Bladder stones

Although bladder stones are often discussed in the section on urolithiasis, we have identified this pathology separately, since in most cases the nature of such stones is secondary – they develop against the background of other diseases and often serve as complications of other pathologies of the urinary and reproductive system.

This disease is mainly observed in males in childhood (primarily in boys in the first 6 years of life) and old age (up to 96-97%).

Symptoms of bladder stones

Some people with bladder stones have no problems, even if the stones are quite large. But if the stone irritates the bladder wall and blocks the flow of urine, symptoms may occur that include:

• pain in the lower abdomen

• pain or discomfort in the penis in men

• pain when urinating

• frequent urination, especially at night

• difficulty urinating or intermittent flow of urine

• leakage of urine (incontinence)

• blood in urine

• change in urine color

Bladder stones have many characteristics:

• They can be small or large enough to fill the entire bladder.

• They can be soft or hard.

• They can be smooth or have sharp edges.

• The stone can be single or multiple.

Causes of bladder stones

The kidneys filter the blood, removing waste and unnecessary substances from your body through urine. Urine is released from your kidneys through two thin tubes called the ureters, then sent to the bladder, where it is stored until it leaves your body.

If your bladder does not empty completely, the retained urine may begin to form crystals that will eventually become bladder stones.
In most cases, one of the following reasons prevents you from completely emptying your bladder:

• enlargement of the prostate gland. An enlarged prostate gland, or BPH, is one of the most common causes of bladder stones in men. Because the prostate is enlarged it can compress the urethra and block the flow of urine, causing urine to remain in your bladder.

• neurogenic bladder. Your brain communicates with your bladder muscles through nerve fibers that help store urine or empty your bladder. If these nerve fibers are damaged due to injury, spinal cord injury, or other medical condition, it is sometimes impossible to completely empty the bladder.

• bladder diverticula. These are areas of the bladder with a weak wall, which are pouch-like protrusions outward. They can be congenital or acquired, developing as a result of BPH or other conditions that prevent adequate bladder drainage.

• inflammation. Bladder stones can form as a result of inflammation. Urinary tract infections and radiation therapy to the pelvis may contribute.

• medical equipment. Sometimes catheters, thin tubes inserted through the urethra to help urine pass from your bladder, can cause bladder stones. It could also be agents that accidentally migrated into the bladder – contraceptive devices or stents. Mineral crystals, which later become stones, can form on the surface of these devices.

• kidney stones. Stones that form in the kidneys are not the same as bladder stones; they develop differently and arise for different reasons. But small kidney stones can travel down the ureters into the bladder and develop into larger stones if they are not removed.

Risk factors for bladder stones

In developing countries, bladder stones are common in children due to dehydration and low protein diet. In other countries, bladder stones are common mainly in older men. If you live in an industrialized country this increases your risk of stone formation.

Paul. Bladder stones occur more often in men.

Age. In countries with high economic development, bladder stones usually occur in people over 50 years of age, although they can occur at an earlier age if there is urinary retention.

Disturbances in the outflow of urine from the bladder. The most common cause of bladder stones is a violation of the outflow of urine from the bladder through the urethra due to various reasons. The most common causes of bladder outlet obstruction are prostate enlargement. Other possible causes include prostate cancer, narrowing of the urethra due to infection or surgery, and certain medications.

• neurogenic bladder. Spinal cord injuries, Parkinson’s disease, diabetes, herniated discs and other diseases can damage these nerves and cause bladder dysfunction. In patients with a neurogenic bladder, the prostate gland may also be enlarged or there may be another reason for the obstruction of urine flow from the bladder.

Frequent bladder infections. Chronic inflammation of the bladder can lead to the formation of bladder stones.

Complications of bladder stones

Unremoved bladder stones, even if they do not cause symptoms, can lead to complications such as:
• Chronic bladder dysfunction. Left untreated, bladder stones can cause long-term problems such as pain or increased frequency of urination. Bladder stones can also be located at the junction of the bladder and the urethra and block the flow of urine.

• Urinary tract infections. Bladder stones can cause recurrent bacterial urinary tract infections.

• Bladder cancer. The chemicals cause persistent irritation of the bladder wall, which increases the risk of bladder cancer.

