Vesical Lithiasis Concomitant with Benign Enlargement of the Prostate

Abstract

It is a commonly accepted fact that urinary stasis is a requisite to the formation of bladder stones. Therefore, one would expect to find stones frequently associated with obstructive lesions at the bladder neck.

In a review of one hundred cases of vesical lithiasis seen at the Cleveland Clinic, 40 per cent were found to have been associated with benign enlargement of the prostate. This is one reason why vesical calculus occurs almost exclusively in men in this country. Only two cases of vesical calculus occurred in women in this group. Other common causes in men were primary urethral stricture, stricture of the bladder neck following prostatectomy, and diverticulum of the bladder.

Stasis of urine alone is not always enough to bring about the formation of calculi. Infection, changes in the level of the pH of the urine, and the presence of a nucleus markedly influence their formation. Infection greatly increases the rapidity of formation. Urine mixed with inflammatory exudates has, by no means, the same physical characteristics as normal urine. Clumps of bacteria, blood clots, and inflammatory exudates often form the nucleus of a stone. Sepsis produces a change in the surface tension of the urine, thus enhancing the tendency to form deposits.

Changes in the composition and pH of the urine have an important bearing on the type of calculus formed. An acid urine predisposes to the formation of calculi composed of urates and oxalates. However, a change in the bacterial flora of the urine may so alter. . .