Urinary calculus

“ While, therefore, a calculus is only as urine precipitated and solidified, and this fluid only as calculous matter suspended in a menstruum, it must appear that the lithic diathesis is as natural and universal as structural disintegration is constant and general in operation. As every individual, therefore, may be said to void day by day a dissolved calculus, it must follow that its form of precipitation within some part of the urinary apparatus alone constitutes the disease, since in this form it cannot be passed. ”

“ Once a minute calculus has been formed, its subsequent growth is highly probable, owing to the deposition on it of the urinary constituent forming it. Calculi formed in the pelvis of the kidney may be single and may reach a very large size, forming, indeed, an actual cast of the interior of the expanded kidney. ”

“ As a rule, treatment is confined to internal medication whilst the animals are fattened.
URINARY LITHIASIS. CALCULUS FORMATION. Normally the urine contains in solution certain salts, such as urates, hippurates and phosphates of lime, magnesia or ammonia. Under certain circumstances, in animals predisposed to the condition, these salts are precipitated in the kidneys, ureters or bladder, and form powdery or sandy deposits known as sediments; or, on the other hand, calculi, produced by the adhesion of the powdery masses. This constitutes urinary lithiasis. ”

“ When urine contains a larger amount of chemical constituents than it can conveniently hold in solution, a certain quantity crystallizes out, and may be deposited in the kidney or in the bladder. If the crystals run together in the kidney the resulting concretion may either remain in that organ or may find its way into the bladder, where it may remain to form the nucleus of a larger vesical calculus, or, especially in the case of females, it may, while still small, escape from the bladder during micturition. ”

“ This alkaline urine deposits its phosphates, which light upon the calculus and encrust it with a mortary shell, which may go on increasing in size until it may even fill the bladder. Sometimes the nucleus of a calculus is a chip of bone or a blood-clot, or some foreign substance which has been introduced into the bladder. Sooner or later the urine becomes alkaline and the calculus is encrusted with lime salts. ”

“ In children, in whom there is a rapid disintegration of nitrogenized tissues, a uric acid calculus in escaping from the bladder may block the urethra and give rise to sudden retention of urine. On introducing a metal “sound,” the surgeon may strike the stone, and if it happens to be near the bladder he may push it back and subsequently remove it by crushing. But if it has made its way some distance along the urethra, so that he can feel it from the outside, he should remove it by a clean incision. ”

“ On another occasion, it seemed to me strange that we should be obliged to open the bladder of patients suffering from the stone, or to subject them to lithotrity, which has also its perils. Nature, I said to myself, forms calculi by uniting organic elements, by crystallizing them, and by cementing them with vesical mucus. But would it not be possible to cure the disease by employing contrary means—dissolving the calculi in the bladder by means of continued injections, changing the chemical agents according to the composition of the calculus, and adding thereto the action of a galvanic current? ”

“ The enlargement of this lobe produces an effect which is not generally known, and leads medical practitioners into an error respecting the nature of the complaint. The orifice of the urinary bladder, which is the lowest part in the natural state, is raised up in proportion to the increase of this lobe; so that none of the contents below that level can be expelled, although whatever is above it is allowed with more or less difficulty to pass out. In this way the person never evacuates more than one half or one third of the urine contained in the bladder ”

“ In medicine, a hard concretion formed within the animal body by the deposition of matters which usually remain in solution. The concretions most commonly found are those formed in the kidneys or bladder, and termed urinary calculi, and those formed in the gall-bladder or biliary ducts, which are called biliary calculi. Urinary calculi are in most cases composed of substances which are constituents of healthy urine, such as uric acid, urate of ammonia, and the phosphates of lime and magnesia ”

“ In adults it is not so much a condition of incontinence in the sense of water being passed against the will, but is rather due to a difficulty in retaining the urine in consequence generally of an over-full bladder, the water which passes being the overflow from a too full reservoir. It is usually caused by an obstruction external to the bladder, e.g., enlarged prostate or stricture of the urethra. Occasionally the presence of a calculus may produce the condition. ”

“ In severe attacks nausea and vomiting are present and the patient is collapsed; sweating breaks out in his face and the pulse is feeble and weak. The pain lasts from an hour to several days, until the stone reaches the bladder, partial suppression of the urine during the attack occurs, but a large quantity of urine is usually passed after it and a feeling of soreness may, be present for several days. The stone may again cause pain in passing through the urethra, or it may remain in the bladder as a nucleus for a bladder calculus (stone) . ”

“ Normally a man passes about 1200 cc. of urine in twenty-four hours, a woman somewhat less. When the amount is under 750 cc. we have an oliguria. To consider a polyuria as present the patient should pass more than 3000 cc., as this amount may be considered the upper normal limit. In anuria we have a cessation of renal activity.
The disease in which anuria is most characteristic is cholera. During the stage of evacuation the urinary secretion becomes less and less along with the progressive failure of circulation and, during the algid stage, we have a suppression of urine. ”

“ To remedy this condition it is necessary to treat the cystitis with which the bacterial decomposition of the urine is associated. It may be that a calculus of acid urine, such as one of uric acid or oxalate of lime, has been resting in the bladder and keeping up incessant irritation, and that the micro-organisms of decomposition or suppuration have found their way to the mucous lining of the bladder from either the bowel, the urethra or the blood-stream; undergoing cultivation there they break up the urea into carbonate of ammonia and so render the urine alkaline. ”

