Bladder stones

Bladder stones are hard lumps of minerals that form in the bladder, usually when urine doesn't empty properly and becomes concentrated. They are less common than kidney stones but can cause significant problems — pain, blood in urine, infection, and blockage. Bladder stones are more common in men, especially older men with enlarged prostates.

Causes

• Enlarged prostate (BPH) — the most common cause in older men; urine can't empty fully, stays in the bladder and concentrates
• Neurogenic bladder — nerve damage from spinal cord injury, stroke, or conditions like spina bifida, causing incomplete emptying
• Urinary catheters — long-term use raises the risk
• Bladder diverticula — outpouchings where urine pools
• Bladder outlet obstruction from other causes
• Recurrent urinary tract infections
• Kidney stones that descend and lodge in the bladder
• In children, nutritional deficiencies or urinary tract abnormalities — "endemic bladder stones" in children was historically common in parts of rural India but has declined with better nutrition

Symptoms

• Lower abdominal pain
• Pain or difficulty during urination
• Blood in urine
• Cloudy or dark urine
• Frequent urination, especially at night
• Urinary urgency
• Interrupted urine stream
• Recurrent urinary infections

Small stones may cause no symptoms and be found incidentally on imaging.

Diagnosis

• Urine tests — for blood and infection
• Ultrasound of the urinary tract — first-line imaging
• CT scan — for detailed assessment
• Cystoscopy — a camera inserted through the urethra to see the bladder directly; can diagnose and sometimes treat

Treatment

• Small stones — may pass on their own with increased fluid intake
• Cystolitholapaxy — the most common treatment: a camera inserted via the urethra breaks the stone with a laser, ultrasound, or mechanical device, and the fragments are flushed out
• Open surgery — for very large or hard stones, or when other options aren't suitable
• Treating the underlying cause is essential — prostate surgery for BPH, intermittent catheterisation for neurogenic bladder, otherwise the stones will recur

Drink plenty of fluids and attend to any urinary symptoms early — stone prevention relies on treating the cause of incomplete bladder emptying.