Vaidyanathan Subramanian, Soni Bakul M, Watson Ian D, Singh Gurpreet, Hughes Peter L, Mansour Paul
Regional Spinal Injuries Centre, District General Hospital, Southport, PR8 6PN, UK.
Cases J. 2008 Nov 17;1(1):318. doi: 10.1186/1757-1626-1-318.
We present a male tetraplegic patient, who developed stones in neuropathic bladder six times within a span of three years. Unusual features of this case are: (1) This patient started developing stones in urinary bladder thirteen years after sustaining spinal cord injury. (2) He was performing intermittent catheterisation and did not have an indwelling catheter. (3) The presenting symptom of vesical lithiasis was abdominal spasms and not urine infection. (4) The major component of the stones was calcium phosphate; magnesium ammonium phosphate was completely absent in the calculus on four occasions. (5) Proteus species were not grown from urine at any time. (6) This patient failed to acidify urine below a pH of 5.3 after taking simultaneously furosemide (40 mg) and fludrocortrisone (1 mg), which suggested incomplete renal tubular acidosis type 1.We learn from this case that biochemical analysis of stones removed from urinary bladder may be useful. If the major component of vesical calculus is calcium phosphate, complete or incomplete renal tubular acidosis type 1 should be excluded, as it may be possible to reduce the risk of recurrence of calcium phosphate stones by oral potassium citrate therapy or, vegetable and fruit rich diet.
我们报告一名男性四肢瘫痪患者，他在三年时间内六次在神经源性膀胱中形成结石。该病例的不寻常特征包括：（1）该患者在脊髓损伤十三年后开始在膀胱中形成结石。（2）他进行间歇性导尿，没有留置导尿管。（3）膀胱结石的主要症状是腹部痉挛，而非尿液感染。（4）结石的主要成分是磷酸钙；四次结石中完全没有磷酸镁铵。（5）任何时候尿液中都未培养出变形杆菌属。（6）该患者在同时服用呋塞米（40毫克）和氟氢可的松（1毫克）后，未能将尿液酸化至pH值低于5.3，这提示存在不完全性1型肾小管酸中毒。我们从该病例中了解到，对从膀胱取出的结石进行生化分析可能会有所帮助。如果膀胱结石的主要成分是磷酸钙，应排除完全性或不完全性1型肾小管酸中毒，因为通过口服柠檬酸钾疗法或富含蔬菜和水果的饮食，有可能降低磷酸钙结石复发的风险。
