Treatment for Bladder Stones (Calculi)
The primary treatment for bladder stones is endoscopic transurethral cystolithotripsy, which offers the best balance of efficacy and safety for most patients with bladder calculi. 1
Treatment Options Based on Stone Characteristics
First-Line Treatment
- Transurethral cystolithotripsy: The preferred approach for most bladder stones
- Involves endoscopic fragmentation of stones through the urethra
- Various lithotripsy devices can be used:
- Ultrasonic lithotripters
- Swiss Lithoclast/LithoClast Trilogy
- Mechanical lithotripters
- Electrohydraulic lithotripters
Alternative Approaches Based on Stone Size and Patient Factors
For Large or Multiple Stones:
Percutaneous cystolitholapaxy:
- Indicated when stones are too large or numerous for transurethral approach
- Particularly useful in patients with closed bladder neck or previous bladder surgeries 2
- Can be performed using an Amplatz sheath or Hasson's trocar 3
- Allows introduction of larger instruments for more efficient stone fragmentation
Open cystolithotomy:
- Reserved for extremely large stone burden
- Higher morbidity compared to endoscopic approaches
- May be necessary when endoscopic approaches fail or are not feasible
For Smaller Stones:
- Extracorporeal shock wave lithotripsy (ESWL):
- Simple, effective, and well-tolerated option
- However, often requires ancillary procedures 1
- Less commonly used for bladder stones than for kidney or ureteral stones
Special Considerations
Concomitant Procedures
- When bladder stones occur with benign prostatic hyperplasia (BPH) in men:
- Combined transurethral resection of prostate (TURP) and cystolithotripsy can be safely performed in the same session 4
Addressing Underlying Causes
- Treatment must address the underlying cause of stone formation:
- Foreign bodies (sutures, synthetic tapes, meshes) should be removed or trimmed 1
- Urinary stasis should be corrected
- Recurrent infections should be treated
Pediatric Considerations
- In endemic regions, bladder stones in children are often related to dietary factors
- Comprehensive preventive strategies including nutritional improvements are critical 5
- Treatment approaches similar to adults but with appropriately sized instruments
Complications and Their Management
Potential complications include:
- Urethral injury (more common with transurethral approach)
- Bladder perforation
- Bleeding
- Infection/sepsis
- Incomplete stone removal
To minimize complications:
- Ensure appropriate antibiotic coverage for infected stones
- Use proper technique and appropriate-sized instruments
- Consider percutaneous approach when urethral anatomy is unfavorable
Post-Treatment Management
- Follow-up imaging to confirm complete stone clearance
- Metabolic evaluation to identify underlying causes
- Preventive measures based on stone composition
- Treatment of any residual fragments
The choice of treatment modality should be based on stone size, number, composition, available equipment, surgeon expertise, and patient-specific factors such as anatomy and comorbidities.