A bladder stone is a solid concretion

Enterolith

An enterolith is a mineral concretion or calculus formed anywhere in the gastrointestinal system. Enteroliths are uncommon and usually incidental findings but, once found, they require at a minimum watchful waiting...

 or crystal

Crystal

A crystal or crystalline solid is a solid material whose constituent atoms, molecules, or ions are arranged in an orderly repeating pattern extending in all three spatial dimensions. The scientific study of crystals and crystal formation is known as crystallography...

 aggregation found in the urinary bladder

Urinary bladder

The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...

. The term cystolithiasis refers to the presence of stones in the bladder.

Classification

Urinary stones may be composed of the following substances:

• Calcium oxalate monohydrate
  Whewellite
  Whewellite is a mineral, hydrated calcium oxalate, formula CaC2O4·H2O. Because of its organic content it is thought to have an indirect biological origin and this is supported by it being found in coal and sedimentary nodules. However, it has also been found in hydrothermal deposits where a...
  
   (whewellite)
• Calcium oxalate dihydrate
  Weddellite
  Weddellite is a mineral form of calcium oxalate named for occurrences of millimeter-sized crystals found in bottom sediments of the Weddell Sea, off Antarctica...
  
   (weddellite)
• Calcium phosphate
  Calcium phosphate
  Calcium phosphate is the name given to a family of minerals containing calcium ions together with orthophosphates , metaphosphates or pyrophosphates and occasionally hydrogen or hydroxide ions ....
  
  
• Magnesium phosphate
  Magnesium phosphate
  Magnesium phosphate is a general term for salts of magnesium and phosphate appearing in three forms:* Magnesium phosphate monobasic * Magnesium phosphate dibasic * Magnesium phosphate tribasic...
  
  
• Ammonium phosphate
  Ammonium phosphate
  Ammonium phosphate is the salt of ammonia and phosphoric acid. It has the formula 3PO4 and consists of ammonium cations and phosphate anion. It is obtained as a crystalline powder upon mixing concentrated solutions of ammonia and phosphoric acid, or on the addition of excess of ammonia to the...
  
  
• Ammonium magnesium phosphate
  Struvite
  Struvite 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 platey mica-like forms. It is a soft mineral with Mohs hardness of 1.5 to 2 and has a low specific gravity of 1.7...
  
   (struvite)
• Calcium hydroxyphosphate
  Apatite
  Apatite is a group of phosphate minerals, usually referring to hydroxylapatite, fluorapatite, chlorapatite and bromapatite, named for high concentrations of OH−, F−, Cl− or Br− ions, respectively, in the crystal...
  
   (apatite)
• Uric acid
  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 created when the body breaks down purine nucleotides. High blood concentrations of uric acid...
  
   and its salts (urates)
• Cystine
  Cystine
  Cystine is a dimeric amino acid formed by the oxidation of two cysteine residues that covalently link to make a disulfide bond. This organosulfur compound has the formula 2. It is a white solid, and melts at 247-249 °C...
  
  
• Xanthine
  Xanthine
  Xanthine , is a purine base found in most human body tissues and fluids and in other organisms. A number of stimulants are derived from xanthine, including caffeine and theobromine....
  
  
• Indigotin (rare)
• Urostealith
  Urostealith
  Urostealith is a fatty or resinous substance identified by the Austrian chemist J. F. Heller in 1845 as the main constituent of some bladder stones....
  
   (rare)
• Sulfonamide
  Sulfonamide (chemistry)
  In chemistry, the sulfonamide functional group is -S2-NH2, a sulfonyl group connected to an amine group.A sulfonamide is a compound that contains this group. The general formula is RSO2NH2, where R is some organic group. For example, "methanesulfonamide" is CH3SO2NH2...
  
   (rare)

Signs and symptoms

Bladder stones are small particles 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 the minerals like calcium or magnesium to crystallize and form stones. Bladder stones vary in number size and consistency. In some cases bladder stones do not cause any symptoms of signs and are discovered as an incidental finding on a plain radiograph

Projectional radiography

Projectional radiography or plain film radiography is the practice of producing two-dimensional images using x-ray radiation. Radiographic exams are typically performed by Radiologic Technologists, highly trained medical professionals who specialize in the usage of radiographic equipment, patient...

. 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

In medicine, hematuria, or haematuria, is the presence of red blood cells in the urine. It may be idiopathic and/or benign, or it can be a sign that there is a kidney stone or a tumor in the urinary tract , ranging from trivial to lethal...

. 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 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. The large prostate

Prostate

The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....

 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

Spinal cord injury

A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...

