BLADDER STONES

Bladder stones - Composition
Struvite (i.e. they are infection stones) or uric acid (in non-infected urine).

Adults
Bladder calculi are predominantly a disease of men aged >50 and with bladder outlet obstruction due to BPE. They also occur in the chronically catheterized patient (e.g. spinal cord injury patients), where the chance of developing a bladder stone is 25% over 5 years (similar risk whether urethral or suprapubic location of the stone).

Children
Bladder stones are still common in Thailand, Indonesia, North Africa, the Middle East, and Burma. In these endemic areas they are usually composed of a combination of ammonium urate and calcium oxalate. A low-phosphate diet in these areas (a diet of breast milk and polished rice or millet) results in high peaks of ammonia excretion in the urine.

Symptoms
May be symptomless (incidental finding on KUB X-ray or bladder ultrasound or on cystoscopy) the common presentation in spinal patients who have limited or no bladder sensation). In the neurologically intact patient suprapubic or perineal pain, haematuria, urgency and/or urge incontinence, recurrent UTI, LUTS (hesitancy, poor flow).

Diagnosis
If you suspect a bladder stone, they will be visible on KUB X-ray or renal ultrasound.

Treatment
Most stones are small enough to be removed cystoscopically (endoscopic cystolitholapaxy), using stone-fragmenting forceps for stones that can be engaged by the jaws of the forceps and EHL or pneumatic lithotripsy for those that cannot. Large stones can be removed by open surgery (open cystolitholapaxy).