Answers :

What does the abdominal radiograph show ?

There are calcified lesions overlying the lower pelvis.

Where does the abnormality lie ?

These are bladder calculi.

The calculi have calcified in layers and appear lamellated. This is not calcification in the bladder wall. Bladder calcification is thin and curvi-linear and conforms to the bladder shape.

They are much commoner in men than women and are frequently associated with outflow tract obstruction, typically secondary to an enlarged prostate. Bladder dysfunction can result in incomplete emptying of the bladder which predisposes the patient to the formation of calculi. Therefore bladder calculi can be associated with a neuropathic bladder.

What are the possible treatments?

Bladder calculi used to be removed surgically with an open operation. (Samuel Peyps died as result of complications of bladder surgery for a bladder stone!) They are usually removed endoscopically through the penis but may need crushing or fragmenting before removal.