Urinary bladder stones in women

PURPOSE: The objective of this study was to review the history, epidemiology, diagnosis, and current management techniques for bladder stones (BS) in women. METHODS: A MEDLINE search for articles published from 1950 to 2011 was done using a list of terms related to BS including calculi, cystolithiasis, stones, urinary bladder, and women. RESULTS: Approximately 5% of all BS occur in women and are usually associated with foreign bodies (sutures, synthetic tapes, or meshes) or urinary stasis. Bladder stones can be asymptomatic but may result in hematuria, recurrent infections, and irritable symptoms. Stones can be detected by x-ray, ultrasound, or computed tomography scan and frequently at the time of routine cystourethroscopy performed during pelvic surgery. Because BS is a sign of an underlying problem, definite treatment of the underlying abnormality is nearly always indicated. The preferred treatment for BS is endoscopic transurethral fragmentation of the stone (cystolithotripsy). Any associated suture or synthetic mesh can be removed or cut flush with the bladder mucosa. Partial resection of the mesh with cystotomy should be considered whenever transurethral treatment failed. When stone burden is large, percutaneous endoscopic disintegration or open suprapubic cystolithotomy is preferable. Extracorporeal shockwave lithotripsy has been demonstrated to be simple, effective, and well tolerated. However, ancillary procedures are required in a significant number of patients. CONCLUSIONS: The increased usage of synthetic material in reconstructive pelvic floor surgery in women will probably increase the incidence of BS on intravesical foreign bodies. Bladder stones should be ruled out in women investigated for irritable bladder symptoms or recurrent urinary infection. TARGET AUDIENCE: Obstetricians and gynecologists, family physicians LEARNING OBJECTIVES: After completing this CME activity, physicians should be better able to identify risk factors for bladder stones, diagnose bladder stones, and compare the optional treatments for bladder stones in women.