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A bladder stone is a
stone In geology, rock (or stone) is any naturally occurring solid mass or aggregate of minerals or mineraloid matter. It is categorized by the minerals included, its Chemical compound, chemical composition, and the way in which it is formed. Rocks ...
found in the
urinary bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine ente ...
.


Signs and symptoms

Bladder stones are small mineral deposits that can form in the bladder. In most cases bladder stones develop when the urine becomes very concentrated or when one is dehydrated. This allows for minerals, such as calcium or magnesium
salts In chemistry, a salt is a chemical compound consisting of an ionic assembly of positively charged cations and negatively charged anions, which results in a compound with no net electric charge. A common example is table salt, with positively c ...
, to crystallize and form stones. Bladder stones vary in number, size and consistency. In some cases bladder stones do not cause any symptoms and are discovered as an incidental finding on a plain
radiograph Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography ("diagnostic" and "therapeut ...
. However, when symptoms do occur, these may include severe lower abdominal and back pain, difficult urination, frequent urination at night, fever, painful urination and
blood in the urine Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. “Gross hematuria” occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable w ...
. The majority of individuals who are symptomatic will complain of pain which comes in waves. The pain may also be associated with nausea, vomiting and chills.Bladder Stones General Overview
, Retrieved on 2010-01-19.
Bladder stones vary in their size, shape and texture- some are small, hard and smooth whereas others are huge, spiked and very soft. One can have one or multiple stones. Bladder stones are somewhat more common in men who have
prostate enlargement Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss o ...
. The large
prostate The prostate is both an accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found only in some mammals. It differs between species anatomically, chemically, and phys ...
presses on the urethra and makes it difficult to pass urine. Over time, stagnant urine collects in the bladder and minerals like calcium start to precipitate. Other individuals who develop bladder stones include those who have had
spinal cord injury A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cor ...
, paralysis, or some type of nerve damage. When nerves to the back are damaged, the bladder cannot empty, resulting in stagnant urine.Bladder Stones Prevention
Retrieved on 2010-01-19.


Causes

Bladder stones may occur whenever the kidneys, bladder, or ureters become
inflamed Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molecu ...
, which may occur when the
urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excreted from the body through the urethra. Cellular ...
becomes too concentrated or when the body becomes dehydrated. Minerals such as calcium and magnesium crystallize into the stones, which then can cause such symptoms as lower back or abdominal pain or difficulty with urination. The use of urinary catheters may cause a bladder stone. Individuals who are paralyzed or are unable to adequately pass urine may require the use of small plastic tubes (
catheter In medicine, a catheter (/ˈkæθətər/) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgi ...
s) placed into the bladder. The use of these tubes may lead to an
infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...
, which irritates the bladder, resulting in stone formation. Finally, a kidney stone may travel down the ureter into the bladder and become a bladder stone. There is some evidence indicating that chronic irritation of the bladder by retained stones may increase the chance of
bladder cancer Bladder cancer is any of several types of cancer arising from the tissues of the urinary bladder. Symptoms include blood in the urine, pain with urination, and low back pain. It is caused when epithelial cells that line the bladder become ma ...
. Urinary schistosomiasis, a disease caused by the digenean
trematode Trematoda is a class of flatworms known as flukes. They are obligate internal parasites with a complex life cycle requiring at least two hosts. The intermediate host, in which asexual reproduction occurs, is usually a snail. The definitive h ...
''
Schistosoma haematobium ''Schistosoma haematobium'' (urinary blood fluke) is a species of digenetic trematode, belonging to a group (genus) of blood flukes (''Schistosoma''). It is found in Africa and the Middle East. It is the major agent of schistosomiasis, the most ...
'', has been implicated in the development of vesical calculi. However, evidence accumulated thus far has not supported this hypothesis.


