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832 UEINE.
Urinary Calculi.
Besides certain pathological constituents of the urine, all those urinary-
constituents which occur as sediments take part in the formation of
urinary calculi. Ebstein 1
considers the essential difference between an
amorphous and crystalline sediment in the urine on the one side and urinary
sand or large calculi on the other to be the occurrence of an organic
frame in the latter. As the sediments which appear in normal acid urine
and in a urine alkaline through fermentation are diverse, so also are the
urinary calculi which appear under corresponding conditions.
.If the formation of the calculus and its further development take place
in an un decomposed urine, it is called a primary formation. If, on the
contrary, the urine has undergone alkaline fermentation and the ammonia
formed thereby has given rise to a calculus formation by precipitating
ammonium urate, triple phosphate, and earthy phosphates, then it is
called a secondary formation. Such a formation takes place, for
instance, when a foreign body in the bladder produces catarrh accom-
panied by alkaline fermentation.
We discriminate between the nucleus or nuclei—if such can be seen
—
and the different layers of the calculus. The nucleus may be essentially
different in ’different cases, for quite frequently it consists of a foreign
body introduced in the bladder. The calculus may have more than
one nucleus. In a tabulation made by Ultzmann of 545 cases of vesic-
ular calculi, the nucleus in 80.9 per cent of the cases consisted of uric
acid (and urates); in 5.6 per cent, of calcium oxalate; in 8.6 per cent,
of earthy phosphates; in 1.4 per cent, of cystein; and in 3.5 per cent,
of some foreign body.
During the growth of a calculus it often happens that, for some reason
or other, the original calculus-forming substance is covered with another
layer of a different substance. A new layer of the original substance may
deposit on the outside of this, and this process may be repeated. In
this way a calculus consisting originally of a simple stone may be con-
verted into a so-called compound stcne with several layers of different
substances. Such calculi are always formed when a primary is changed
into a secondary formation. By the continued action of an alkaline
urine containing pus, the primary constituents of a primary calculus
may be partly dissolved and be replaced by phosphates. Metamor-
phosed urinary calculi are formed in this way.
Die Natur unci Behandlung der Harnsteine. Wiesbaden, 1884.
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