Urolithiasis - diagnosis, symptoms and treatment

What is Urolithiasis

The formation of calcifications (also called calculi) in the BLADDER. Most bladder stones, like kidney stones, form of calcium in combination with oxalate (the most common combination), phosphate, or magnesium. Bladder stones are less common today than kidney stones (NEPHROLITHIASIS), though throughout recorded history bladder stones have been a common urologic condition. Bladder stones are most likely to form when URINE remains in the bladder for an extended time, particularly with URINARY RETENTION (in which the bladder fails to completely empty with URINATION). URETHRAL STRICTURE, CYSTOCELE, BENIGN PROSTATIC HYPERPLASIA (BPH), long-term BLADDER CATHETERIZATION, and NEUROGENIC BLADDER are among the conditions that contribute to the formation of bladder stones. Chronic DEHYDRATION, such as occurs with drinking too little water, further contributes to calcification. Bladder stones are also common during PREGNANCY.

Symptoms of Urolithiasis

In urinary stasis the minerals dissolved in the urine begin to settle out when the urine is static (not moving), forming crystals. The formed crystals attract more of their composite minerals, eventually hardening into calculi. Small stones often easily pass through the urethra in the urine without the person’s awareness of them. Stones that are large enough to scrape the walls of the urethra, or sandlike clumps of calculi that surge through the URETHRA, may cause irritation such as DYSURIA (burning sensation) with urination. Other symptoms may include URINARY FREQUENCY, URINARY URGENCY, and urinary hesitation (difficulty starting urination, or start-and-stop urination).

A stone that completely blocks the urethra, often at the neck of the bladder, causes excruciating PAIN that may feel as though it arises in the groin or, in men, in the TESTES (testicles). Often a change in position relieves the pain, causing the urine to wash the stone from its point of occlusion. A stone that is larger than the diameter of the urethra will intermittently though persistently obstruct the passage of urine. It may also cause bleeding, resulting in HEMATURIA (blood in the urine).

Urolithiasis Diagnosis and Treatment

The diagnostic path typically includes urinalysis, ULTRASOUND to detect the presence of stones in the bladder, and CYSTOSCOPY. Cystoscopy often is both diagnostic and therapeutic, allowing the urologist to confirm the presence of stones as well as remove them from the bladder. Larger stones may require treatments such as EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY (ESWL) or surgical procedures such as percutaneous lithotomy or open cystostomy to remove the stones. Most people recover fully. Bladder stones tend to recur, however.


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