The diagnosis of foreign bodies in the bladder is made by palpation and inspection. Many foreign bodies may be felt by the finger in the vagina; obstacles include a small foreign body or thickened bladder wall. The base of the bladder should always be palpated. A sound introduced per urethram will hit a stone with a metallic click, though stones covered in mucus might not produce this sound. Phosphatic deposits on an ulcerated area give a grating feeling to the sound similar to that of a round calculus. Drumming of the bladder wall on the end of the catheter must not be mistaken for the metallic click; it is physiological and can occur in healthy bladders during catheterization without symptoms. The exact diagnosis of stone is made by cystoscope, with the foreign body dropping to the most dependent part unless adherent to the bladder wall. Electric cystoscope with water-distended bladder is well adapted for inspection of small calculi.
CYSTITIS: Inflammation of the bladder is more frequent in adult women during menstrual periods, pregnancy, and menopause. Acute or chronic forms are classified according to clinical manifestations. Symptoms include frequency of passing urine accompanied by pain, especially near the neck of the bladder. The urine in cystitis is cloudy with pus and large pavement epithelial cells; blood may also be present.
<Callout type="important" title="Critical for Diagnosis">Palpation of the base of the bladder can reveal areas of tenderness or thickening indicative of inflammation.</Callout>
The diagnosis rests on urine examination and physical examination. Palpation by bimanual touch elicits tender areas, especially at the base of the bladder.
Key Takeaways
- Foreign body diagnosis in the bladder involves palpation and inspection.
- Cystitis symptoms include frequent painful urination, especially near the neck of the bladder.
- Urine examination is crucial for diagnosing cystitis.
Practical Tips
- Always check the base of the bladder during palpation for signs of inflammation or tenderness.
- Use a catheter to differentiate between physiological drumming and foreign body clicks in the bladder.
Warnings & Risks
- Do not mistake physiological drumming on the end of the catheter for the metallic click of a stone.
- Ensure proper diagnosis by using cystoscopy to confirm the presence of stones or foreign bodies.
Modern Application
While this chapter provides detailed diagnostic techniques from 1910, many modern tools and imaging technologies have advanced bladder disease detection. However, understanding these historical methods is still valuable for recognizing symptoms and ensuring accurate diagnosis in resource-limited settings.
Frequently Asked Questions
Q: What are the common causes of cystitis?
Cystitis can be caused by bacteria such as bacillus coli communis, gonococcus, streptococcus pyogenes, typhoid bacillus, and staphylococcus aureus. Local causes include injuries to the bladder wall or mucous membrane, while general causes may involve lowered vitality due to chronic diseases.
Q: How is tuberculous cystitis diagnosed?
Tuberculous cystitis can be confirmed by finding tubercle bacilli in urine sediment. Inoculation of urinary sediment into a guinea pig and examining enlarged inguinal glands for characteristic lesions also aids diagnosis.
Q: What are the symptoms of vesicular cystitis?
Vesicular cystitis is characterized by minute vesicles on congested bladder mucosa, which may be arranged in bead-like strings. Larger vesicles or bullae can also occur but should not be confused with tubercles due to their shiny, translucent appearance.