, paralysis or some type of nerve damage. When nerves to the back are damaged, the bladder cannot empty and stagnant urine results.

Causes

Bladder stones may occur whenever the kidneys, bladder, or ureters become inflamed

Inflammation

Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

. The use of urinary catheters

Urinary catheterization

In urinary catheterization , a latex, polyurethane or silicone tube known as a urinary catheter is inserted into a patient's bladder via his or her urethra. Catheterization allows the patient's urine to drain freely from the bladder for collection. It may be used to inject liquids used for...

 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

Catheter

In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...

s) placed into the bladder. The use of these tubes may lead to an infection

Infection

An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

, 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

Bladder cancer is any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis...

. Urinary schistosomiasis

Schistosomiasis

Schistosomiasis is a parasitic disease caused by several species of trematodes , a parasitic worm of the genus Schistosoma. Snails often act as an intermediary agent for the infectious diseases until a new human host is found...

, a disease caused by the digenea

Digenea

Digenea is a subclass within the Platyhelminthes consisting of parasitic flatworms with a syncytial tegument and, usually, two suckers, one ventral and one oral. Adults are particularly common in the digestive tract, but occur throughout the organ systems of all classes of vertebrates...

n trematode

Trematoda

Trematoda is a class within the phylum Platyhelminthes that contains two groups of parasitic flatworms, commonly referred to as "flukes".-Taxonomy and biodiversity:...

 Schistosoma haematobium

Schistosoma haematobium

Schistosoma haematobium is an important digenetic trematode, and is found in the Middle East, India, Portugal and Africa. It is a major agent of schistosomiasis; more specifically, it is associated with urinary schistosomiasis....

, 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 urinalysis , also known as Routine and Microscopy , is an array of tests performed on urine, and one of the most common methods of medical diagnosis...

, ultrasonography

Medical ultrasonography

Diagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...

, x rays

Medical radiography

Radiography is the use of ionizing electromagnetic radiation such as X-rays to view objects. Although not technically radiographic techniques, imaging modalities such as PET and MRI are sometimes grouped in radiography because the radiology department of hospitals handle all forms of imaging...

 or cystoscopy

Cystoscopy

Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.Diagnostic cystoscopy is usually carried out with local anaesthesia...

 (inserting a small thin camera into the urethra and viewing the bladder). The intravenous pyelogram

Intravenous pyelogram

An intravenous pyelogram is a radiological procedure used to visualize abnormalities of the urinary system, including the kidneys, ureters, and bladder.-Procedure:...

 can also be used to assess the presence of kidney stones. This test involves injecting a radiocontrast

Radiocontrast

Radiocontrast agents are a type of medical contrast medium used to improve the visibility of internal bodily structures in an X-ray based imaging techniques such as computed tomography or radiography...

 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.

Prevention

The best way to prevent bladder stones is to drink plenty of liquids. Juices containing citrates 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 prostatic hypertrophy

Benign prostatic hyperplasia

Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....

 should seek treatment.

Management

Increasing fluid intake can facilitate the passage of small bladder stones. However, larger stones may require other methods of treatment. Fragmentation of bladder stones can be achieved by use of a cystoscope

Cystoscopy

Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.Diagnostic cystoscopy is usually carried out with local anaesthesia...

 which is inserted into the bladder. The urologist

Urology

Urology is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological...

 visualizes the stone and uses ultrasonic energy

Ultrasound

Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...

 or laser lithotripsy

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 Wellman Center for Photomedicine in the 1980s to remove impacted stones from the urinary tract. Laser pulses delivered through a fiber...

 to to cause fragmentation of the stones into small pieces which are then flushed out of the bladder. This procedure requires anesthesia

Anesthesia

Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

 and may require admission to a hospital. Complications of this treatment include infection and damage to the bladder. 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.

History

Lithoclastic cystotomy is attributed to Ammonius Lithotomos

Ammonius Lithotomos

Ammonius Lithotomos ,, of Alexandria, Greek lithotomist. Reported by Celsus he invented the tools to break up "bladder stones"....

 (stone-cutter) of Alexandria, Egypt. The term "lithotomy

Lithotomy

Lithotomy from Greek for "lithos" and "tomos" , is a surgical method for removal of calculi, stones formed inside certain hollow organs, such as the kidneys , bladder , and gallbladder , that cannot exit naturally through the urinary system or biliary tract...

" is derived from the same words (λιθοτομία (lithotomia) - stone-cutting). Aulus Cornelius Celsus

Aulus Cornelius Celsus

Aulus Cornelius Celsus was a Roman encyclopedist, 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 diet, pharmacy, surgery and related fields, and it is one of the best sources...

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.