IS Case 398: Bladder stones
2009 URMC Imaging Sciences
Publication Date: 2010-03-09
Patient is a 61-year-old male with chronic suprapubic pain.
Several radiopaque calculi within the bladder. Incidental note is made of a penile prosthesis.
Bladder calculi are an uncommon cause of suprapubic pain. They are usually associated with bladder outlet obstruction and urinary stasis. A foreign body in the bladder, such as a suprapubic catheter (as in this patient), can also serve as a nidus for stone formation. Common symptoms include pain, dysuria, intermittency, terminal gross hematuria, frequency, hesitancy, and nocturia.
Imaging findings include the presence of radiopaque stones overlying the region of the bladder on plain radiography [i.e. of the kidneys, ureters, and bladder (KUB)]. The stones are found in the most dependent portion of the bladder and are seen to move on patient repositioning. The differential diagnosis includes clot, fungal ball, and papillary urothelial carcinoma on a stalk.
Medical treatment includes alkalinization of the urine with potassium citrate, which causes dissolution if the urinary pH is greater than 6.4. Surgical treatment includes cystolitholapaxy (fragmentation of the stone(s) and removal through the cystoscope), which can be performed in a transurethral or percutaneous suprapubic approach.
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