystalluria stone

Possible
metabolic
factors
Most vesical calculi are formed de novo within the bladder, but some initially
may have formed within the kidneys as a dissociated Randall plaque or on a
sloughed papilla and subsequently may have passed into the bladder, where
additional deposition of crystals cause the stone to grow.
In older men with bladder stones composed of uric acid, the stone most likely
formed in the bladder. Stones composed of calcium oxalate are usually
initially formed in the kidney.
In adults, the most common type of vesical stone (seen in more than 50% of
cases) is composed of uric acid. Less frequently, bladder calculi are composed
of calcium oxalate, calcium phosphate, ammonium urate, cysteine, or
magnesium ammonium phosphate (when associated with infection
In patients with spinal cord injuries (SCIs), bladder stones are often composed
of struvite or calcium phosphate.
SIGN AND SYMPTOMS
Irritative voiding symptoms
Intermittent urinary stream
Urinary tract infections
Hematuria
Pelvic pain
Stone moves with changing body position
 PEMERIKSAAN
PENUNJANG
LAB DARAH LAB URIN BNO polos BNO IVP
Hb rendah +/- BJ meningkat Mengidentifikasi Mengidentifikasi
Leukositosis +/- Ph asam/ basa masa dengan masa dengan
Shift to the left Nitrit + densitas radio- densitas radio-
Leukosit +/- opak pada vesika lusen pada vesika
urinaria urinaria dengan
esterase,+/-
gambaran berupa
Darah +/- filling defect
USG SISTOSKOPI CT scan
gambaran objek memvisualisasikan dilakukan karena alasan
hiperekoik yang batu, menilai ukuran lain (misalnya, nyeri
berbayang pada serta posisi batu perut, massa panggul,
bagian posterior atau dicurigai abses)
tetapi mungkin juga
dapat menunjukkan
vesikolitiasis bila
dilakukan tanpa kontras.
 Cystography
Abdominal Radiograph
CT - Scan
USG

Cystoscopy
DIAGNOSA BANDING
HEMATURIA NYERI KOLIK

ISK

Sistitis
Kolik sal
cerna
KEGANASAN
Kolik empedu
TREATMENT Diet (drink lot of water)
Conservati
ve Simptomatic
Pharmacologic stone
<5mm
dissolution

Lithotripsy
ESWL
<20mm

Transurethral
Cystolitholapaxy
Open Precutaneus Suprapubic
Surgery
Cystolitholapaxy
Suprapubic Cystostomy
KOMPLIKASI

ISK

Sindroma Gagal
uremia ginjal
 PENCEGAHAN
Mencegah dan meminimalisir faktor eksternal pembentukan batu.

OBAT-
OBATAN

ATASI
DIET
PENYEBAB
TERIMA KASIH