How do I identify bacteria biofilm and phleboliths/calcification for UTI symptoms in bladder x-ray?

Doctor's Answers 2

An Xray of the Kidneys, Ureters and Bladder (KUB Xray) is done to look for stones, which may cause UTI or symptoms similar to UTI such as pain on passing urine or abdominal pain.

Biofilms are a collection of microorganism on a surface. Their formation begins when free-floating bacteria come in contact with an appropriate surface such as the inner lining of the bladder and begins attach to this surface. This enables the bacteria in a biofilm to stick together. Attachment is followed by a period of growth. Biofilm increases the resistance of bacteria to the host immune response and to antibiotics. Biofilms are microscopic, so they will not be visible on x-rays.

Phleboliths are small round calcifications located in veins. They are more common in the pelvis, and their significance is that they can be mistaken for stones on xrays. Phleboliths typically do not move and are harmless.

The difference between phleboliths and stones in the ureter are: 1) Round shape (stones are not typically round and have jagged edges), Position, Presence of central lucency. In some cases, a CT scan may be needed to differentiate between a stone and phlebolith.

Photo of Dr Grace Su
Dr Grace Su

General Practitioner

To answer this question, we first need to discuss briefly how X-rays work.

When X-rays travel through the body, they are absorbed in different amounts by different tissues, depending on the properties of these tissues, in particular, how radiologically dense these tissues are.

Structures such as bone contain calcium which helps them absorb X-rays more readily. This, in turn, produces high contrast on the X-ray detector causing bony structures to appear whiter than other tissues on an X-ray image.

Conversely, X-rays travel more easily through less radiologically dense tissues such as fat and muscle, as well as structures that are air-filled, like our lungs. These structures are displayed in shades of grey on a radiograph.

Phleboliths and calcification have differing radiologic densities and, depending on how white they appear on a film, radiologists are usually able to guess at their likely consistency and, hence, what they are likely to be when a white image appears on a bladder X-ray.

Unfortunately, bacterial biofilms are too small and aren't radiologically dense. Hence, they would not appear as an image on an X-ray.

Identifying phleboliths/calcifications is important for UTIs because they are a nidus for infection to grow (which can result in recurrent infections). Calcifications in the wrong places (like the ureter) can also result in discomfort, obstruction and infection and, depending on size and location, may even require surgical removal.

Similar Questions

Under what circumstances are belching a sign of bacterial overgrowth and how do I relieve the symptoms?

In general, belching is normal and physiological and most people belch after meals. Belching may be associated with muscular weakness at the gastro-esophageal junction and may bring along with it acid from the stomach resulting in heartburns. This is not necessarily problematic unless the heartburn becomes frequent or disturbing. Bacteria is present throughout our digestive tract and each person has his or her own bacteria colonies in various quantities depending on their diet.

Photo of Dr Wai Leong Quan

Answered By

Dr Wai Leong Quan


What are the signs and symptoms of a UTI (urinary tract infection)?

This depends on the site of the infection. The most common site of UTI in a young female is the bladder - this is called cystitis. Symptoms of cystitis may include one or more the following: Painful burning sensation during urination (Dysuria) Frequent urination (frequency) Difficulty postponing urination (urgency) Pain over the lower abdomen Fever Signs of Cystitis include tenderness of the lower abdomen when it is pressed.

Photo of Human

Answered By


Ask any health question for free

I’m not so sure about a procedure...

Ask Icon Ask a Question

Join Human

Sign up now for a free Human account to get answers from specialists in Singapore.

Sign Up

Get The Pill

Be healthier with our Bite-sized health news straight in your inbox