Diagnosis

The diagnosis of bladder stone includes
urinalysis Urinalysis, a portmanteau of the words ''urine'' and ''analysis'', is a panel of medical tests that includes physical (macroscopic) examination of the urine, chemical evaluation using urine test strips, and microscopic examination. Macroscopic ...
,
ultrasonography Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies fr ...
,
x rays An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10  picometers to 10 nanometers, corresponding to frequencies in the range 30&nbs ...
or
cystoscopy Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope. The urethra is the tube that carries urine from the bladder to the outside of the body. The cystoscope has lenses like a telescope or microscop ...
(inserting a small thin camera into the urethra and viewing the bladder). The
intravenous pyelogram Pyelogram (or pyelography or urography) is a form of imaging of the renal pelvis and ureter. Types include: * Intravenous pyelogram – In which a contrast solution is introduced through a vein into the circulatory system. * Retrograde pyelogram ...
can also be used to assess the presence of kidney stones. This test involves injecting a
radiocontrast Radiocontrast agents are substances used to enhance the visibility of internal structures in X-ray-based imaging techniques such as computed tomography ( contrast CT), projectional radiography, and fluoroscopy. Radiocontrast agents are typically i ...
agent which is passed into the urinary system. X-ray images are then obtained every few minutes to determine if there is any obstruction to the contrast as it is excreted into the bladder. Today, intravenous pyelogram has been replaced at many health centers by CT scans. CT scans are more sensitive and can identify very small stones not seen by other tests.Bladder Stones: eMedicine Urology
Retrieved on 2010-01-19.


Classification

Urinary stones may be composed of the following substances:S. Materazzi, R. Curini, G. D'Ascenzo, and A. D. Magri (1995), ''TG-FTIR coupled analysis applied to the studies in urolithiasis: characterization of human renal calculi''. Termochimica Acta, volume 264, 75--93. * Calcium oxalate monohydrate (whewellite) * Calcium oxalate dihydrate (weddellite) *
Calcium phosphate The term calcium phosphate refers to a family of materials and minerals containing calcium ions (Ca2+) together with inorganic phosphate anions. Some so-called calcium phosphates contain oxide and hydroxide as well. Calcium phosphates are whi ...
*
Magnesium phosphate Magnesium phosphate is a general term for salts of magnesium and phosphate In chemistry, a phosphate is an anion, salt, functional group or ester derived from a phosphoric acid. It most commonly means orthophosphate, a derivative of orthop ...
*
Ammonium phosphate Ammonium phosphate is the inorganic compound with the formula (NH4)3PO4. It is the ammonium salt of orthophosphoric acid. A related "double salt", (NH4)3PO4.(NH4)2HPO4 is also recognized but is impractical use. Both triammonium salts evolve ammoni ...
*
Ammonium magnesium phosphate Struvite (magnesium ammonium phosphate) is a phosphate mineral with formula: NH4MgPO4·6H2O. Struvite crystallizes in the orthorhombic system as white to yellowish or brownish-white pyramidal crystals or in platy mica-like forms. It is a soft m ...
(struvite) * Calcium hydroxyphosphate (apatite) *
Uric acid Uric acid is a heterocyclic compound of carbon, nitrogen, oxygen, and hydrogen with the formula C5H4N4O3. It forms ions and salts known as urates and acid urates, such as ammonium acid urate. Uric acid is a product of the metabolic breakdown ...
and its salts (urates) *
Cystine Cystine is the oxidized derivative of the amino acid cysteine and has the formula (SCH2CH(NH2)CO2H)2. It is a white solid that is poorly soluble in water. As a residue in proteins, cystine serves two functions: a site of redox reactions and a mec ...
*
Xanthine Xanthine ( or ; archaically xanthic acid; systematic name 3,7-dihydropurine-2,6-dione) is a purine base found in most human body tissues and fluids, as well as in other organisms. Several stimulants are derived from xanthine, including caffeine ...
* Indigotin (rare) * Urostealith (rare) * Sulfonamide (rare)


Jackstone calculus

Jackstone calculi are rare bladder stones that have an appearance resembling toy jacks. They are almost always composed of calcium oxalate dihydrate and consist of a dense central core and radiating
spicules Spicules are any of various small needle-like anatomical structures occurring in organisms Spicule may also refer to: *Spicule (sponge), small skeletal elements of sea sponges *Spicule (nematode), reproductive structures found in male nematodes ( ...
. They are typically light brown with dark patches and are usually formed in the urinary bladder and rarely in the upper urinary tract. Their appearance on plain radiographs and computed tomography in human patients is usually easily recognizable. Jackstones often must be removed via cystolithotomy.


Prevention

The best way to prevent bladder stones is to drink plenty of liquids. Juices containing
citrates Citric acid is an organic compound with the chemical formula HOC(CO2H)(CH2CO2H)2. It is a colorless weak organic acid. It occurs naturally in citrus fruits. In biochemistry, it is an intermediate in the citric acid cycle, which occurs in t ...
are thought to reduce the risk of stone formation. A study published in the ''Clinical Journal of the American Society of Nephrology'' indicate orange juice is more effective at preventing stone formation than other citrus juices. Men who have difficulty with urination due to
prostate enlargement Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss o ...
should seek treatment,Bladder Stones: Prevention
Retrieved on 2010-01-19.
however, urinating in a sitting position appears to improve bladder emptying which might decrease the risk of bladder stones forming. Prevention in newborn children, especially in the first three months of life when most stones begin, is critical. Studies show that feeding newborn infants milk (mother's, cow or goat) with no substitutes or supplements until at least the third month has proven successful in preventing most stones.


