Bladder stones

Treating bladder stones

Surgery will usually be needed to removebladder stones.

It may be possible to flush small bladder stones out of your bladder by drinking lots of water, but this may not work if you can't completely empty your bladder of urine.

Transurethral cystolitholapaxy

A transurethral cystolitholapaxy is the most common procedure used to treat adults with bladder stones.

The surgeon inserts a small, rigidtube with a camera at the end (a cystoscope) into your urethra and up into your bladder.

The camera is used to help locate the bladder stones. A 'crushing' device, lasers, or ultrasound waves transmitted from the cystoscope can be used to break up the stones into smaller fragments, which can be washed out of your bladder with fluids.

A transurethral cystolitholapaxy is carried out under either a regional or general anaesthetic , so you shouldn't feel any pain during the procedure.

There's a risk of developing an infection during the procedure, so you may be given Penicillin as a precaution. There's also a small risk of injury to the bladder.

Percutaneous suprapubic cystolitholapaxy

Apercutaneous suprapubic cystolitholapaxy is mainly used to treat children, to avoid damaging their urethra. It's also sometimes used for adults with large bladder stones.

Instead of inserting a tube into the urethra,the surgeon makes a small incision in the skin of the lower abdomen. A further incision is then made in the bladder so the stones can be removed. This will be done using ageneral anaesthetic.

Open cystostomy

An open cystostomy isoften used to remove bladder stones in men with a very large prostate, or if the stone itself is very large.

It's a similar procedure to percutaneous suprapubic cystolitholapaxy, except the surgeon makes a much larger incision in the abdomen and bladder.

Itmay be combined with other types of surgery, such as removing some or all of the prostate or bladder diverticula (pouches that develop in the lining of the bladder).

The disadvantage of an open cystostomy is that it causes more pain afterwardsand has a longer recovery time than the other types of surgery. However, an open cystostomy will be needed if the bladder stone is large.

You'll need to use a catheter for a day or two after the procedure.

Complications of surgery

The most common complication of bladder stone surgery is infection of the bladder or urethra, known as a urinary tract infection (UTI) .

UTIs affect about 1 in 10 people who have bladder surgery and can usually be treated with antibiotics.

Recovery and follow-up

After having atransurethral cystolitholapaxy or percutaneous suprapubic cystolitholapaxy, you'll usually need to stay in hospital for afew days to recover.

If you've had an open cystostomy, it may be several days before you're well enough to go home.

After surgery, you may be asked to attend a follow-up appointment where an X-ray or CTscan can be used to check that all fragments of the bladder stones have been removed from your bladder.

Treating the underlying cause

Once the bladder stones have been removed, the underlying cause will need to be treated to avoid new bladder stones forming.

Prostate enlargement

Prostate enlargement can be treated using medication to help reduce the size of the prostate. This will relieve the pressure on the bladder,making it easier for you to pee.

If medication doesn't work, surgery may be needed to remove some or all of the prostate.

Neurogenic bladder

If you have a neurogenic bladder (an inability to control the bladder because of nerve damage) and you develop bladder stones, it's often a sign you need to change the way you're draining your bladder.

You may need further training in fitting your catheter or you mayneed to change the type of catheter you're using and use medication to help control the bladder.

A pessary is designed to fit inside the vagina and hold the bladder in its correct position.

More severe cases of cystocele may require surgery to strengthen and support the walls of the bladder.