Etiology and pathogenesis. Primary stones are formed against the background of infravesical obstruction. Factors of bladder outlet obstruction: prostate hyperplasia and cancer, urethral stricture, diverticulum, tumor, neurogenic bladder, etc. In children, the development of bladder stones is often caused by phimosis, balanoposthitis, narrowing of the external opening of the urethra (meatostenosis), and urethral valve. Stone formation in women is observed in diseases of the bladder neck due to radiation cystitis, in vesicovaginal fistulas, etc.

Foreign bodies (ligatures, etc.) in the bladder can cause stone formation.

Secondary stones are stones that have migrated from the kidney and are most common in men with prostatic hyperplasia (15%).

Bladder stones come in different shapes, sizes, and the chemical composition and color are the same as kidney stones. Stones can be single or multiple, located only in the bladder or combined with stones of another location.

Symptoms. The clinical picture is varied, but there is not a single symptom that can be considered pathognomonic.
Pain in the projection of the bladder (suprapubic region) at rest is insignificant, but intensifies with movement and urination with irradiation to the head of the penis, testicle and perineum.

Dysuria. Urination becomes more frequent when walking or jolting, but remains normal at rest, so a bladder stone is characterized by an increased urge to urinate during the day, but not at night (in the absence of clinical manifestations of prostatic hyperplasia). During urination, a symptom of interruption (“backing up”) of the urine stream is often observed, which disappears when changing body position (with large stones, some patients can urinate only in a lying position).

When a stone becomes wedged into the neck of the bladder or migrates into the urethra, acute urinary retention develops. With large stones, urinary incontinence is also possible.

Hematuria occurs as a result of injury to the bladder mucosa and the development of an inflammatory process. Incarceration of a stone in the neck of the bladder sometimes leads to terminal hematuria, and in the presence of prostatic hyperplasia (due to damage to the dilated veins in the neck of the bladder), total gross hematuria is possible.

Diagnostics. Diagnosis is based on the analysis of anamnesis, complaints, clinical symptoms, objective examination and the results of a comprehensive clinical examination (radiation, instrumental, etc.).

History It is necessary to detail complaints (the nature of pain, dysuria and hematuria), episodes of stone passage and take into account diseases leading to bladder outlet obstruction (hyperplasia and prostate cancer, urethral stricture, diverticulum, tumor, neurogenic bladder, etc.).
Examination of the patient. Physical findings are of little help in diagnosis; only very large stones can rarely be detected during rectal or vaginal examination, especially if bimanual examination is performed. The examination of male patients should end with rectal palpation of the prostate gland, which makes it possible to identify its diseases (hyperplasia or prostate cancer, chronic prostatitis). When examining women per vaginam, concomitant diseases can also be identified.

Laboratory research methods.

General blood test. Patients are more likely to have normal blood counts.

A urine test reveals red blood cells and white blood cells. Salt crystals can be episodic and often depend on the nature of the diet and urine pH.

Bacteriological culture of urine makes it possible to identify the microflora of urine and determine the titer of bacteriuria, which is important when carrying out antibacterial treatment.

Radiation diagnostics. Ultrasound examination allows you to identify the stone(s) and determine its size. The ultrasound picture of a bladder stone is characterized by the presence of a hyperechoic formation with an acoustic shadow (“track”) distally and the movement of the hyperechoic formation in the bladder when the patient’s position changes.

Survey radiography is indicated for the purpose of detecting and localizing radiopositive (radiopaque) shadows suspicious for stones in the projection of the bladder and diagnosing possible urolithiasis.
Stones can be radiopositive (radio-opaque), radio-negative (radio-opaque) or low-contrast, which depends on the chemical composition (primarily the presence and amount of the calcium component) of urinary stones. Excretory urography (EU) with cystography allows you to assess the condition of the urinary tract and identify concomitant diseases (urolithiasis, prostatic hyperplasia, bladder diverticulum, etc.). In case of an X-ray negative bladder stone, a filling defect corresponding to the stone is determined against the background of bladder contrast (cystography).

Additional X-ray examinations: retrograde (ascending) urethrocystography, and in the presence of cystostomy drainage, antegrade cystography are performed as indicated.

Computed tomography. The clinical significance of computed tomography (spiral, multispiral) is associated not only with the diagnosis of bladder stones, but, above all, concomitant diseases (urolithiasis, etc.) and diseases leading to bladder outlet obstruction (prostate hyperplasia and cancer, bladder tumor, etc.). CT makes it possible to identify X-ray negative bladder stones and, therefore, to abandon various cystography techniques. The modern and most informative methods of examining patients are SCT and MSCT with the possibility of three-dimensional image reconstruction.

