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2.1
Bladder Calculus
Bladder Stones

A bladder calculus is a mass of mineral deposits that is either formed in the urinary bladder or descends from the pelvis of the kidneys. Primary bladder calculi are rarely encountered in the Western world and are usually secondary to urinary stasis following an obstruction.

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WIKIDATA, CC BY-SA 3.0
WIKIDATA, CC BY-SA 3.0
WIKIDATA, Public Domain
WIKIDATA, CC BY-SA 3.0

Presentation

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].

Entire Body System

  • Recurrent Urinary Tract Infection

    There are early and late complications of cervical cerclage placement, but they rarely involve the lower urinary tract. We present a case of a lower urinary tract complication from this procedure presenting as recurrent urinary tract infections. [ncbi.nlm.nih.gov]

    The main risk factors are obstruction of urinary tract and recurrent urinary tract infection [ 1 ]. These calculi are most commonly found in children with a posterior urethral valve or vesicoureteral reflux [ 2 ]. [academic.oup.com]

    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]

    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]

    Urinary tract infections and catheterization: Recurrent or chronic urinary tract infections with urease-producing bacteria lead to magnesium ammonium phosphate stones. [urology-textbook.com]

Gastrointestinal

  • 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]

    But if a stone irritates the bladder wall or blocks the flow of urine, signs and symptoms may include: Lower abdominal pain In men, pain or discomfort in the penis or testicles A burning sensation during urination Frequent urination Difficulty urinating [mayoclinic.com]

    Typical symptoms of bladder stones include: lower abdominal pain, which can often be severe (men may also have pain in or around their penis) pain or difficulty when peeing peeing more frequently (particularly at night) cloudy or dark-coloured urine blood [nhs.uk]

  • Suprapubic Pain

    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. [symptoma.com]

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

    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]

    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]

Urogenital

  • Hematuria

    […] 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]

    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]

    There is no significant clinical manifestation of this disease, although urinary infection, hematuria and prostatic hyperplasia are clinical symptoms. [spandidos-publications.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]

    Unenhanced CT scan of the pelvis in patient with hematuria shows stone material layering in the dependent portion of the bladder (arrows). [med-ed.virginia.edu]

  • 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]

    Dysuria, alguria, frequency Interrupted urinary flow or urinary retention The majority of bladder stones cause no additional problems in addition to the underlying bladder disorder. [urology-textbook.com]

  • Urinary Retention

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

    […] may be indicated when there is acute urinary 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]

    Dysuria, alguria, frequency Interrupted urinary flow or urinary 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]

Workup

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].

Urine

  • 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]

Treatment

This contributes to the treatment of secondary bladder diverticula and prevents stone occurrence ( 13, 14 ). [spandidos-publications.com]

In this unique case report we discuss the formation and successful endoscopic treatment of a large stone in a neuropathic bladder on the tip of a migrated VP shunt. [ncbi.nlm.nih.gov]

Diagnosis may require: Urinalysis Ultrasound X-ray Cystoscopy CT Scan NEXT: Treatment Options › Treatment Options Staying hydrated is the best way to help prevent bladder stones. [mdmercy.com]

The risk of potency restriction is also very low in the case of this laser treatment. The image shows three large bladder stones before treatment. [prostata-therapie.de]

Treatment of Urinary Bladder Stones The majority of bladder stones can be treated endoscopically. Treatment options are influenced by the anatomy, etiology, concomitant diseases and stone size. [urology-textbook.com]

Prognosis

Treatment and prognosis The earliest method of operative removal of bladder calculus was performed via the perineum with the patient in a supine position and the legs elevated - hence the term lithotomy position. Promoted articles (advertising) [radiopaedia.org]

Kidney Stone Prognosis Once a patient has passed a stone, there is a great likelihood that another stone will be passed in his or her lifetime. Since kidney stones may also be hereditary, this likelihood is passed on to the next generation. [emedicinehealth.com]

Etiology

Schneider, Epidemiology of Urolithiasis, Urolithiasis: Etiology · Diagnosis, 10.1007/978-3-642-70579-3_2, (137-184), (1985). [doi.org]

