Signs and Symptoms of Cystolithiasis (Bladder Stones)
Cystolithiasis typically presents with recurrent urinary tract infections, hematuria, and urinary retention, though patients may be asymptomatic if stones are not causing obstruction or irritation. 1
Primary Clinical Manifestations
Pain Patterns
- Lower abdominal or suprapubic pain is the most common presenting symptom, distinct from the severe flank pain characteristic of kidney stones 2
- Pain may worsen with movement or physical activity as the stone shifts position within the bladder 1
- Unlike renal colic, bladder stone pain is typically less severe and more chronic in nature 2
Urinary Symptoms
- Hematuria (blood in urine) occurs from mechanical irritation of the bladder wall by the stone 2, 1
- Urinary retention or difficulty voiding, particularly in patients with underlying bladder outlet obstruction 1
- Intermittent urinary stream or sudden interruption of flow when the stone obstructs the bladder neck 1
- Increased urinary frequency and urgency from bladder irritation 1
Infectious Complications
- Recurrent urinary tract infections are a hallmark feature, presenting with cloudy or foul-smelling urine 2, 1
- Fever and chills when infection is present 2
- Bladder stones can develop secondary to chronic UTIs with urease-producing organisms, creating a vicious cycle 3
Asymptomatic Presentation
- Some patients, particularly those with neurogenic bladder or cognitive impairment, may have completely asymptomatic stones discovered incidentally on imaging 1
- Asymptomatic stones that don't cause obstruction or infection may remain undetected for extended periods 2
Risk Factors and Associated Conditions
- Bladder outlet obstruction from benign prostatic hyperplasia is the most common predisposing factor in men 4, 1
- Neurogenic bladder and voiding dysfunction increase risk through urinary stasis 3
- Presence of foreign bodies (catheters, sutures) or urinary diversion 4, 3
- History of urethral stricture disease or closed bladder neck 4
Red Flag Symptoms Requiring Urgent Evaluation
- Complete urinary retention (anuria) suggests bladder neck obstruction requiring immediate intervention 2
- Fever with urinary symptoms indicates possible infected stone, which can progress to urosepsis 2, 3
- Signs of sepsis including high fever, hypotension, tachycardia, or altered mental status constitute a medical emergency 2
Common Pitfalls
- Mistaking bladder stone symptoms for simple UTI or prostatism without imaging evaluation can delay diagnosis 1
- In mentally impaired or neurologically compromised patients, stones may grow to massive size (>400g reported) without obvious symptoms due to inability to communicate discomfort 1
- Assuming all lower urinary tract symptoms in elderly men are due to BPH without ruling out bladder stones 4