How are Bladder Stones Removed: A Comprehensive Guide

How are Bladder Stones Removed?

Bladder stones, though not as common as kidney stones, can cause significant discomfort and health issues. In this article, we will delve into the topic of bladder stones, exploring their development, causes, symptoms, diagnosis, and most importantly, how are bladder stones removed with various methods. Dr. Ravi Gupta, an expert urologist in Jaipur and a renal transplant surgeon, will discuss everything in detail about bladder stones and their removal options.

What are bladder stones?

Bladder stones are hard masses that form in the bladder when minerals in urine crystallize. They can range in size from tiny grains to larger, more problematic stones. 

How do bladder stones develop?

The development of bladder stones is often linked to the concentration of minerals in urine. When urine becomes too concentrated, minerals such as calcium and oxalate can crystallize and form stones. Additionally, insufficient fluid intake can contribute to the formation of these troublesome masses.

What Causes Bladder Stones? 

The most common reasons for bladder stones are discussed below:

Urinary Tract Infections (UTIs)

Frequent UTIs can lead to the formation of bladder stones. The infection creates an environment conducive to stone development, emphasizing the importance of prompt UTI treatment.

Enlargement of the Prostate Gland

In men, bladder stones can be caused by an enlarged prostate (benign prostatic hyperplasia, or BPH). An enlarged prostate can block urine flow, preventing the bladder from entirely emptying.

Nerve Damage

Normally, nerves send information from the brain to the bladder muscles, instructing them to tighten or relax. If these nerves are injured as a result of a stroke, spinal cord injury, or other medical condition, the bladder may not empty entirely. Instead, it is referred to as a “neurogenic bladder.”

Stones in the Kidney

Stones in the kidneys are not the same as stones in the bladder. They develop in various ways. On the other hand, small kidney stones can move down the ureters into the bladder and, if not ejected, evolve into bladder stones.

Inflammation

Bladder inflammation, induced by urinary tract infections or pelvic radiation therapy, can result in bladder stones.

What are the symptoms of bladder stones?

Here are some symptoms of bladder stones:-

• Difficulty passing urine
• Urine passes out frequently
• Urine that is dark or mixed with blood
• Penis or lower abdomen pain
• Urinary infections 
• Frequent Urge to urinate

How are Bladder Stones Diagnosed?

• X-ray KUB: An essential examination that can aid in the diagnosis of a bladder stone. Ultrasound can detect the existence of stones, the size of the prostate, and the kidney’s condition.
• NCCT KUB: This is the preferred investigation for stone detection. It determines the exact size and position of bladder stones, kidney stones, and the hardness of the stone, which can be determined using Hounsfield units.
• Uroflowmetry: To rule out the restriction of the urine route, i.e., stricture urethra, before bladder stone surgery.
• Urine Routine: This test is required to rule out infection before considering any surgical intervention for bladder stone treatment.

Also, Understanding the size and composition of the stones guides the urologist in determining the most suitable removal method.

How are bladder stones removed?

1. Transurethral Cystolitholapaxy

Transurethral Cystolitholapaxy stands as an effective and minimally invasive method for removing bladder stones. This procedure offers a quicker recovery and a successful resolution to the discomfort caused by bladder stones.

The procedure of transurethral cystolitholapaxy is used to break down and remove bladder stones. The process is carried out under either spinal or general anesthesia. Antibiotics may be administered to patients during surgery to reduce the risk of infection. 

A cystoscope, which is a tiny tube attached with a camera at the end, is inserted into the patient’s urethra and advanced into the target organ bladder by the surgeon. Ultrasound waves or a laser are transmitted through the cystoscope to shatter the stones into tiny particles. Fluids are then used to flush the minute shards of stones out of the bladder.

Transurethral Cystolitholapaxy is a commonly used approach for treating bladder stones, especially when the stones are relatively small. It avoids the need for external incisions and is associated with a quicker recovery compared to more invasive surgical methods. The choice of procedure depends on the size and nature of the stones, as well as the overall health of the patient.

2. Percutaneous Suprapubic Cystolithotomy (PCCL)

Certainly! Percutaneous Suprapubic Cystolithotomy (PCCL) is a medical procedure used to remove bladder stones. It is a minimally invasive technique that involves making a small incision in the lower abdomen to access the bladder and remove the stones.

This procedure involves creating a small incision in the lower abdomen area, that is, just above the pubic bone. This allows the surgeon to have quick access to the bladder area. The cystoscope is then inserted through the cut or incision into the bladder, which makes it easy to visualize the stone.

As the stone is located, several techniques are used for stone fragmentation and removal. These techniques may include using laser energy, mechanical crushing devices, or ultrasonic lithotripsy. In some cases, a cystolithotripsy device can be used to directly fragment and remove the stone.

PCCL is often chosen when bladder stones are too large to be treated with less invasive methods like extracorporeal shock wave lithotripsy (ESWL) or when other medical conditions prevent the use of those methods. It is considered a safe and effective procedure with a shorter recovery time compared to traditional open surgery.

3. Open Cystolithotomy

Open cystolithotomy is a surgical procedure performed to remove bladder stones through an external incision in the lower abdomen. Unlike minimally invasive techniques such as transurethral cystolitholapaxy or percutaneous Suprapubic Cystolithotomy (PCCL), open cystolithotomy involves a larger incision to directly access the bladder. 

Open bladder stone removal is conducted as an inpatient surgery under general anesthesia. A cystoscopy is a very first step. After the bladder has been checked, an incision in the lower abdomen is made to provide access to the bladder. The stone is removed when the bladder is opened.

An absorbable stitch is used to repair the bladder, and a catheter is introduced into the bladder through the urethra. Because there is often some bleeding from the bladder due to the surgery, it is often essential to gently drip liquids in and out of the bladder for a certain amount of time.

Open cystolithotomy is typically reserved for cases where bladder stones are too large or numerous to be effectively treated with less invasive procedures. While it may have a longer recovery time and a higher risk of complications compared to minimally invasive techniques, open cystolithotomy remains a viable option for certain patients depending on their overall health and the characteristics of the bladder stones.

It’s important to consult with expert urologists like Dr Ravi Gupta, for an accurate diagnosis and proper treatment options for bladder stone removal.

Also Read:- Top 5 Warning Signs of Bladder Cancer

Conclusion

If you are experiencing symptoms of bladder stones, it’s crucial to consult with a urologist. Early detection and appropriate treatment can prevent complications and improve your overall quality of life. Remember, addressing bladder stones promptly will save you from other diseases and from high-risk surgeries.

Frequently Asked Questions

1. Can bladder stones be prevented?

Yes, maintaining proper hydration, treating urinary tract infections promptly, and adopting a healthy lifestyle can reduce the risk of bladder stone formation.

2. Is surgery the only option for bladder stone removal?

No, for smaller stones, medications can be effective. However, surgery may be necessary for larger stones or cases where medications are not successful.

3. Are bladder stones common in both men and women?

Yes, bladder stones can affect both men and women, although men are more prone to developing them due to factors like an enlarged prostate.

4. How long is the recovery period after bladder stone removal surgery?

The recovery period varies depending on the complexity of the surgery, but many individuals can resume normal activities within a few days to a week.

5. Can bladder stones recur after removal?

Yes, without proper preventive measures, bladder stones can recur. Following a urologist’s recommendations and adopting a healthy lifestyle can minimize this risk.