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Bladder Calculus

Cystolith

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.


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].

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]
  • 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]
  • 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]
Enuresis
  • Small children may encounter episodes of priapism, as well as occasional enuresis.[symptoma.com]
  • BladderAcinesisVesical Palsy 183 Vesical Calculi CystoLithiasis 185 Cystorrhagia Vesical HsematuriaHemorrhage from the Bladder 187 CystitisAcute Subacute and Chronic 188 Pericystitis 198 Hypertrophy of the Bladder 199 New Growths and Foreign Bodies in the Bladder 203 Enuresis[books.google.com]
Hunting
  • Hospital, Sandwell, UK a.midgley-hunt{at}nhs.net A 40 year old woman presented with four weeks of persistent vomiting and reduced urination in the absence of abdominal pain.[bmj.com]
Abdominal Pain
  • 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]
Persistent Vomiting
  • vomiting and reduced urination in the absence of abdominal pain.[bmj.com]
Hematuria
  • CASE: 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
  • Abstract 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]
  • The presentation of vesical calculi varies from completely asymptomatic to symptoms of suprapubic pain, dysuria, intermittency, frequency, hesitancy, nocturia, and urinary retention.[doi.org]
  • Patients in urinary retention caused by a vesical calculus usually pass urine in supine position.[ispub.com]
  • retention The majority of bladder stones cause no additional problems in addition to the underlying bladder disorder.[urology-textbook.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]
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]

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].

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]
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. 2017 BMJ Publishing Group Ltd.[ncbi.nlm.nih.gov]
  • Three days after the surgery, the level of serum creatinine decreased to 224 μmol/l. He was discharged from our hospital with uneventful course. Bladder calculus is thought to be a rare cause of renal failure.[ncbi.nlm.nih.gov]
Polyps
  • 704 Semispecific Liver Patterns in Cirrhosis 719 Viral Markers of Hepatitis 738 Intravenous Contrast Strategies for Liver Lesions 745 Balthazar CTSeverity Index for Acute Pancreatitis 757 GASTROINTESTINAL TRACT 769 Differential Diagnosis of Colonic Polyps[books.google.com]

Treatment

  • 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. Copyright 2013 Elsevier Inc. All rights reserved.[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]
  • This contributes to the treatment of secondary bladder diverticula and prevents stone occurrence ( 13, 14 ).[spandidos-publications.com]
  • 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]
  • Available treatment options for vesical calculus include open surgical removal, extracorporeal fragmentation and endoscopic crushing.[banglajol.info]

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]

Etiology

  • 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]
  • 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]
  • The choices for treatment depend on etiology and size of calculus; various techniques may be employed.[scirp.org]
  • In this case, the complex etiology of our patient’s bladder symptoms became clear only after performing the relevant imaging and taking a thorough history.[jmedicalcasereports.biomedcentral.com]
  • Bushman W (2009) Etiology, Epidemiology, and Natural History. Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms 36: 403–415 View Article Google Scholar 11.[doi.org]

Epidemiology

  • 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]
  • 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]
  • 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]
  • Bushman W (2009) Etiology, Epidemiology, and Natural History. Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms 36: 403–415 View Article Google Scholar 11.[doi.org]
Sex distribution
Age distribution

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 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]

Prevention

  • Some research indicates citrus juices aid in preventing the development of bladder stones.[mdmercy.com]
  • 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]
  • 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]
  • Jackstones often must be removed via cystolithotomy. [10] Prevention [ edit ] The best way to prevent bladder stones is to drink plenty of liquids. Juices containing citrates are thought to reduce the risk of stone formation.[en.wikipedia.org]
  • Prompt treatment of UTI or other urinary tract conditions may help prevent bladder stones. Stones - bladder; Urinary tract stones; Bladder calculi Benway BM, Bhayani SB. Lower urinary tract calculi.[nlm.nih.gov]

References

Article

  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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Last updated: 2018-06-22 08:19