Bladder Calculi Typically Present with Painful Hematuria, Not Painless Hematuria
FALSE. Bladder calculi typically present with painful hematuria, irritative voiding symptoms, and suprapubic discomfort rather than painless hematuria.
Clinical Presentation of Bladder Calculi
Bladder calculi present with a constellation of symptoms that typically include:
- Painful hematuria, often associated with irritative voiding symptoms including dysuria, frequency, and urgency 1
- Suprapubic pain or discomfort, especially during urination or at the end of micturition 2
- Recurrent urinary tract infections, which are common in patients with bladder stones 3
- Intermittent urinary stream or urinary retention, particularly in males with concurrent prostatic enlargement 1
Differentiating from Painless Hematuria
Painless hematuria is more commonly associated with:
- Bladder cancer, where approximately 80% of patients present with painless hematuria 4
- Upper tract urothelial carcinoma, which also frequently presents with painless hematuria 5
- Certain glomerular disorders, which can cause microscopic hematuria without pain 6
Risk Factors for Bladder Calculi
Bladder stones typically develop secondary to:
- Bladder outlet obstruction (e.g., prostatic enlargement, urethral stricture) 1
- Foreign bodies (e.g., indwelling catheters, sutures, synthetic mesh) 2
- Neurogenic bladder dysfunction 3
- Urinary stasis and chronic infection 1
- In children, dietary factors in endemic areas 7
Diagnostic Approach for Suspected Bladder Calculi
When bladder calculi are suspected, the appropriate diagnostic approach includes:
- Urinalysis to confirm hematuria and assess for signs of infection 6
- Imaging studies, typically starting with ultrasound which can effectively visualize bladder stones 6
- Cystoscopy, which is indicated for patients with hematuria and allows direct visualization of bladder stones 6, 5
Important Clinical Considerations
- Any episode of gross hematuria in adults warrants urologic evaluation due to the risk of underlying malignancy, regardless of whether it is painful or painless 6
- Patients with neurogenic lower urinary tract dysfunction who develop hematuria should undergo cystoscopy to rule out bladder stones, strictures, or malignancy 6
- Bladder calculi can occasionally be asymptomatic but are rarely associated with purely painless hematuria 2
- In patients with spinal cord injury or neurogenic bladder, symptoms may be atypical due to altered sensation 6
Common Pitfalls to Avoid
- Do not attribute hematuria solely to anticoagulant or antiplatelet therapy without appropriate evaluation 6
- Do not assume that painless hematuria indicates a benign condition; it is more strongly associated with malignancy than with bladder calculi 4, 5
- Do not delay urologic referral for patients with gross hematuria while waiting for other test results 5
- Remember that patients with neurogenic bladder may not experience typical pain symptoms despite having bladder calculi 6