Bladder Stones Clinical Presentation

Updated: Feb 04, 2020
  • Author: Joseph Basler, MD, PhD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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History and Physical Examination

The presentation of vesical calculi ranges from a complete absence of symptoms to the presence of suprapubic pain, dysuria, intermittency, frequency, hesitancy, nocturia, and urinary retention. [3] Parents of children with vesical calculi may notice priapism and occasional enuresis. [10]

Other common signs include terminal gross hematuria and sudden termination of voiding with some degree of associated pain referred to the tip of the penis, scrotum, perineum, back, or hip. The discomfort may be dull or sharp and is often aggravated by sudden movements and exercise. Assuming a supine, prone, or lateral head-down position may alleviate the pain initiated when the stone contacts the bladder neck by causing the stone to roll back into the bladder.

A history of prior pelvic surgery should be sought in all patients, especially when synthetic materials were implanted. [26]

Common physical examination findings include suprapubic tenderness, fullness, and, occasionally, a palpable distended bladder if the patient is in acute urinary retention. Associated findings include cystoceles in women, stomal stenosis (if the patient had undergone prior urinary diversion), and neurologic deficits in patients with neurogenic bladder.

Historically, bladder calculi were diagnosed on the basis of transurethral passage of van Buren sounds. Contact between a van Buren sound and a stone causes transmission of a clicking noise or vibration, which confirms the presence of the stone. Because of advances in cystoscopy, this maneuver is not used today. Currently, imaging studies are used to identify bladder stones (see Workup).