- Bladder calculi are uncommon in the Western world
- They are well described in ancient medical literature
- Hippocrates wrote about the management of bladder stone
- Operations to remove stones via the perineum were described in the
centuries BC
- Suprapubic lithotomy was described in the 15th century
- Transurethral lithotomy became popular in the 18th century
- Lithotripsy was first described in 1822
- Surgery was often associated with significant morbidity and
mortality
Pathophysiology
- Bladder calculi are usually associated with urinary stasis
- Urinary infections increase the risk of stone formation
- Foreign bodies (e.g. suture material) can also act as a nidus for
stone formation
- They can however form in a normal bladder
- There is no recognised association with ureteric calculi
- Most bladder calculi form in the bladder and are not from the upper
urinary tract
- They vary in size and can be multiple
- They are more common in elderly men
- In Asia, they are seen more commonly in children
- Most stones in adults are formed of uric acid
- Long-standing untreated bladder stones are associated with squamous
cell carcinoma
Clinical features
- Bladder calculi can be asymptomatic
- Common symptoms include
- Suprapubic pain
- Dysuria
- Haematuria
- Abdominal examination may be normal
Diagnosis
- Historically stones were diagnosed by the passage of urethral
'sounds'
- Today thy can be identified on
- Plain abdominal x-ray
- Bladder ultrasound
- CT scan
- Cystoscopy
- Uric acid stones are radiolucent but may have an opaque calcified
layer
- Patients may present in acute urinary retention
Picture provided by Sandip Sinha, King George
University Hospital, Ludinow, India
Surgery
- Indications for surgery include
- Recurrent urinary tract infections
- Acute urinary retention
- Frank haematuria
- Any underlying bladder abnormality should be sought
- Historically the surgical approach involved 'cutting for a stone'
- This was via either a perineal or suprapubic approach
- The three common approaches today are
- Transurethral cystolitholapaxy
- Percutaneous cystolitholapaxy
- Open suprapubic cystostomy
- Extracorporeal shockwave lithotripsy is relatively ineffective
- Complications of cystolitholapaxy include
- Infection
- Haemorrhage
- Bladder perforation
- Hyponatraemia
Picture provided by Sandip Sinha, King George
University Hospital, Ludinow, India
Bibliography
Schwartz B F, Stoller M L. The vesical calculus.
Urol Clin North Am 2000; 27: 333-346. |