What is the treatment for bladder stones?

Treatment for Bladder Stones

Transurethral cystolithotripsy (TUCL) is the recommended first-line treatment for bladder stones in adults and children where feasible. 1

Diagnostic Approach

Before initiating treatment, proper diagnosis is essential:

• Imaging studies:

  • Ultrasound is the primary diagnostic tool with 45% sensitivity and 94% specificity for urinary stones 2
  • CT scan is the gold standard with approximately 97% sensitivity for detecting kidney stones 3
  • KUB radiography helps differentiate between radioopaque and radiolucent stones and aids in follow-up 2

• Laboratory evaluation:

  • Biochemical urine work-up (dipstick)
  • Blood tests (creatinine, uric acid, ionized calcium, sodium, potassium, blood cell count, C-reactive protein) 2
  • Stone analysis should be performed for all first-time stone formers 2

Treatment Options

Treatment selection depends on stone size, composition, and patient factors:

1. Endoscopic Procedures

• Transurethral cystolithotripsy (TUCL):

  • First-line treatment for most bladder stones 1
  • Advantages: shorter hospital stay compared to percutaneous approaches, less invasive 3
  • Using a nephroscope rather than a cystoscope reduces procedure duration 1

• Percutaneous cystolithotripsy (PCCL):

  • Alternative to TUCL for larger stones
  • Similar stone-free rates to TUCL but longer hospital stay (mean difference 0.82 days) and procedure duration (mean difference 9.83 minutes) 1

2. Shock Wave Lithotripsy (SWL)

• Less effective than TUCL with lower stone-free rates 1
• Generally not recommended as first-line therapy for bladder stones

3. Open Cystolithotomy

• Reserved for very large stones or when endoscopic approaches are not feasible
• Similar stone-free rates to endoscopic procedures but longer hospital stay and recovery time 1
• Tubeless cystolithotomy may offer shorter hospital stays in selected cases 1

4. Medical Management

• Medical expulsive therapy (alpha-blockers) can increase stone passage rates by 29% compared to control treatments 3
• Oral chemolysis is strongly recommended for uric acid stones, with 80.5% success rate 3

Special Considerations

Infection and Obstruction Management

• In cases of sepsis and/or anuria with obstruction:
  • Urgent decompression via percutaneous nephrostomy or ureteral stenting is strongly recommended 2
  • Definitive stone treatment should be delayed until infection is resolved 2, 3
  • Antibiotics should be administered immediately and regimen re-evaluated following antibiogram findings 2

Underlying Conditions

• Bladder stones often occur secondary to:

  • Prostate hypertrophy in men 4
  • Previous incontinence surgery in women 4
  • Urinary stasis
  • Metabolic abnormalities

• High concordance (70%) between bladder stone and kidney stone composition suggests metabolic factors play a significant role 5

Follow-up and Prevention

• Follow-up imaging (KUB X-ray or ultrasound) within 1-2 weeks of treatment 3
• Increase fluid intake to more than 2L/day to prevent recurrence 3
• Metabolic evaluation should be considered to prevent recurrence 3
• Evaluation for predisposing factors including congenital abnormalities, neurogenic bladder, metabolic disorders, and recurrent UTIs 3

Common Pitfalls

• Failing to address underlying causes (e.g., bladder outlet obstruction, metabolic abnormalities) may lead to stone recurrence
• Delaying treatment in cases of infection with obstruction can lead to urosepsis and increased morbidity
• Underestimating the role of metabolic factors in bladder stone formation may result in inadequate prevention strategies
• Not considering stone composition when selecting treatment approach (e.g., oral chemolysis for uric acid stones)