Management

Increasing fluid intake can facilitate the passage of small bladder stones. However, larger stones may require other methods of treatment.
Retrieved on 2010-01-19.
Fragmentation of bladder stones can be achieved by use of a
cystoscope Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope. The urethra is the tube that carries urine from the bladder to the outside of the body. The cystoscope has lenses like a telescope or microscope ...
which is inserted into the bladder. The
urologist Urology (from Greek οὖρον ''ouron'' "urine" and '' -logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive org ...
visualizes the stone and uses ultrasonic energy or
laser lithotripsy Laser lithotripsy is a surgical procedure to remove stones from urinary tract, i.e., kidney, ureter, bladder, or urethra. History Laser lithotripsy was invented at the Wellman Center for Photo medicine at Massachusetts General Hospital in the 198 ...
to cause fragmentation of the stones into small pieces, which are then flushed out of the bladder. This procedure requires anesthesia and may require admission to a hospital. Complications of this treatment include infection and damage to the bladder.Bladder Stones Overview: University of Maryland Medical Center
Retrieved on 2010-01-19.
Some stones are too large even for cystoscopic treatment and may require open cystotomy, in which an incision is made in the bladder and the stones are removed manually. For children with urinary stones, the evidence supporting treatment options is very weak and high quality trials are necessary to help guide clinical management.


Cystolithotomy

Cystolithotomy is a surgical procedure for the removal of bladder stones in the case that one has been deemed too large to pass naturally, such as developed jackstone calculi. This may require open surgery to remove the stone, however robotic cystolithotomy allows for a minimally invasive approach to remove the stone through much smaller incisions than the traditional approach. Most bladder stones can be dealt with by an endoscopic procedure, to avoid the need for a surgical incision. An open cystolithotomy is performed under
general anesthesia General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general ...
as an
inpatient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health car ...
procedure. The first step is a
cystoscopy Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope. The urethra is the tube that carries urine from the bladder to the outside of the body. The cystoscope has lenses like a telescope or microscop ...
to examine the bladder, then an incision is made in the lower abdomen. Once the stone is removed, the bladder is repaired with an absorbable stitch, and a
catheter In medicine, a catheter (/ˈkæθətər/) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgi ...
is inserted into the bladder via the
urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra c ...
. Occasionally it is necessary to gently drip fluid in and out of the bladder for a period, as there is often some bleeding following the procedure. The majority of patients do not have major side effects following cystolithotomy, but it may be followed by a minor burning sensation and light bleeding. More serious side effects include bladder infection, a prolonged need of catheter use, and infection in the surgical incision. Rare side effects may include delayed bleeding requiring removal of clots or further surgery, injury to the urethra causing
scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a n ...
formation, fever and more serious infection requiring a longer hospital stay, and delayed healing of the bladder, which may require a further procedure.


History

''Lithoclastic cystotomy'' is attributed to Ammonius Lithotomos (stone-cutter) of Alexandria, Egypt. The term "
lithotomy Lithotomy from Greek for "lithos" (stone) and "tomos" ( cut), is a surgical method for removal of calculi, stones formed inside certain organs, such as the urinary tract (kidney stones), bladder ( bladder stones), and gallbladder (gallstones), ...
" is derived from the same words (λιθοτομία (lithotomia) - stone-cutting).
Aulus Cornelius Celsus Aulus Cornelius Celsus ( 25 BC 50 AD) was a Roman encyclopaedist, known for his extant medical work, ''De Medicina'', which is believed to be the only surviving section of a much larger encyclopedia. The ''De Medicina'' is a primary source on ...
wrote that Lithotomos developed instruments to break up and extract bladder stones. Celsus gave the first description of lithotomy as performed before and during his time, and the operation has ever since borne his name—the Celsian method.


Etymology

Lithiasis (stone formation) in the bladder is called cystolithiasis (), from '' cysto-'' (bladder/cyst) + '' -lith'' (stone) + '' -iasis'' (disorder).


Other animals


References


External links

{{Urinary tract disease Urological conditions