Bladder calculus develops in cases of urinary stasis, chronic infection or as a result of a foreign body. Patient history can provide data about possible causes of calculi formation contributing to stasis, for example, outlet obstruction due to prostate hyperplasia or malignancies in the prostate gland. Patients with neuronal damage e.g. in stroke or spinal cord injury, or diabetes mellitus are at risk of developing neurogenic calculi, hence inquiry about the latter is useful. Indwelling urethral catheterization, recurrent urinary tract infections can also be a cause of bladder calculi, for that reason, history of previous inpatient care, surgeries and previous infections should be obtained [1] [2]. Descending renal stones can also result in bladder calculi. In such cases a patient may have had previous renal colics or renal stones [3].

On examination, a palpable mass in the suprapubic region can be found.

Symptoms may range in intensity i.e. they can be completely absent or patient will complain of suprapubic pain, dysuria, frequency, urgency, hesitancy and a small stream. Additionally, symptoms of gross hematuria, nocturia, pollakiuria, dysuria, or abrupt cessation of voiding can be present [4] [5]. Small children may encounter episodes of priapism, as well as occasional enuresis [3].

• Recurrent Urinary Tract Infection

  We present a case of a lower urinary tract complication from this procedure presenting as recurrent urinary tract infections. [ncbi.nlm.nih.gov]

  Indwelling urethral catheterization, recurrent urinary tract infections can also be a cause of bladder calculi, for that reason, history of previous inpatient care, surgeries and previous infections should be obtained. [symptoma.com]

  The patient had a ten-year history of recurrent urinary tract infections. He was obtunded, dehydrated, tachycardic (120 bpm), dyspneic (42 rpm) and had abdominal tenderness and signs of peritonitis. [academic.oup.com]

  He had a history of recurrent urinary tract infections for the last 6-7 years for which he took medical treatment many times. There was history of passage of blood and pus flakes in urine on different occasions. [ispub.com]

  Urolithiasis is not uncommon in pediatric patients who have undergone a kidney transplant. [4] Factors associated with post-kidney transplant urolithiasis include retention of suture material, recurrent urinary tract infection, hypercalciuria, and urinary [emedicine.com]

• Abdominal Pain

  We present a 39-year-old man with repeated urinary tract infection and lower abdominal pain. Kidney-ureter-bladder (KUB) and IVU film showed a huge 450-g elliptical pelvic calculus that was surgically removed with excellent results. [ncbi.nlm.nih.gov]

  Signs and symptoms can vary from severe abdominal pain to blood in your urine. Sometimes, bladder stones don't cause any symptoms. Small bladder stones may pass without treatment, but some need medications or surgery. [mayoclinic.com]

  When to see your GP See your GP if you experience any of the above symptoms, particularly if you have persistent abdominal pain, need to pee more frequently, or have blood in your urine. [nhs.uk]

• Suprapubic Pain

  Symptoms may range in intensity i.e. they can be completely absent or patient will complain of suprapubic pain, dysuria, frequency, urgency, hesitancy and a small stream. [symptoma.com]

  pain, dysuria and disorientation. [academic.oup.com]

  The presentation of vesical calculi varies from completely asymptomatic to symptoms of suprapubic pain, dysuria, intermittency, frequency, hesitancy, nocturia, and urinary retention. [doi.org]

  While most stones are asymptomatic, symptomatic presentations may include microscopic hematuria, suprapubic pain, or interruption of urine stream. Stones may be seen on plain film if sufficiently calcified. [med-ed.virginia.edu]

  More commonly, however, patients report suprapubic pain, dysuria, intermittency, terminal gross hematuria, frequency, hesitancy, and nocturia. [arabmedmag.com]

• Hematuria

  A 43-year-old woman with a history of cerclage placement during her second pregnancy (10 years prior) presented with recurrent urinary tract infections and hematuria. [ncbi.nlm.nih.gov]

