Bladder calculi: Did the clinical picture change?

Objectives: Recent improvements in socioeconomic conditions have changed the clinical picture of urinary stones, including bladder calculi. With the ongoing changes in these predisposing factors, it is possible that the clinical picture of bladder calculi will show additional changes. Nevertheless, few contemporary series of bladder calculi in published English reports have addressed these issues. Methods: We retrospectively reviewed the records of 328 patients who underwent surgical therapy for bladder calculi at our institution from January 1995 to June 2005. Results: Acute urinary retention was the most common presenting symptom (n = 221, 67%). Patients who presented with urinary retention were younger (37 versus 48 years, P <0.001), had a greater incidence of recent renal colic (40% versus 19%, P <0.01), and had a lower incidence of bladder outlet obstruction (14% versus 37%, P <0.001) compared with the nonretention group. However, previous stone passage did not influence the probability of presenting with urinary retention. Small bladder stones were associated with a greater likelihood of presenting with urinary retention. The retention group had greater incidence of stones less than 1 cm in diameter compared with the nonretention group (72% versus 39%, P <0.001). Finally, calcium oxalate was found in 78% of patients with bladder calculi. Conclusions: Acute urinary retention was the main mode of presentation in patients with bladder calculi. Younger age, a history of recent renal colic, and smaller stones appeared to increase the likelihood for patients to present with urinary retention.