Surgical problems in urinary lithiasis

ABSTRACT

A rapid survey of the 253 cases of urinary lithiasis shows 57 cases with obstruction below the stone. This gives an incidence of 22.3. Since practically all of these 253 cases had infected urine, the absence of close relation between the incidence of urinary infection and urinary obstruction would seem to preclude any possibility of cause-and-effect relations between the two factors. However, the high incidence of urinary infection in the cases of lithiasis discussed above cannot be of etiologic significance, as far as infection is concerned, unless it be proven in every instance of lithiasis that there had been an antecedent urinary infectionNothing of the sort was found in my cases. One is tempted to conclude, therefore, that neither infection nor obstruction had much significance in the production of stones in these patients, although, once the stone had formed, infection and obstruction might possibly accelerate the growth of the stone, even to the extent of perpetuating the lithiasic stateSuch a superficial analysis as this of a small series cannot very well advance, except by elimination, the studies on the etiology of stone. It can only be hoped that, when a thousand of more cases are studied and more histological sections of the urinary tract are made, some more light may be shed on the problem. For when one says that the majority of the stones in this series are "primary" stones, the use of the adjective "primary" wound only reveal an ignorance of elusive etiologic factors.(Summary and Comments)