Bladder stones are hardened mineral clumps that form in the urinary bladder. These formations occur when minerals in concentrated urine crystallize and accumulate. While some individuals might not experience symptoms, larger bladder stones can cause discomfort. Although certain bladder stones require surgical removal, some types can be dissolved with medical interventions.
Types of Bladder Stones
Uric acid stones are particularly amenable to dissolution through medical management. Struvite stones, which often form in conjunction with urinary tract infections, can sometimes be dissolved with specific treatment targeting the underlying infection.
Conversely, calcium oxalate stones and cysteine stones are generally not dissolvable with current medical therapies. Identifying the specific type of bladder stone is important for guiding treatment decisions. Stone composition can be determined through laboratory analysis of passed stones or, indirectly, through urine tests and imaging studies.
Medical Dissolution Approaches
Uric acid stones are most responsive to medical therapy. This process typically involves alkalinizing the urine, which increases the solubility of uric acid. Medications like potassium citrate are commonly prescribed to achieve a urinary pH of 6.5 or higher, making it less favorable for uric acid stone formation and promoting their breakdown.
Increased fluid intake complements medication by diluting urine, further aiding the dissolution process. Dietary modifications, such as adhering to a low-purine diet, can also help reduce uric acid levels in the body. For struvite stones, treatment often focuses on eradicating the associated urinary tract infection with long-term antibiotic therapy. These stones sometimes require urine acidification, though this approach is less common than for uric acid stones. Medical supervision is necessary throughout the dissolution process, with regular monitoring of urine pH, stone size, and kidney function to ensure effectiveness and safety. This dissolution process can extend over several weeks to many months.
When Dissolution Isn’t an Option
Very large stones or those that do not decrease in size despite appropriate medical therapy may require alternative interventions. In these situations, several procedures are available to remove the stones.
Surgical Removal Methods
One common minimally invasive procedure is cystolitholapaxy, where a cystoscope is inserted through the urethra into the bladder to locate the stone. A laser, ultrasound, or mechanical device is then used to break the stone into smaller fragments, which are subsequently flushed out of the bladder. For larger or more complex stones, percutaneous cystolithotomy may be performed, involving a small incision in the lower abdomen and bladder to access and remove the stones. Open surgery, known as cystolithotomy, is a traditional approach reserved for very large stones, or when other surgical indications are present. Extracorporeal shock wave lithotripsy (ESWL), which uses shock waves to break stones from outside the body, is less frequently used for bladder stones compared to kidney stones, but can be an option in specific circumstances.
Preventing Bladder Stone Recurrence
Preventing the formation of new bladder stones after initial treatment is an important aspect of long-term management. Staying well-hydrated is a fundamental preventative measure, as drinking sufficient water helps to keep urine dilute, reducing the concentration of stone-forming minerals. Specific dietary adjustments can also play a significant role, tailored to the individual’s stone type. For instance, limiting animal protein and reducing salt intake can be beneficial for certain stone compositions.
Some individuals may require long-term medications to maintain optimal urine chemistry and inhibit stone formation. Regular follow-up appointments with a healthcare provider, including urine tests and imaging, are important to monitor for any signs of stone recurrence and adjust preventative strategies as needed.