STONES IN THE BLADDER AND TX THE URETHRA What was said in regard to the influence of endemic conclitions upon the appearance of stones in the kidney in infancy, is also true in regard to concretions in the bladder and in the urethra. There exists along the lower part of the Danube an area of stone formation. Bokay has been able to collect in this region alone the records of more than 1621 cases of vesical calculi. In Russia, France, and England, too, the formation of concretions in the bladder appears to be much more fre quent than in Germany, where the affection is rare. Bokay's statistics show that the majority- of cases occur between the second and the seventh year. The youngest child in whom Bokay observed stone formation was in its second month. Only- four per cent. were girls. We learn from the tables of Englisch in regard to stones incarcerated in the urethra that more than one third occurred in children, and that most of the cases were observed in the second, and between the eleventh and fifteenth year.
Etiology.—Bokay regards interference with the urinary discharge as a factor disposing to the formation of calculi in the bladder; hence the predisposition caused by phimosis and the relative frequency of the condition in boys. The immediate cause of the stone formation may be either a concretion descending from the kidney, or a foreign body introduced for the purpose of masturbation. If there results an inflam matory reaction of the vesical mucous membrane and with it decompo sition of the urine, the result will be the formation of a calculus by the precipitation of insoluble phosphates.
Englisch explains the great frequency' of urethral calculi in the second year by the congenital narrowness of the urethra. In the eleventh
and fifteenth years by the abundance of blood vessels and the swelling which is associated with it. Uric acid and its salts, phosphates and oxalates, take part in the composition of calculi.
symptoms are, at first, increased micturition, radiating pains in the glands and vesical tenesmus. Incontinence of the urine may be also an early symptom. Gradually there are added the symptoms of vesical catarrh with admixture of blood in the urine. The more severe the pains and the cystitis, the greater the systemic clisturbance. Among the serious complications are to be mentioned deep ulcerations of the vesical membrane, with consecutive pericystitis or pelvic abscess. Prolapse of the rectum is frequently seen.
The diagnosis is made from the above symptoms, the most impor tant of which is the variable difficulties in urination. At one time there will be no trouble and at another urination is painful and difficult. A correct diagnosis can only be made after a rectal examination, explora tion with a sound and a cystoscopic examination.
The prognosis is influenced by the extension of the inflammation due to the presence of the stones in the urinary tract, and by the amount of systemic disturbance.
Treatment is surgical. Excellent results have been obtained both by lithotripsy and by suprapubic eystotomy. After the removal of the stone the inflammation of the urinary tract must be treated according to the usual methods.