  […] patient Pathophysiology Most bladder stones form from a nidus inside the bladder, not in the kidney They may be single or multiple Most move freely in the bladder Clinical findings May be asymptomatic Pain, dysuria, frequency, hesitation, terminal gross hematuria [learningradiology.com]

  Additionally, symptoms of gross hematuria, nocturia, pollakiuria, dysuria, or abrupt cessation of voiding can be present. Small children may encounter episodes of priapism, as well as occasional enuresis. [symptoma.com]

  Abstract A 10kg, 5 year old dachshund bitch (case no 36181) was presented to the Universit y of Nairobi Small Animal Clinic (UON, SAC) with a history of hematuria. The patient was mildly dehydrated and dull. [erepository.uonbi.ac.ke]

  Bladder calculi may present with pain, infection, hematuria or may be asymptomatic. Plain radiograph Usually densely radiopaque, calculi may be single or multiple and are often large. [radiopaedia.org]

• Dysuria

  Symptoms may range in intensity i.e. they can be completely absent or patient will complain of suprapubic pain, dysuria, frequency, urgency, hesitancy and a small stream. [symptoma.com]

  A 62-year-old woman presented with dysuria and ulcer of the hypogastric wall. Urine drained through the ulcer. Both X-ray and computed tomography (CT) of the abdomen showed a giant bladder calculus with vesicocutaneous fistula. [ncbi.nlm.nih.gov]

  […] iatrogenically (Foley catheters) or placed there by patient Pathophysiology Most bladder stones form from a nidus inside the bladder, not in the kidney They may be single or multiple Most move freely in the bladder Clinical findings May be asymptomatic Pain, dysuria [learningradiology.com]

  Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil Search for other works by this author on: Alexandre Braga Libório Received: 15 November 2007 Accepted: 31 December 2007 Case A 23-year-old man was admitted with fever, suprapubic pain, dysuria [academic.oup.com]

  The presentation of vesical calculi varies from completely asymptomatic to symptoms of suprapubic pain, dysuria, intermittency, frequency, hesitancy, nocturia, and urinary retention. [doi.org]

• Urinary Retention

  Urinary retention due to bladder calculus formation is unusual in the pediatric population. [ncbi.nlm.nih.gov]

  retention, gross hematuria or recurrent infections Most stones are removed via cystoscopy including the use of lithotripsy to fragment the stones Larger stones may require suprapubic surgery Bladder Calculi. [learningradiology.com]

  Patients in urinary retention caused by a vesical calculus usually pass urine in supine position. [ispub.com]

  The presentation of vesical calculi varies from completely asymptomatic to symptoms of suprapubic pain, dysuria, intermittency, frequency, hesitancy, nocturia, and urinary retention. [doi.org]

  retention The majority of bladder stones cause no additional problems in addition to the underlying bladder disorder. [urology-textbook.com]

• Nocturia

  Additionally, symptoms of gross hematuria, nocturia, pollakiuria, dysuria, or abrupt cessation of voiding can be present. Small children may encounter episodes of priapism, as well as occasional enuresis. [symptoma.com]

  The presentation of vesical calculi varies from completely asymptomatic to symptoms of suprapubic pain, dysuria, intermittency, frequency, hesitancy, nocturia, and urinary retention. [doi.org]

  More commonly, however, patients report suprapubic pain, dysuria, intermittency, terminal gross hematuria, frequency, hesitancy, and nocturia. [arabmedmag.com]

• Urinary Incontinence

  We present the sonographic findings in a case of a bladder stone forming around nonabsorbable sutures after a Marshall-Marchetti-Krantz operation for stress urinary incontinence. [ncbi.nlm.nih.gov]

  It can be a useful way of treating a type of urinary incontinence known as urge incontinence. Research suggests that around 1 in 20 people who have bladder augmentation surgery will develop bladder stones. [nhsdirect.wales.nhs.uk]

In patients with a bladder calculus, urinalysis is essential to identify the presence of red blood cells (RBC), pyuria, levels of nitrite and urine pH, which is acidic e.g. in the case, of uric acid calculi. Microscopy may provide clues about stone composition that correlates with crystals found in the urine [6].

