Bladder Stones: Symptoms, Causes & Treatment – Complete Guide

What are bladder stones? (Vesical calculi)

Bladder stones (vesical calculi) are hard mineral masses that form in the urinary bladder. Unlike kidney stones, which form in the kidney and travel down, bladder stones usually form directly in the bladder due to incomplete emptying (urinary stasis). They are much less common than kidney stones, accounting for about 5% of all urinary tract stones. Bladder stones are more common in men (especially older men with prostate enlargement) and in people with neurogenic bladder or chronic urinary retention.

Bladder stones can vary in size from microscopic grit to large stones several centimetres across. Large stones may become “impacted” in the bladder neck or urethra, causing acute urinary retention.

Causes – urinary stasis, BPH, neurogenic bladder

The fundamental cause of bladder stones is incomplete bladder emptying (urinary stasis). Stagnant urine allows crystals to aggregate and form stones. Common predisposing conditions include:

• Benign prostatic hyperplasia (BPH): Enlarged prostate compresses the urethra, preventing complete bladder emptying. This is the most common cause in older men.
• Neurogenic bladder: Conditions like spinal cord injury, multiple sclerosis, spina bifida, or diabetic neuropathy impair bladder contraction or coordination.
• Bladder outlet obstruction: Urethral stricture (scar tissue), bladder neck contracture, or posterior urethral valves (in children).
• Urinary tract infections (UTI): Chronic UTIs (especially with urease‑producing bacteria) can lead to struvite bladder stones.
• Foreign bodies: Indwelling urinary catheters, surgical mesh, or migrated intrauterine devices can act as a nidus for stone formation.
• Bladder diverticula: Pockets in the bladder wall where urine stagnates.
• Dehydration and dietary factors: Less common than in kidney stones, but concentrated urine increases risk.

Symptoms – pain, blood, interrupted stream, urgency

Bladder stones can be asymptomatic if small and free‑floating. When symptomatic, typical symptoms include:

• Suprapubic pain (lower abdomen): Dull ache or sharp pain, often worse after urination or with movement.
• Hematuria (blood in urine): Visible or microscopic – common due to stone irritation of the bladder lining.
• Intermittent or interrupted urine stream: The stone may act like a ball valve, blocking the bladder outlet. The stream may start, stop, and start again.
• Terminal hematuria (blood at the end of urination): Classic sign – the stone irritates the trigone as the bladder contracts.
• Suprapubic or penile pain at the end of urination: Stone impacts the bladder neck.
• Urgency and frequency: Irritation of the bladder wall.
• Acute urinary retention: Complete inability to urinate if the stone obstructs the bladder outlet – a urological emergency.

Diagnosis – imaging, cystoscopy, urine tests

Diagnosing bladder stones is usually straightforward:

• Urinalysis: Shows hematuria, possibly pyuria (white blood cells) if infection present.
• Ultrasound (KUB): Good initial test – stones appear as bright echoes with acoustic shadowing. Can also assess prostate size and post‑void residual urine.
• Plain X‑ray (KUB): Most bladder stones are radiopaque (calcium or struvite). Uric acid stones are radiolucent.
• CT scan (non‑contrast): Gold standard – detects all stone types, measures size, and identifies complications (bladder wall thickening, diverticula).
• Cystoscopy: Direct visualisation of the stone(s) using a small camera passed through the urethra. This is both diagnostic and therapeutic (can remove small stones in the same session).
• Urodynamics (if neurogenic bladder): Assesses bladder function.

At Vivekananda Hospital, we often start with ultrasound and plain X‑ray. If stones are confirmed, cystoscopy is usually performed for definitive treatment.

Treatment – cystolitholapaxy (gold standard), surgery

The goal of treatment is to remove the stone and correct the underlying cause. Options depend on stone size and number:

Cystolitholapaxy (transurethral bladder stone fragmentation)

This is the gold standard for most bladder stones. A rigid or semi‑rigid cystoscope is passed through the urethra into the bladder. The stone is visualised and fragmented using a holmium laser, pneumatic lithotripter, or ultrasound probe. Fragments are then suctioned out or flushed. For stones up to 2‑3 cm, this is usually a same‑day procedure with spinal or general anaesthesia. A urethral catheter is placed for 24‑48 hours.

Success rate: >95% for stones <4 cm. Large or very hard stones may require multiple sessions.

Open cystolithotomy (surgical removal)

For very large stones (>5‑6 cm), extremely hard stones, or when the urethra is too narrow to pass a cystoscope (e.g., urethral stricture), an open procedure through a lower abdominal incision (suprapubic) is performed. This is now rare but still used in select cases. Recovery takes 2‑3 weeks.

Treating the underlying cause

Stone removal alone is not enough – the underlying condition must be addressed:

• BPH: Transurethral resection of the prostate (TURP) or medical therapy (alpha‑blockers, 5‑alpha reductase inhibitors).
• Urethral stricture: Urethral dilation or urethroplasty.
• Neurogenic bladder: Intermittent catheterisation, anticholinergic medications, or bladder augmentation.
• Bladder diverticula: Diverticulectomy if symptomatic.
• Infection stones: Complete stone removal + culture‑guided antibiotics.

Prevention – treat underlying cause, hydration

Preventing bladder stone recurrence focuses on eliminating urinary stasis:

• Treat BPH: Alpha‑blockers (tamsulosin) or surgery (TURP) if indicated.
• Intermittent self‑catheterisation: For neurogenic bladder or chronic retention.
• Treat urethral strictures: Dilation or surgical repair.
• Hydration: 2‑3 litres of water daily to keep urine dilute.
• Low purine diet (if uric acid stones): Limit red meat, organ meats, seafood, beer.
• Alkalinisation (for uric acid stones): Potassium citrate to raise urine pH.
• Regular follow‑up: Annual ultrasound to monitor for recurrence, especially if underlying cause cannot be fully corrected.

Interactive FAQ – Bladder stones

Disclaimer: This information is for educational purposes. If you have symptoms of bladder stones (suprapubic pain, interrupted stream, blood in urine), consult a urologist at Vivekananda Hospital for evaluation.