Bladder stones (bladder calculi) are hardened masses of minerals that form inside the urinary bladder. They develop primarily when the bladder does not empty completely, causing urine to become concentrated, allowing minerals to crystallize and solidify over time. Common underlying causes include an enlarged prostate in men, which blocks urine flow, or nerve damage that impairs bladder function (neurogenic bladder).
The presence of these stones often irritates the bladder wall or obstructs urine flow, leading to noticeable symptoms. Patients frequently experience lower abdominal pain, a burning sensation during urination (dysuria), or blood in the urine (hematuria). An increased urge to urinate, especially at night, and a urine stream that stops and starts are also common indicators.
Initial Steps Before Intervention
Before determining the best removal method, diagnostic steps are necessary to confirm the presence of stones and assess the underlying cause. Initial evaluation typically involves a urine test to check for infection or blood, and a blood test. Imaging techniques, such as an X-ray, ultrasound, or CT scan, are then used to visualize the stones, measure their size, and determine their exact location.
For very small stones or mineral sludge, increasing fluid intake may be attempted to help the body flush them out naturally. Drinking large volumes of water dilutes the mineral concentration in the urine, making it less likely for crystals to form or grow. However, since bladder stones often form due to incomplete bladder emptying, this non-surgical approach is usually ineffective for established, larger stones, which require procedural intervention.
Endoscopic Stone Crushing
The most common and preferred method for removing bladder stones in adults is transurethral cystolitholapaxy. This minimally invasive technique avoids external incisions by accessing the bladder through the natural urinary opening. The procedure is performed under general or regional anesthesia.
The surgeon inserts a thin, rigid instrument called a cystoscope through the urethra and guides it into the bladder. The cystoscope has a camera that transmits live images to a screen, allowing the surgeon to visualize the bladder wall and the stone. Once located, specialized instruments are passed through the working channel of the cystoscope.
These instruments are used to break the stone into smaller fragments. Fragmentation is commonly achieved using laser energy, high-frequency ultrasonic waves, or a mechanical crushing device. The laser, such as a Holmium laser, is highly effective. After the stone is broken down, the resulting small fragments are flushed out of the bladder using irrigation fluids.
This method is favored because it is less invasive, resulting in a shorter hospital stay and a faster recovery period compared to open surgery. Cystolitholapaxy is highly effective, but its success depends on the stone’s size and the patient’s anatomy, particularly for men with a large prostate.
Traditional Open Surgery
Open surgery, termed open cystotomy or cystolithotomy, is a more invasive method reserved for specific, complex cases. This approach is chosen when the stone is extremely large, making endoscopic fragmentation impractical. Open surgery is also necessary when the stone is associated with complex anatomical issues, such as a large prostate gland requiring simultaneous removal or diverticula (pouches in the bladder wall) that need repair.
The procedure begins under general anesthesia with an incision in the lower abdomen, above the pubic bone. The surgeon dissects down to the bladder wall, which is opened with a small incision. This direct access allows the surgeon to physically remove the stone whole or in large pieces using grasping instruments.
After removal, the bladder is inspected, and the incision in the bladder wall is closed with sutures. The abdominal incision is then closed in layers. This technique is highly effective for removing massive stones, but it involves more post-operative pain and a longer recovery time than the endoscopic approach.
Post-Procedure Recovery and Prevention
Following any removal procedure, patients can expect a recovery period. A temporary urinary catheter is often placed in the bladder for a short time to help with drainage and allow the urethra or bladder wall to heal. Temporary side effects include burning or discomfort during urination and blood in the urine (hematuria) for a few days.
Pain management is controlled with medication. Patients typically resume light activities within a week following cystolitholapaxy. Complete recovery for open surgery involves a hospital stay of several days and a longer period before strenuous activity can be resumed. Follow-up imaging, such as an X-ray or CT scan, is scheduled to confirm that all stone fragments have been removed.
Long-term prevention is crucial, as recurrence is common if the underlying cause is not addressed. This involves treating the root problem, such as managing an enlarged prostate or addressing a neurogenic bladder. Patients are also advised to increase fluid intake, aiming for two to three liters per day, to keep the urine diluted. Dietary modifications, based on the stone’s composition determined by analysis, may be recommended.