Prevention and Management of Bladder Stones

The first step in the prevention and management of bladder stones is to drink a large volume of water to help flush out any small stones in the bladder to be excreted in the urine.

However, a surgical procedure may be required to remove bladder stones, particularly if the stones are large or the bladder does not empty entirely. Following the removal of stones, any underlying cause should be identified and appropriately managed to prevent the recurrence of bladder stones.

Prevention of Bladder Stone

Individuals with recurrent urinary tract infections (UTIs) are at an increased risk for bladder stones forming and may benefit from techniques to prevent them. These include:

• Increasing fluid intake to lower urine concentration (2-3 liters a day)
• Regular emptying of the bladder
• Double voiding to increasing emptying of urine from the bladder
• Using laxatives to avoid constipation

These techniques are often beneficial and help to stop the formation of bladder stones with minimal adverse effects on the individual.

Transurethral Cystolitholapaxy

Transurethral cystolitholapaxy is a procedure that is commonly used to remove bladder stones in adults. The procedure involves the insertion of a cystoscope into the urethra, which is gentle pushed up into the bladder. The small camera at the end of the cystoscope helps to locate the stones, which can then be broken into fragments with lasers or ultrasound waves that are transmitted from the cystoscope. The resulting smaller pieces can usually be excreted when the patient next passes urine.

This procedure occurs under local or general anaesthetic so that it is painless for most patients. Some individuals may acquire a urinary tract infection following the procedure and, for this reason, a short course of prophylactic antibiotics is routinely prescribed. Other complications may include injury to the bladder.

Percutaneous suprapubic cystolitholapaxy

Percutaneous suprapubic cystolitholapaxy is a procedure usually used for young children to reduce the risk of urethral damage but can also be used for some adult patients.

It involves a small incision in the lower abdominal skin and the bladder to allow the direct removal of the stones. This is usually carried out under general anesthetic.

Open cystostomy

Open cystostomy is a procedure used for very large stones or men with an enlarged prostate. It involves a large incision in the abdomen and bladder to remove the stone and may be combined with other purposes to remove part of the prostate gland or bladder diverticula, depending on the specific case.

This procedure is associated with more severe pain following the surgery and a longer recovery time when compared to other procedure types. However, it is the only option in some cases, such as when the bladder stone is large.

Underlying Cause

Following the removal of the bladder stones, it is important to identify any underlying causes that may lead to the formation of new stones in the bladder. These can then be prevented by:

• Reduction of prostate enlargement with medication or surgery to decrease the pressure on the bladder.
• Use of catheter to help drain bladder if it doesn’t empty entirely (e.g. neurogenic bladder)
• Use of a pessary or surgical procedures to hold the bladder in position if cystocele is present
• Surgical removal of bladder diverticula

This is an important step, as patients with these conditions are susceptible to the recurrence of bladder stones.

References

• http://www.nhs.uk/conditions/bladder-stones/pages/introduction.aspx
• http://www.nhs.uk/Conditions/Bladder-stones/Pages/Treatment.aspx
• http://emedicine.medscape.com/article/2120102-treatment#showall
• http://www.mayoclinic.org/diseases-conditions/bladder-stones/basics/treatment/con-20030296
• https://www.nlm.nih.gov/medlineplus/ency/article/001275.htm