Inhalt GENERAL CONSIDERATIONS 1 II 22 Summary of the Etiology Semeiology Diagnosis 47 SPECIAL CONSIDERATIONS 74 urethral stenosis prostatic obstruction etc Symptoms of acute 102 VI 132 General and special indications Constitutional and local treatment [books.google.com]

Treatment options are influenced by the anatomy, etiology, concomitant diseases and stone size. Extracorporeal Shock Wave Lithotripsy (ESWL): ESWL of bladder stones is a treatment option for children or patients with a high risk for anesthesia. [urology-textbook.com]

Physiopathology and etiology of stone formation in the kidney and the urinary tract. Evan AP. Pediatr Nephrol. 2010 May;25(5):831-41. Epub 2009 Feb 7. Review. 2. Mayo Foundation for Medical Education and Research (Ed). [passeportsante.net]

Other etiologic factors for bladder stone formation include foreign bodies in the bladder that act as a nidus for stone formation. These may be iatrogenic or noniatrogenic in origin. [emedicine.medscape.com]

Epidemiology

Schneider, Epidemiology of Urolithiasis, Urolithiasis: Etiology · Diagnosis, 10.1007/978-3-642-70579-3_2, (137-184), (1985). [doi.org]

Epidemiology and Causes of Bladder Stones Endemic bladder stones: Malnutrition in developing countries causes bladder stones in children without the presence of bladder emptying disorders. Affected areas are North Africa, the Middle and Far East. [urology-textbook.com]

Due to the rarity of this condition, we investigated similar cases on the following search platform: Pubmed, Research Gate, Virtual Health Library and tried to document its epidemiology, diagnosis, complications and management. [scirp.org]

Epidemiology of urolithiasis in Japan: a chronological and geographical study. Urol Int. 1990;45(2):104–11. View Article PubMed Google Scholar Harrison-Woolrych M, Ashton J, Coulter D. [jmedicalcasereports.biomedcentral.com]

In females, examples include an incontinence repair that is too tight, cystoceles, and bladder diverticula. [21] Epidemiology Since the 19th century, the incidence of primary bladder calculi in the United States and Western Europe has been steadily and [emedicine.medscape.com]

Pathophysiology

[…] obstruction is most common cause In females, causes may include cystocoele and bladder diverticula Urinary infections Neurogenic bladder Schistosomiasis Foreign bodies either left in place iatrogenically (Foley catheters) or placed there by patient Pathophysiology [learningradiology.com]

[Pathophysiology, diagnosis and conservative therapy in calcium kidney calculi]Ther Umsch. 2003 Feb; 60(2): 79-87. German. 4. Robertson WG, Peacock M, Marshall DH. Prevalence of urinary stone disease in vegetarians.Eur Urol. 1982; 8(6): 334-9. 5. [passeportsante.net]

Pathophysiology Most vesical calculi formed de novo within the bladder, but some initially may have formed within the kidneys as a dissociated Randall plaque or on a sloughed papilla and subsequently passed into the bladder, where additional deposition [emedicine.medscape.com]

Shionogi Research Laboratories, Shionogi & Co., Ltd., Osaka, Japan (10,12) Hiroshi Tanimura and Yorninori Hikasa, The Etiology and Pathophysiology of Cholelithiasis. [gallbladderattack.com]

Prevention

A new study shows that a daily glass of orange juice may help prevent recurrent kidney stones better than other citrus juices like lemonade. Researchers say many people assume that all citrus juices prevent the formation of kidney stones. [webmd.com]

Some research indicates citrus juices aid in preventing the development of bladder stones. [mdmercy.com]

Prevention Bladder stones usually result from an underlying condition that's hard to prevent, but you can decrease your chance of developing bladder stones by following these tips: Ask about unusual urinary symptoms. [mayoclinic.com]

Citrus juices like orange juice can also help prevent the formation of bladder stones. [belmarrahealth.com]

These include diuretic drugs to prevent calcium stones and drugs to reduce the production of uric acid to prevent uric acid stones, Michelis said. [livescience.com]

References

  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.
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2.1
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