Can uric acid bladder stones cause dyspareunia?

Uric Acid Bladder Stones Can Cause Dyspareunia

Uric acid bladder stones can cause dyspareunia through direct mechanical irritation of the bladder wall and surrounding pelvic structures during sexual intercourse.

Mechanism and Presentation

Bladder stones, including those composed of uric acid, can contribute to dyspareunia through several mechanisms:

• Direct mechanical irritation: During intercourse, the movement can cause the stone to irritate the bladder wall, triggering pain that may be felt during penetration 1
• Referred pain: Bladder irritation from stones can cause pain that radiates to the vaginal area or pelvis
• Associated inflammation: Chronic irritation from stones can lead to inflammation of the bladder wall, which sensitizes surrounding tissues

Diagnostic Considerations

When evaluating dyspareunia potentially related to bladder stones:

• Imaging studies are essential for diagnosis:

  • Non-contrast CT scan is the gold standard for detecting urinary stones 2
  • Ultrasound may be used but has lower sensitivity (45%) compared to CT 2
  • Dual-energy CT can specifically identify uric acid composition of bladder sediment or stones 3

• Clinical symptoms that may suggest bladder stones as the cause of dyspareunia:

  • Pain during intercourse, particularly with deep penetration
  • Concurrent urinary symptoms (frequency, urgency, hematuria)
  • Suprapubic pain that worsens with bladder filling or movement
  • Pain that changes with position during intercourse

Management Approach

If uric acid bladder stones are identified as the cause of dyspareunia:

1. Stone removal is indicated when:

   • Symptoms are present (including dyspareunia)
   • Stone growth is documented
   • Associated infection develops 2

2. Treatment options based on stone size and composition:

   • Medical dissolution therapy for uric acid stones:

     • Urinary alkalization with potassium citrate or sodium bicarbonate to maintain pH between 6.2-6.8 4, 5
     • High fluid intake (>2 liters daily) to increase urine volume 4
     • Low-purine diet to reduce urinary uric acid excretion 4

   • Surgical intervention when medical management fails:

     • Cystoscopy with stone removal for smaller stones
     • Percutaneous cystolithotomy for larger stones
     • Transurethral cystolitholapaxy

Prevention of Recurrence

After successful treatment:

• Continued urinary alkalization with potassium citrate (preferred over sodium bicarbonate) to maintain pH 6.2-6.8 4, 5
• Increased fluid intake to maintain urine output >2 liters daily 4
• Regular follow-up to monitor for stone recurrence
• Dietary modifications to reduce purine intake if hyperuricosuria is present 4

Important Considerations

• Dyspareunia has multiple potential causes, and bladder stones may be overlooked if not specifically considered
• The AUA guidelines specifically mention that bladder stones are a clinical mimic of interstitial cystitis/bladder pain syndrome, which commonly presents with dyspareunia 1
• Treatment of the underlying stone is essential, as symptomatic management alone will not resolve the problem
• Resolution of dyspareunia should be expected following successful treatment of bladder stones

In cases where dyspareunia persists after stone treatment, further evaluation for other causes such as interstitial cystitis, pelvic floor dysfunction, or gynecological conditions should be pursued.