🪨 Men's Health

Bladder Stones in Nigeria

Causes, symptoms, and treatment of stones in the urinary bladder

Bladder stones (vesical calculi) are hard deposits of minerals that form in the bladder when urine becomes concentrated and minerals crystallise. Unlike kidney stones (which form in the kidney and may pass into the bladder), primary bladder stones form directly in the bladder, usually because urine cannot drain properly. In Nigeria, bladder stones are associated with untreated benign prostatic hyperplasia (BPH) in men, recurrent urinary tract infections, urinary catheters, and bladder foreign bodies (including bladder sutures from prior pelvic surgery). They cause significant pain, urinary symptoms, and recurrent infections if not treated.

Signs and Symptoms

✓ Lower abdominal pain or suprapubic discomfort
✓ Urinary frequency and urgency
✓ Difficulty starting urination or weak stream (especially with co-existing BPH)
✓ Interruption of urinary stream: stops suddenly in mid-flow (classic symptom, stone blocks internal urethral opening, then moves)
✓ Painful urination (dysuria)
✓ Haematuria: blood in urine (visible or microscopic)
✓ Urinary tract infections: recurrent infections despite treatment
✓ Urinary retention: unable to pass urine at all (complete obstruction)

Risk Factors

  • Benign prostatic hyperplasia (BPH): most common cause in Nigerian men > 50, incomplete bladder emptying causes stasis and stone formation
  • Recurrent urinary tract infections: certain bacteria (urease-producing: Proteus, Klebsiella) produce ammonia that crystallises into struvite stones
  • Indwelling urinary catheter: biofilm and encrustation on catheter surface
  • Bladder diverticulum (outpouching): poor drainage predisposes to stone formation
  • Neurogenic bladder (diabetes, spinal cord injury, Parkinson's): incomplete emptying
  • Dehydration: concentrated urine precipitates crystals
  • Foreign bodies in bladder
  • Prior pelvic surgery with non-absorbable suture material migrating into bladder

When to Seek Help

Interruption of urine streamThe pathognomonic symptom of bladder stone: seek investigation with bladder ultrasound
Blood in urine + lower urinary tract symptomsBladder stone AND bladder cancer can both present this way, imaging needed to distinguish
Acute urinary retention: unable to pass urineEmergency: needs urethral catheterisation
Recurrent UTIs in a manMen rarely get UTIs: recurrent UTIs in men almost always indicate an underlying structural cause: BPH, bladder stone, or stricture
All confirmed bladder stonesUnlike small kidney stones, bladder stones rarely pass spontaneously. They require active treatment

Tests & Diagnosis

🧪 Bladder ultrasound
The primary investigation: shows hyperechoic (bright) stone with posterior acoustic shadowing. Can detect stones > 5mm. Also assesses prostate size (if BPH co-exists) and post-void residual
🧪 Plain X-ray (KUB)
Calcium oxalate and calcium phosphate stones are radio-opaque. Uric acid stones are radiolucent (not visible on plain X-ray)
🧪 CT scan of urinary tract (non-contrast)
Gold standard for stone detection: 95% sensitivity. Shows all stone types. Identifies coexisting upper tract stones
🧪 Urine dipstick and culture
Haematuria on dipstick confirms. Culture identifies organism if UTI present
🧪 Serum urea and creatinine
Assess kidney function: especially if obstruction or recurrent stones
🧪 PSA (prostate-specific antigen) in men > 50
If BPH co-exists: assess prostate health

Treatment Options

1
Cystoscopy and litholapaxy
Most common treatment: cystoscope passed through urethra into bladder under anaesthesia. Stone fragmented with lithotrite, pneumatic, ultrasonic, or laser energy, then washed out. Day case or short stay. Available at urology departments in teaching hospitals and private hospitals
2
Extracorporeal shock wave lithotripsy (ESWL)
Shock waves break the stone: less invasive but less effective for bladder stones than for kidney stones. Limited availability in Nigeria
3
Open surgical cystolithotomy
Open surgical removal: reserved for very large stones (> 4cm), failed endoscopic treatment, or when cystoscopy equipment unavailable. Longer recovery but highly effective
4
Treating the underlying cause (essential)
Removing the stone without treating the cause (BPH, infection, foreign body) leads to recurrence. BPH: alpha-blockers (tamsulosin) or TURP surgery. Recurrent UTI: prolonged antibiotic treatment
5
Hydration
Maintain good fluid intake (> 2L/day) to dilute urine and reduce recurrence risk after treatment
6
Stone composition analysis
Sent to laboratory after removal: guides dietary advice to prevent recurrence (uric acid stones: reduce red meat; calcium stones: reduce salt, moderate calcium intake)

Frequently Asked Questions

Can bladder stones pass on their own?
Unlike small kidney stones (< 5mm), bladder stones very rarely pass spontaneously. They are usually too large when detected, and incomplete bladder emptying (the cause) makes passage unlikely. Almost all bladder stones require active treatment (cystoscopy). Do not wait hoping they will pass.
Is bladder stone related to kidney stone?
They can be: kidney stones that pass from the kidney down the ureter into the bladder may remain and grow in the bladder. However, most primary bladder stones form in the bladder itself due to local factors (BPH, infection). Bladder and kidney stones can coexist and a CT scan of the whole urinary tract assesses both simultaneously.
Will surgery for bladder stone affect my ability to urinate?
Endoscopic surgery (cystoscopy) rarely affects urinary function, the urethra is temporarily enlarged during the procedure and there may be mild discomfort for 2–3 days. A temporary catheter is often left overnight. Most patients return to normal voiding within 24–48 hours.
Is a bladder stone the same as a prostate problem?
They are different conditions but frequently coexist: BPH (benign prostate enlargement) causes incomplete bladder emptying, which leads to stasis and stone formation. Treating BPH alone without removing the stone (or vice versa) leads to recurrence. Both need to be addressed.

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Last updated 16 October 2026.