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Bladder Stones

Bladder Stones are hard mineral deposits that form within the urinary bladder. They usually develop when the bladder does not empty completely, allowing urine to stagnate and minerals to crystallize. Bladder Stones may cause lower urinary tract symptoms, hematuria, recurrent infection, and urinary obstruction

Also called

Cystolithiasis

ICD-10

N21.0

Specialty

Urology

Onset

Chronic

Reviewed

August 2026
On This Page

Overview

–Bladder Stones may form primarily in the bladder or develop when a stone migrates from the upper urinary tract and becomes retained. The most important mechanism is urinary stasis caused by incomplete bladder emptying.

-Common underlying causes include:

  • Bladder outlet obstruction
  • Benign Prostatic Hyperplasia (BPH)
  • Neurogenic bladder

Etiology & Risk Factors

-Etiology

–Bladder Stones usually develop because stagnant urine becomes concentrated, allowing crystals to precipitate and enlarge around a nidus.

Important causes include:

  • Bladder outlet obstruction
  • Benign Prostatic Hyperplasia (BPH)
  • Neurogenic bladder
  • Chronic urinary retention
  • Recurrent UTI
  • Bladder foreign bodies

-Risk Factors

  • Benign Prostatic Hyperplasia (BPH)
  • Neurogenic bladder
  • Chronic incomplete bladder emptying
  • Recurrent Urinary Tract Infection (UTI)
  • Indwelling urinary catheters

Pathophysiology

Incomplete bladder emptying → urinary stasis → concentrated urine and mineral precipitation → crystal formation → aggregation and stone growth → bladder irritation or obstruction

Clinical Presentation

-Symptoms:

  • Suprapubic pain
  • Dysuria
  • Urinary frequency
  • Urinary urgency
  • Intermittent urinary stream
  • Sudden interruption of the urinary stream
  • Terminal hematuria

 

-Signs:

  • Suprapubic tenderness
  • Palpable distended bladder when chronic retention is present
  • Signs of an underlying neurological disorder
  • Signs of bladder outlet obstruction
Bladder Stones Overview
Bladder Stones Overview

History Taking

-Ask about:

  • Suprapubic pain
  • Dysuria
  • Hematuria
  • Frequency and urgency
  • Interrupted urinary stream
  • Weak urinary stream
  • Hesitancy
  • Feeling of incomplete bladder emptying
  • Previous urinary stones
  • Recurrent UTI
  • History of Benign Prostatic Hyperplasia (BPH)

Physical Examination

-General Examination

  • Assess for fever or systemic infection
  • Assess hydration status
  • Look for signs of neurological disease

 

-System-Specific Examination:

  • Assess suprapubic tenderness
  • Check for a distended bladder
  • Perform a focused neurological examination when indicated
  • Assess the prostate when bladder outlet obstruction is suspected

Investigations

Biochemistry / Specific Tests

  • Urinalysis

  • Urine culture when infection is suspected

  • Renal function when obstruction or kidney impairment is suspected

  • Post-void residual urine measurement

  • Stone analysis after removal

 

-Imaging

Ultrasound

Useful for detecting Bladder Stones and assessing post-void residual urine.

Plain X-ray of the Kidneys, Ureters, and Bladder (KUB)

May detect radiopaque stones.

Non-contrast Computed Tomography (CT)

Useful when the diagnosis is uncertain or additional upper urinary tract stones are suspected.

 

-Special / Confirmatory Tests

Cystoscopy

Allows direct visualization of the stone and may identify underlying obstruction, foreign bodies, or other bladder pathology.

Diagnosis

-Bladder Stones are diagnosed by:

Lower urinary tract symptoms → urinalysis and assessment for infection → ultrasound or other imaging → cystoscopy when direct visualization or treatment is required.

The underlying cause of urinary stasis should always be assessed.

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Management

1. Definitive Treatment

Most symptomatic Bladder Stones require removal.

The treatment method depends on stone size, number, anatomy, and available expertise.

 

2. Medical Treatment

Medication alone usually does not remove most bladder stones.

Important treatment may include:

  • Antibiotics for proven Urinary Tract Infection (UTI)

  • Analgesics for pain

  • Treatment of the underlying bladder outlet obstruction

 

3. Surgical / Procedural Treatment

Cystolitholapaxy

Endoscopic fragmentation and removal of bladder stones. This is a common definitive treatment.

Percutaneous Cystolitholapaxy

May be used for selected large stones.

Open Cystolithotomy

May be required for very large stones or when endoscopic treatment is unsuitable.

The underlying cause, such as significant BPH, may also require treatment.

 

4. Supportive Management

  • Adequate hydration

  • Management of urinary retention

  • Treatment of bladder outlet obstruction

  • Prevention of recurrent UTI

Complications

  • Recurrent Urinary Tract Infection (UTI)
  • Acute urinary retention
  • Chronic urinary retention
  • Bladder outlet obstruction
  • Hematuria
  • Hydronephrosis
  • Kidney dysfunction
  • Stone recurrence

Prognosis

The prognosis of Bladder Stones is generally excellent after complete stone removal and correction of the underlying cause. Recurrence is more likely when urinary retention, neurogenic bladder, recurrent infection, or bladder outlet obstruction persists.

Key Points / Clinical Pearls

  • Bladder Stones are mineral calculi located within the urinary bladder.
  • Incomplete bladder emptying is a major cause.
  • Benign Prostatic Hyperplasia (BPH) is an important cause in adult men.
  • Neurogenic bladder can predispose to recurrent stones.
  • Common symptoms include suprapubic pain, dysuria, and hematuria.
  • Sudden interruption of the urinary stream is a classic clinical clue.
  • Urinalysis helps identify hematuria and infection.
  • Ultrasound can detect stones and assess residual urine.
  • Cystoscopy can directly visualize and treat many bladder stones.
  • Most symptomatic Bladder Stones require removal.
  • Cystolitholapaxy is a common definitive treatment.
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