“ Neither the kidneys, ureters, nor [218] bladder, were loaded or crusted with any calcarious matter; an effect most unjustly ascribed to soap and lime-water, since in the urinary passages, to which the air has no access, they cannot deposite their calcarious part [137] ; and since the white stuff observable in the urine of such patients, as take these medicines in large quantities, is only the usual sediment of the urine changed in its nature and colour, with, perhaps, some of the dissolved particles of the stone [138] . ”

“ This is a most interesting chapter, as containing the most ancient observations which we possess on the important subject of urinary calculi. The ancients never improved the theory, nor added much to the facts which are here stated by our author. We have given the summary of their opinions in the Commentary on Paulus Ægineta, B. III., 45. I would beg leave to remark that, notwithstanding the number of curious facts which modern chemistry has evolved regarding the composition of urinary calculi, the etiology of the disease is nearly as obscure now as it was in the days of Hippocrates. ”

“ In such cases the bladder often attains a very large size. At first the accumulation produces all the uneasy symptoms formerly mentioned, but after some time these subside, and the urine drains away according as it is secreted, without, however, the original accumulation and tumour being diminished. This state of the urinary system is very common in old people, who neglect natural calls to empty the viscus during the night, or while sitting socially after dinner. The uneasiness gradually goes off, and when they at length think of making water, none can be got to flow. ”

“ This collection takes place in the kidney, the ureters (the vessels that convey the urine to the bladder) , the bladder, and sometimes in the urethra. The stone so formed varies in its composition and size, and is one of the saddest ills that can befall human nature. Hence the importance of watching, and attending to every urinary disturbance, of which gravel forms a prominent feature, the treatment of which has been already stated; but which, as it involves more practised judgment than a non-professional invalid can be supposed to possess, had better be intrusted only to professional hands. ”

“ As a proof that it is as I say, persons affected with calculus have very limpid urine, because the thickest and foulest part remains and is concreted. [408] Thus it generally is in cases of calculus. It forms also in children from milk, when it is not wholesome, but very hot and bilious, for it heats the bowels and bladder, so that the urine being also heated undergoes the same change. And I hold that it is better to give children only the most diluted wine, for such will least burn up and dry the veins. ”

“ A calculus had descended into the ureter and had become incarcerated in it. Repeated doses of Nux relieved the incarceration, and I distinctly felt that the calculus was descending towards the bladder. After twenty-four hours of horrible suffering the vomiting ceased, the pain became duller and was felt in the region where the ureter dips into and becomes interwoven with the tissue of the bladder: it continued for three days and then disappeared all of a sudden (the stone had not got into the bladder) . Thirty-six hours afterwards the calculus entered the bulb of the urethra. ”

“ The urinary apparatus (consisting of the kidneys, ureters, bladder, and urethra) is known to be the principal emunctory for eliminating and voiding the detritus formed by the continual decay of the parts comprising the animal economy. The urine is this detritus in a state of solution. The components of urine are chemically similar to those of calculi, and as the components of the one vary according to the disintegration occurring at the time in the vital alembic, so do those of the other. ”

“ Where the inconvenience thus detailed is present, the quantity of fluids must by degrees be diminished, the general state of health must be studied. Dieting and warm-bathing are two sheet-anchors, if properly applied. All remedies tending to afford strength to the urinary system must be had recourse to; and where the bladder loses any of its retentive power, I entertain the greatest benefit from an injection.
The next form of urinary disturbance of a proximate nature to the one just described, is also where the urine is discharged in large quantities ”

“ An abundant flow of urine might perhaps carry off more rapidly such individuals as have found their way into the urinary passages, and, considering the character of the deposit described above as causing stoppage of the ureter, treatment directed against the uric-acid diathesis might diminish the risk of this particular form of trouble. ”

“ Renal Calculus.—The urine is usually somewhat concentrated, with high color and strongly acid reaction. Small amounts of albumin and a few casts may be present as a result of kidney irritation. Blood is frequently present, especially in the daytime and after severe exercise. Crystals of the substance composing the calculus—uric [p. 136] acid, calcium oxalate, cystin—may often be found. The presence of a calculus generally produces pyelitis, and variable amounts of pus then appear, the urine remaining acid in reaction. ”

“ The amount of local disturbance produced in the pelvis of the kidney by the presence of a foreign body seems to depend somewhat upon the character of its surface. Rough and uneven calculi, such as oxalate of lime, are apt to produce inflammation much more rapidly than smooth and polished ones, but it is seldom that any calculus remains without some pyelitis. At first only a loss of polish of the mucous membrane, with a little increase of mucus, may be observed, to which succeed roughening and suppuration with occasional fibrinous deposit. ”

“ Fortunately this substance is rarely found in the urine. When present however it indicates liability to, or the actual presence of, a calculus or stone in the bladder. In division C is a representation of the deposits seen in the urine of those who are greatly debilitated. In division D are seen epithelial cells mixed with mucus.
Fig. 8.
In Fig. 8, division A, are represented the caudated cells from the deep structure of the bladder. The cells represented in division B are amyloid concretions, found where there is an enlarged prostate gland. ”

“ The bladder is very sensitive when overdistended, inflamed or pendent on the abdominal floor, or when the seat of calculus. In the absence of any liquid contents a calculus is felt as a hard solid mass firmly clasped by the contracted vesical walls. If liquid is present the solid hard calculus is felt movable in the fluid. ”

“ Diseases of the kidneys are generally very slow in their inception, coming on gradually and manifesting no special symptoms of their presence until they have assumed a formidable character. For this reason they are the more dangerous. Simple derangement of the urinary secretion is no evidence of disease of these organs, as changes in the color, quantity and specific gravity of the urine are often produced by changes of temperature, active or sedentary habits, mental emotion, and sometimes by articles of diet, or drink, as well as by the use of different drugs. ”