1. Vesical calculus

2. Introduction Bladder calculi are uncommon in the Western world
They are well described in ancient medical literature
Hippocrates wrote about the management of bladder stone
Operations to remove stones via the perineum were described in the centuries BC
Suprapubic lithotomy was described in the 15th century
Transurethral lithotomy became popular in the 18th century
Lithotripsy was first described in 1822
Surgery was often associated with significant morbidity and mortality

3. Pathophysiology
Bladder calculi are usually associated with urinary stasis
Urinary infections increase the risk of stone formation
Foreign bodies (e.g. suture material) can also act as a nidus for stone formation
They can however form in a normal bladder
There is no recognized association with ureteric calculi

4. Pathophysiology
Most bladder calculi form in the bladder and are not from the upper urinary tract
They vary in size and can be multiple
They are more common in elderly men
In Asia, they are seen more commonly in children
Most stones in adults are formed of uric acid
Long-standing untreated bladder stones are associated with squamous cell carcinoma

5. Types
Primary
Secondary

6. Primary vesical calculus
Develops in sterile urine
Mostly originates in the kidney
Usually of oxalate or uric acid or urate type

7. Secondary vesical calculus
Associated with infection
Mostly originates in the bladder
Mostly made up of triple phosphate

8. Clinical features Bladder calculi can be asymptomatic
Common symptoms include
Suprapubic pain
Dysuria
Haematuria
Abdominal examination may be normal

9. Diagnosis
Historically stones were diagnosed by the passage of urethral 'sounds'
Today thy can be identified on
Plain abdominal x-ray
Bladder ultrasound
CT scan
Cystoscopy
Uric acid stones are radiolucent but may have an opaque calcified layer
Patients may present in acute urinary retention

10. 95% of the stones are radio- opaque

11. Management
Basically surgical
Suprapubic lithotomy
Litholaplaxy

12. Surgery Indications for surgery include
Recurrent urinary tract infections
Acute urinary retention
Frank haematuria
Any underlying bladder abnormality should be sought
Historically the surgical approach involved 'cutting for a stone'
This was via either a perineal or suprapubic approach
The three common approaches today are
Transurethral cystolitholapaxy
Percutaneous cystolitholapaxy
Open suprapubic cystostomy
Extracorporeal shockwave lithotripsy is relatively ineffective
Complications of cystolitholapaxy include
Infection
Haemorrhage
Bladder perforation
Hyponatraemia