Definition & Overview
Bladder stone treatment takes several forms, depending on the size of the stone, the underlying condition, and the patient's overall health status. Whenever possible, physicians recommend removing the stones using medication. If this method does not adequately address the condition, surgical intervention is considered.
The urinary bladder, more commonly called the bladder, is a sac located behind the pubic bone in the pelvic area. It is connected to the kidneys via a pair of tubes called the ureters. It is composed of muscular tissues laid in layers and stretches to hold urine coming from the kidneys. Without the bladder, there is no conscious or voluntary way for the body to control the frequency of urination.
A bladder stone develops when urine is stored for a long time and becomes concentrated, causing the minerals to crystallise and harden into masses. The hardened masses are sometimes called bladder calculi. There are several types of bladder stones, categorised based on their composition. An example is a uric acid stone, which is the most common type. Another type is composed of calcium oxalate, typically found in kidneys. Other stones are composed of lesser occurring components, such as ammonium urate, magnesium ammonium phosphate, calcium phosphate or struvite, and cysteine.
Who Should Undergo and Expected Results
Patients with bladder stones should undergo treatment for their condition. In cases where the stones are quite small, no symptoms may manifest. However, if they become large enough to cause urine blockage, the patient will experience pain in the abdomen, especially in the lower area. Urination becomes a painful task, and in most cases, the need to void becomes more and more frequent. The urine also becomes dark coloured and cloudy, sometimes becoming pink when blood is mixed in it. Patients who have underlying kidney conditions may also develop stones in their kidneys that may get carried down into the bladder and grow in size with the addition of crystals.
There are several risk factors that contribute to the development of bladder stones. These include:
Damage to the nerves that control bladder function - Conditions like spina bifida or motor neuron diseases can degrade the said nerves. This prevents patients from being able to complete empty their bladder. The residual urine crystallises and forms into stones.
Enlargement of the prostate gland — Among older men, the enlargement of this gland also increases the risk of developing bladder stones. The gland can block the flow of urine by pressing on the urethra, the tube that serves as a passageway for the urine from the bladder to the penis.
Surgery of the bladder to treat urge incontinence - The procedure, termed bladder augmentation surgery, involves making the bladder larger by transplanting tissue from the bowel.
The presence of bladder diverticula - This condition is characterised by the development of small pouches in the bladder wall that can become larger and hinder the flow of urine. There are children who are born with this condition while some adults develop it due to the enlargement of the prostate or infection.
Childbirth – Women who undergo the strain of labour can develop a condition called cystocele. This occurs when part of the bladder wall drops down into the vagina and impede the flow of urine.
Diet - A high fat diet coupled with less fluid intake can increase the risk of developing bladder stones.
Most modalities for the treatment of bladder stones are quite effective, allowing the patient to achieve relief from their condition.
How is the Procedure Performed?
One pharmacologic method of treating bladder stones is the use of alkalising agents to dissolve these hardened masses. The use of potassium citrate can be quite effective in dissolving small stones made up of uric acid.
Another treatment option is the surgical fragmentation of these stones. There are several techniques for achieving this depending on the age and general health status of the patient.
The surgeon may elect to perform transurethral cystolitholapaxy using a cystoscope, a small tube with a camera at the tip. The cystoscope is inserted into the urethra and guided to locate the bladder stones. Once the stones are located and visualised, the surgeon introduces an energy source to fragment the stones to pieces. This energy source could be a laser, an ultrasound, a manual lithotrite, or an electrohydraulic device. The stones are then voided with the urine.
Among children, the preferred surgical method of treating bladder stones is called percutaneous suprapubic cystolitholapaxy. For this procedure, the patient is placed under general anaesthesia and the surgeon makes an incision in the lower abdomen to locate the bladder. An incision is also made in the bladder to access and remove the stones. After removal, the incisions are closed with sutures.
The third surgical technique is called open cystostomy. This involves making a large incision in the abdominal area to access the bladder. The bladder is likewise surgically opened to remove the bladder stones. This procedure is indicated for men with an enlarged prostate gland. It is also considered if the bladder stone is too large and cannot be fragmented without causing damage to the bladder wall. In some cases, open cystostomy also addresses the underlying cause of bladder stones. Examples include the removal of the enlarged prostate gland.
Possible Risks and Complications
The use of alkalising agent to dissolve bladder stones may lead to an increased amount of calcium phosphate in the bladder, which could exacerbate the condition. On the other hand, the surgical treatment of bladder stones carries the risk of bleeding and infection in the urinary tract.
Hick EJ, Hernández J, Yordán R, Morey AF, Avilés R, García CR. Bladder calculus resulting from the migration of an intrauterine contraceptive device. J Urol. 2004 Nov. 172(5 Pt 1):1903.
Mizuno K, Kamisawa H, Hamamoto S, Okamura T, Kohri K. Bilateral single-system ureteroceles with multiple calculi in an adult woman. Urology. 2008 Aug. 72(2):294-5.