Bladder Stones

Overview

Bladder stones (vesical calculi) are mineral deposits that form within the bladder itself, as distinct from kidney stones that originate in the kidney. They are much less common than kidney stones and are more frequently seen in older men, often in association with conditions that impair bladder emptying.

The most common underlying cause is incomplete bladder emptying, which allows urine to stagnate. Concentrated, stagnant urine promotes the crystallisation of urinary salts into stone material. Other contributing factors include a foreign body within the bladder (such as a long-standing urinary catheter or suture material from previous surgery), chronic urinary infection, and neurogenic bladder dysfunction.

In contrast to kidney stones, bladder stones in adults are rarely caused by metabolic disorders alone and are almost always associated with a structural or functional underlying problem that should be identified and addressed.

Symptoms

Bladder stones can produce a characteristic cluster of symptoms:

• Pain at the end of voiding — a distinctive feature caused by the stone dropping onto the bladder neck at the end of urination
• Interrupted urine stream — the stone may temporarily block the bladder outlet during voiding
• Urinary frequency and urgency — the stone irritates the bladder lining
• Haematuria — blood in the urine, often visible
• Recurrent urinary tract infections — bacteria colonise the stone surface and are difficult to eradicate with antibiotics alone
• Dysuria — discomfort or burning on urination

Some smaller bladder stones are asymptomatic and discovered incidentally on imaging performed for another reason.

Diagnosis

Bladder stones are diagnosed by imaging:

• Ultrasound of the bladder — can identify stones as hyperechoic structures with shadowing; also assesses post-void residual urine volume and the prostate
• Plain abdominal X-ray — detects calcium-containing stones, which are radiopaque
• CT scan (CT-KUB or CT abdomen/pelvis) — the most sensitive investigation; identifies all stone types, their size, and any associated upper urinary tract problems
• Flexible cystoscopy — direct visualisation of the bladder; confirms the presence of stones and allows assessment of the bladder lining and prostate

Blood tests and urine culture are usually performed to assess kidney function and exclude active infection before any surgical intervention.

Treatment

Cystolitholapaxy The standard treatment for bladder stones is endoscopic fragmentation under general or spinal anaesthesia. A telescope (cystoscope) is passed into the bladder via the urethra, and the stones are broken into small fragments using laser energy or a mechanical lithotrite. The fragments are then irrigated out of the bladder. This is typically a day-case procedure, and patients go home with a urinary catheter that is removed after 24–48 hours.

Simultaneous treatment of underlying cause When bladder stones are associated with BPH, the prostate can be treated at the same operation — for example, by performing HoLEP or TURP alongside the cystolitholapaxy. Treating the outlet obstruction reduces the risk of stone recurrence by restoring effective bladder emptying.

Open cystolithotomy For very large stones (over approximately 4 cm), or when endoscopic access is difficult due to urethral stricture or other anatomical factors, open surgical removal through a small incision in the lower abdomen may be required.

Prevention Addressing the underlying cause of stone formation — most commonly by treating BPH or other causes of bladder outlet obstruction — is the most effective preventive strategy. Ensuring adequate fluid intake and maintaining good urinary hygiene also reduce the risk.