What are the risks of leaving bladder stones in place?

Risks of Leaving Bladder Stones in Place

Leaving bladder stones untreated carries significant risks including recurrent urinary tract infections, urosepsis, renal damage, and potential progression to renal failure. 1

Major Risks of Untreated Bladder Stones

Infection-Related Complications

• Recurrent urinary tract infections (UTIs): Bladder stones serve as a nidus for bacterial colonization, leading to persistent or recurrent infections 1, 2
• Urosepsis: Untreated infections can progress to life-threatening systemic infection 3
• Stone growth: Infection stones (struvite, carbonate apatite) can rapidly enlarge, especially with urease-producing bacteria 2

Mechanical Complications

• Urinary obstruction: Larger stones can cause acute or chronic urinary retention 4
• Hematuria: Bleeding from bladder wall irritation and trauma 4
• Bladder pain and voiding dysfunction: Chronic irritation of the bladder wall 2

Long-Term Complications

• Renal damage: The American Urological Association (AUA) guidelines specifically note that untreated stones, particularly infection stones, can lead to renal damage 1
• Progressive renal failure: Especially with recurrent infections and obstruction 3
• Giant stone formation: In rare cases, untreated stones can grow to extraordinary size (>100g) 4

High-Risk Populations

Certain patient populations face increased risk from untreated bladder stones:

• Neurogenic bladder patients: 36% develop bladder stones within 8 years of spinal cord injury 3
• Patients with bladder augmentation: Nearly 48% experience stone recurrence within 9 years 5
• Men with prostatic hypertrophy: Increased risk due to urinary stasis 6
• Patients with indwelling catheters: Higher risk of infection stones 2
• Mentally impaired patients: May have delayed diagnosis due to communication difficulties 4

Evidence-Based Management Approach

The AUA guidelines strongly recommend removing bladder stones, particularly when:

1. Infection stones are suspected: The panel "advocates for the removal of suspected infection stones or infected stone fragments to limit the possibility of further stone growth, recurrent UTI, and renal damage" 1

2. Residual fragments remain: When residual fragments are present after initial treatment, endoscopic procedures should be offered to render patients stone-free 1

3. Stones cause symptoms or complications: Particularly with recurrent UTIs, hematuria, or obstruction 1, 2

Treatment Considerations

• Stone analysis is essential: To guide prevention strategies and identify infection stones 1
• Antimicrobial prophylaxis: Required prior to stone intervention based on urine culture results 1
• Endoscopic management: Preferred for most bladder stones 1
• Open/laparoscopic/robotic surgery: Reserved for cases with anatomic abnormalities or very large stones 1

Prevention of Recurrence

For patients at high risk of recurrence:

• Regular imaging surveillance: Yearly X-ray and ultrasound recommended for high-risk groups like augmentation patients 5
• Increased fluid intake: To achieve urine volume of at least 2.5 liters daily 1
• Treatment of underlying conditions: Address anatomic abnormalities, neurogenic bladder, or other predisposing factors 2

Pitfalls to Avoid

• Delaying treatment: Even asymptomatic stones can harbor bacteria and lead to silent renal damage
• Incomplete stone removal: Residual fragments serve as nidus for recurrence; 43% of patients with residual fragments experience stone-related events within 32 months 1
• Inadequate follow-up: Particularly important in high-risk populations like neurogenic bladder patients 3
• Failure to address underlying causes: Anatomic abnormalities, voiding dysfunction, or metabolic disorders must be treated to prevent recurrence 2