From the Research
Treatment of bladder stones typically requires surgical intervention, as these stones rarely pass spontaneously, and the most effective approach is often cystolitholapaxy, as indicated by the most recent and highest quality study 1.
Overview of Treatment Options
The primary treatment options for bladder stones include:
- Cystolitholapaxy (endoscopic stone fragmentation and removal)
- Open cystolithotomy (surgical removal through an incision in the bladder)
- Percutaneous suprapubic cystolithotomy For smaller stones, cystolitholapaxy is preferred as it's less invasive, using laser, ultrasonic, or pneumatic energy to break stones before removal. Larger stones may require open surgery.
Pre-Treatment Evaluation
Prior to treatment, patients need a complete evaluation including:
- Urinalysis
- Urine culture
- Imaging studies like ultrasound or CT scan If infection is present, antibiotics should be administered before stone removal.
Addressing Underlying Causes
The underlying cause of stone formation must also be addressed to prevent recurrence. This may involve:
- Treating bladder outlet obstruction (like prostate enlargement)
- Managing neurogenic bladder with clean intermittent catheterization
- Removing foreign bodies
Post-Treatment Care
Post-treatment, increased fluid intake (2-3 liters daily), regular bladder emptying, and treatment of recurrent urinary tract infections are essential preventive measures. Some patients may benefit from dietary modifications or medications to alter urine composition, depending on the stone type identified through analysis, as suggested by studies such as 2 and 3.
Medical Expulsive Therapy
Alpha-blockers may be used as medical expulsive therapy to facilitate stone passage, as shown in studies like 4, 5, and 3, although the evidence is not always consistent and the effectiveness may vary depending on the specific context and patient population.
Recommendation
Based on the most recent and highest quality evidence, cystolitholapaxy is the recommended treatment approach for bladder stones, with consideration of the patient's specific condition and the potential benefits and risks of medical expulsive therapy with alpha-blockers 1.