Diagnostic Workup and Management of Bladder Stones

Diagnostic Evaluation

Non-contrast CT scan is the gold standard imaging modality for diagnosing bladder stones, providing detailed information about stone location, size, density, and surrounding anatomy 3
Ultrasound is recommended as the first-line imaging tool with 88% sensitivity for bladder stones, offering the advantage of no radiation exposure 3
KUB (kidney-ureter-bladder) radiography helps differentiate between radiopaque and radiolucent stones and is useful for follow-up imaging 3
Basic laboratory evaluation should include serum electrolytes, calcium, creatinine, and uric acid to identify underlying medical conditions 3
Urinalysis with dipstick and microscopic evaluation to assess for infection, pH, and crystals that may indicate stone type 3
Urine culture to rule out infection, especially if intervention is planned 4, 5

Urgent intervention required if signs of infection or sepsis with obstructing stone, renal insufficiency, or intractable pain or hematuria 4, 5
Presence of bladder outlet obstruction (e.g., BPH) should be addressed concurrently with stone removal 1, 2
Neurogenic bladder or recurrent UTIs require active intervention and appropriate bladder management strategies 1, 2

Surgical management of BPH (e.g., TURP) should be considered concurrently with stone removal for bladder stones due to BPH 1, 2
Implement appropriate bladder management strategies (intermittent catheterization, indwelling catheter) for bladder stones due to neurogenic bladder 2
Address any urinary tract infection before definitive stone treatment 4, 5

Antimicrobial prophylaxis should be administered prior to all endoscopic stone procedures, based on prior urine culture results and local antibiogram 4, 5
All retrieved stone material should be sent for analysis to guide prevention strategies, except for patients with multiple recurrent stones of previously documented composition 3, 4, 5

Increased fluid intake to target urine output >2.5 L/day can help prevent recurrent stone formation 1, 3
Management of bladder outlet obstruction and appropriate bladder drainage in neurogenic bladder can help prevent recurrent stone formation 1, 2, 3