The first examination is usually an imaging study i.e. plain radiography of kidneys, ureters, and bladder (KUB) that helps identify radiopaque calculi. These stones may be coated with calcium crystals that contribute to their detection on x-ray. If no stones are detected, but clinical presentation suggests calculi, then an ultrasonography of the bladder is advised to reveal these mineral deposits [3].

Ultrasonography is a convenient method, for it is useful in identifying calculi that would have been missed on plain radiology. Ultrasonography exposes the stones as hyperechoic bodies with posterior shadowing and renders detection of both radiopaque and radiolucent stones [7] [8]. It is also useful in differentiating stones from tumors of the bladder, as stones reposition during movement. Tumors, on the other hand, are fixed to the tissues and appear non-motile. Although, these findings are insufficient for diagnosis or exclusion of a malignant tumor [3].

Intravenous pyelogram (IVP) or cystography may reveal disrupted flow of contrast due to calculi [3].

Cystoscopy is the diagnostic method of choice and is usually performed after imaging studies. Cystoscopy confirms bladder stones including their location, quantity, and size. Furthermore, it is useful for identifying structures contributing to urinary stasis, like urethra, prostate, anatomical orifices of ureters in the bladder or bladder mucosa and its anatomical characteristics [3].

• Pyuria

  We should keep that long-term pyuria and urinary symptom, and repeated urinary tract infection can cause huge bladder calculus and renal failure in mind. [ncbi.nlm.nih.gov]

  In patients with a bladder calculus, urinalysis is essential to identify the presence of red blood cells (RBC), pyuria, levels of nitrite and urine pH, which is acidic e.g. in the case, of uric acid calculi. [symptoma.com]

  Urine examination showed pyuria and microscopic hematuria and urine culture showed E.coli. Ultrasonography revealed a vesical calculus of 2 cm size with some hyperechoic intraluminal lesion in base of bladder. [austinpublishinggroup.com]

  Microscopy usually demonstrates red blood cells (RBCs) and pyuria (WBCs). Microscopic crystals usually are consistent with the composition of the stone. Urine culture and sensitivity help document and direct treatment of associated infections. [arabmedmag.com]

  Infection is suggested by fever, elevated WBC count, and urine microscopy demonstrating pyuria and bacteriuria. [auanet.org]

• Creatinine Decreased

  Ten days after the surgery, serum creatinine decreased to 0.7 mg/dL. In this report, we highlight an unusual cause of renal failure. [ncbi.nlm.nih.gov]

1. Su CM, Lin HY, Li CC, Chou YH, Huang CH. Bladder stone in a woman after cesarean section: a case report. Kaohsiung J Med Sci. Jan 2003; 19(1):42-4.
2. Aydogdu O, Telli O, Burgu B, Beduk Y. Infravesical obstruction results as giant bladder calculi. Can Urol Asoc J. 2011 ;5:77–8.
3. Ho K, Segura J. Lower Urinary Tract Calculi. In: Wein A, Kavoussi L, Novick A, Partin A, Peters C ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier. 2007; 3:2663-73.
4. Hammad FT, Kaya M, Kazim E. Bladder calculi: did the clinical picture change?. Urology. Jun 2006; 67(6):1154-8.
5. Tahtalı İN, Karataş T. Giant bladder stone: A case report and review of the literature. Turk J Urol. 2014; 40(3):189-191.
6. Straub M, Strohmaier WL, Berg W, et al. Diagnosis and metaphylaxis of stone disease. Consensus concept of the National Working Committee on Stone Disease for the upcoming German Urolithiasis Guideline. World J Urol. Nov 2005; 23(5):309-23.
7. Huang WC, Yang JM. Sonographic appearance of a bladder calculus secondary to a suture from a bladder neck suspension. J Ultrasound Med. Nov 2002; 21(11):1303-5.
8. Ray AA, Ghiculete D, Pace KT, et al. Limitations to ultrasound in the detection and measurement of urinary tract calculi. Urology. Aug 2010; 76(2):295-300.