Instrumental diagnostics. Urethrocystoscopy. When inserting a urethrocystoscope into the bladder, there is often a sensation of friction between the cystoscope and a stone (with a large stone or multiple stones). Urethrocystoscopy allows you to determine the capacity and condition of the mucous membrane of the bladder, detail the size and number of stones, and also identify concomitant diseases (prostatic hyperplasia, urethral stricture, diverticulum, tumor, etc.).

Preparation for treatment for bladder stones
You will have one or more tests to help diagnose bladder stones. Make sure you ask your Doctor if you need to follow any diet before the test. You can prepare a list of questions for your doctor:

• Do bladder stones pass on their own?

• If not, should they be removed and what is the best method?

• What are the risks of the treatment you are planning to undertake?

• What happens if the stones are not removed?

• What treatment can be undertaken to eliminate stones?

• How can a recurrence of the disease be prevented?

Treatment. Most bladder stones should be removed. If the stones are small, your doctor may recommend that you drink plenty of water every day to help pass the stones. If the stone is large enough and does not pass on its own, the doctor recommends that you remove the stone.
Stone removal for bladder stones

Two main methods are used in the treatment of patients: stone crushing (lithotripsy) and stone cutting (lithotomy). Stone crushing is the method of choice and is performed using contact lithotripters, distance lithotripters or mechanical cystolithotripters (usually not used at present).

Contact cystolithotripsy. After cystoscopy and visualization of the bladder stone(s), their fragmentation is performed using various lithotripters (pneumatic, electrohydraulic and ultrasonic) and cystolitholapaxy (washing and suction of fragments).

A small tube with a camera on the end (cystoscope) is inserted through the urethra into the bladder to remove the stone. The doctor may use a laser, ultrasound, or mechanical device to break the stone into small fragments so that it can be flushed out of the bladder.

The procedure will be performed under regional or general anesthesia to make the procedure more comfortable. Complications of cystolitholapaxia are rare and include urinary tract infection, fever, and bleeding. Your doctor may prescribe antibiotics before the procedure to reduce the risk of infection. A month after cystolitholapaxy, the doctor will prescribe a follow-up examination to make sure that no stone fragments remain in the bladder.

Contact cystolithotripsy can be performed as an independent operation or in combination with variousendoscopic operations, which allows not only to remove a bladder stone, but at the same time carry out the necessary treatment of the underlying disease (transurethral resection for prostatic hyperplasia, etc.). d.).

External cystolithotripsy. Remote cystolithotripsy can be recommended for bladder stones not accompanied by bladder outlet obstruction, stage I benign prostatic hyperplasia and secondary bladder stones in patients with a burdened intercurrent background, when transurethral surgery is associated with a high risk of complications.

Cystolithotomy (stone cutting). Sometimes bladder stones are very large or too hard and require open surgery to remove them. In such cases, an incision is made on your bladder and the stones are directly removed. Any underlying cause of stone formation, such as prostate enlargement, can be corrected at the same time. The most common method of surgical treatment is suprapubic extraperitoneal cystolithotomy. Transperitoneal cystolithotomy is used extremely rarely, and perineal cystolithotomy is used as an exception.

Non-traditional methods

For centuries, people have used herbs to treat and prevent the formation of bladder and kidney stones. Traditional herbs that are used for urolithiasis are kidney root, stone root (citronella or colinsonia), hydrangea (wild or mountain hydrangea).

These herbs are used individually or in various combinations as tea or tincture form. Some preparations use marshmallow, which covers and envelops the fragments so that they can be removed painlessly. However, there are no studies confirming that stones can be dissolved with herbs, since stones are usually quite hard and require the use of laser, ultrasound or other methods of treatment.

Prevention of bladder stones

Bladder stones usually occur for a specific reason. Their development without eliminating the cause is difficult to prevent, but the risk of stone formation can be reduced by following the following principles:
• treatment for minor urinary symptoms. Early diagnosis and treatment of prostatic hyperplasia and other urological diseases can reduce the risk of developing bladder stones.

• Drinking plenty of fluids, especially water, will help prevent bladder stones because fluid makes the urine less concentrated. The amount of water you should drink depends on your age, weight, health, and activity level. Ask your doctor how much fluid you should drink.

• drink cranberry juice. Chronic bladder infections can lead to the formation of stones. Cranberry juice helps prevent these infections by slowing down the growth of bacteria and preventing bacteria from multiplying in your bladder.