Bladder stones are hard lumps of minerals that can form inside the bladder when it's not completely empty of urine.
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Bladder stones are generally a mark of incomplete bladder emptying, therefore it is more common in men than women. Having said that, there are other reasons for the formation of bladder stones, such as foreign bodies, recurrent infection, migrating stones from the kidney and in cases of neo-bladders (artificial bladder made from bowel).
Benign prostatic hyperplasia is the most common diagnosis in patients with bladder stones. It usually happens due to long standing incomplete bladder emptying which leads to stasis of urine, crystallisation, infection and stone formation. In fact, bladder stone removal surgery (cystolithotomy) was one of the first surgical procedures performed in patients with haematuria (blood in urine).
In very rare situations, missed ureteric stents or any surgical material that have accidentally been inserted to the bladder could generate bladder stones. Bladder stones in women are very rare and could happen due to incomplete bladder emptying due to urethral stenosis of bladder atonia. Kidney stones usually pass spontaneously with urine as they migrate from the kidney to the bladder. However, in some situations they fail to pass urethrally and this will lead to the formation of bladder stones that could increase in size with time if left untreated.
Small bladder stones are usually asymptomatic and are found incidentally on imaging or cystoscopy. However, larger stones could cause bladder irritation, recurrent urinary tract infection, bladder pain and hematuria (blood in urine). Symptoms of bladder stones are usually severe and those patients will require rapid treatment. Some patients are treated initially with antibiotics to treat any possible associated infections.
In very few cases, patients with bladder stones might suffer from severe infection that require hospital admission and intravenous antibiotic treatmen
Most bladder stones are easy to treat and can be removed endoscopically under short anaesthetic. Multiple instruments have been used and are very effective in treating bladder stones such as Holmium or Thulium lasers. Once stones are fragmented then these will be sent for biochemical analysis to assess the composition of these stones. This will help address any pre-existing factors for stone formation. Lifestyle modification and occasionally medications are advised to prevent stone formation.
Most of these cases are performed as day case surgery and patients might require a urethral catheter to drain the bladder for a short period of time.
Once bladder stones are addressed, attention should be given to the primary cause for the stone formation. Some surgeons might combine the use of lasers to treat the enlarged prostate as well as the bladder stones.
Bladder stones cause patients to have multiple symptoms such as bladder pain, recurrent urinary tract infections and blood in urine. If stones are not treated, these symptoms are likely to persist and increase in intensity and frequency. Also, stones are likely to continue to grow and therefore simple endoscopic removal might not be any longer suitable and patients might need open surgery to remove them. If for any reason patients are unfit or do not wish to have general anaesthetic, special instruments can be used to treat bladder stones using flexible instruments and laser.
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