Bladder stones (bladder calculi) are hardened masses of minerals that form inside the urinary bladder. They typically develop when the bladder cannot empty completely, leaving behind concentrated residual urine. Over time, minerals like uric acid or calcium compounds crystallize and harden into stones. Their presence signals an underlying issue preventing normal urinary flow, requiring both removal and treatment of the root cause.
Minimally Invasive Removal Procedures
The primary and most common treatment for bladder stones in adults is a minimally invasive procedure called cystolitholapaxy. This technique involves inserting a narrow, lighted instrument (a cystoscope) through the urethra and into the bladder, allowing the surgeon to visualize the stone without an external incision.
Once located, specialized tools passed through the cystoscope break the stone into smaller fragments. Fragmentation methods include using lasers, ultrasonic devices that emit high-frequency sound waves, or mechanical crushers. After the stone is broken down, the small pieces are flushed or suctioned out of the bladder. This procedure is generally performed on an outpatient basis or requires a short hospital stay, often allowing the patient to go home within 24 to 48 hours.
Open Surgical Removal
While endoscopic techniques are preferred, open surgery, known as a cystotomy, is sometimes necessary for stone removal. This method is usually reserved for stones that are exceptionally large or dense, making them too difficult or time-consuming to break down endoscopically. Open surgery is also selected when the patient has a co-existing bladder condition that requires simultaneous repair.
Conditions such as a large bladder diverticulum (a pouch in the bladder wall) or a very large prostate gland may necessitate this approach. The procedure involves making an incision in the lower abdomen to access the bladder directly. This allows the surgeon to remove the stone in one piece and address structural issues concurrently, though it is associated with a longer hospital stay and recovery time compared to cystolitholapaxy.
Identifying and Managing the Underlying Cause
Successfully treating bladder stones requires more than just physical removal; the underlying medical condition causing incomplete bladder emptying must be identified and managed to prevent recurrence.
Causes Requiring Specific Management
In men, the most frequent cause is Benign Prostatic Hyperplasia (BPH), where the enlarged prostate gland presses on the urethra and obstructs urine flow. Treatment for BPH may involve medication to shrink the prostate or relax the bladder neck, or a surgical procedure to remove the obstructive tissue.
Another common cause is neurogenic bladder, where nerve damage from a spinal injury or disease prevents the bladder from contracting properly. Patients with this condition may need to learn clean intermittent self-catheterization to ensure the bladder is fully drained several times a day. This eliminates stagnant urine, which is the necessary environment for mineral crystallization.
Chronic or recurrent urinary tract infections (UTIs) can also lead to the formation of certain types of stones, like struvite. These require targeted antibiotic therapy based on a culture and sensitivity report.
Medical Dissolution and Prevention
For stones composed of uric acid, a medical approach called chemolysis can be utilized. This involves taking oral medications to make the urine less acidic, helping to dissolve the stones over time.
General preventative measures center on increasing fluid intake, specifically water, to dilute the concentration of minerals in the urine. A diluted urine environment makes it significantly harder for crystals to form and clump together. While diet is generally less of a factor than for kidney stones, making dietary adjustments based on the stone’s composition can be a helpful, individualized strategy to reduce the risk of future formation.