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Urogenital Imaging

Calculus, bladder

stone formation in the bladder, classified as secondary, migrant, or endemic. Bladder calculi are usually secondary to bladder pathology, commonly bladder outlet obstruction, resulting in calcium oxalate or calcium phosphate stones. Other causes include bladder infection with urea-splitting organisms (results in triple phosphate stones), long-term catherization, bladder wall sutures and self-introduced foreign bodies. Migrant bladder stones originate in the kidney and pass into the bladder via the ureter. These are usually small and transient, exiting per urethra. However, if there is co-existent bladder outlet obstruction, such migrant stones may remain and grow in the bladder. Primary endemic bladder calculi were common in England and France during the 19th century, but are not now seen in the western world, probably due to nutritional and dietary improvements. Endemic bladder calculi still occur in children in countries such as Thailand and Indonesia.

Many bladder stones are asymptomatic and discovered incidentally on plain radiographs or urography (Fig.1). Possible symptoms include dull, suprapubic pain and haematuria. Up to 50% of bladder stones may not be discernable on plain radiographs. When visible, stones may be single or multiple, small or large, smooth or spiculated. Ultrasound reliably demonstrates bladder stones as echogenic lesions with acoustic shadowing. Mobility aids in the distinction from calcified bladder tumour. Stones can also be demonstrated by CT or MRI.

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Fig.1

Intravenous urogram showing multiple faceted stones in the bladder.
Calculus, bladder, Fig.1