BLADDER STONES

The urinary bladder is a muscular sac in the pelvis, just above and behind the pubic bone. When empty, the bladder is about the size and shape of a pear. Urine is made in the kidneys, and travels down two tubes called ureters to the bladder. The bladder stores urine, allowing urination to be infrequent and voluntary. The bladder is lined by layers of muscle tissue that stretch to accommodate urine. The normal capacity of the bladder is 400 to 600 mL.

During urination, the bladder muscles contract, and two sphincters (valves) open to allow urine to flow out. Urine exits the bladder into the urethra, which carries urine out of the body. Because it passes through the penis, the urethra is longer in men (8 inches) than in women (1.5 inches).

Bladder stones are hard pieces of mineral that form in the bladder. The stones may form because of a urinary tract infection or enlarged prostate. Bladder stones are created when urine is concentrated and minerals crystallize and clump together. Bladder stones may block the tube that carries urine from the bladder to the outside of the body (urethra). Small bladder stones may pass without treatment, but some need medications or surgery. Left untreated, bladder stones may lead to infections and other complications.

Sometimes bladder stones — even large ones — cause no problems. But if a stone irritates the bladder wall or blocks the flow of urine, signs and symptoms may include:

  • Lower abdominal pain
  • In men, pain or discomfort in the penis or testicles
  • A burning sensation during urination
  • Frequent urination
  • Difficulty urinating or interrupted urine flow
  • Blood in the urine
  • Cloudy or abnormally dark-colored urine

DIAGNOSIS

Diagnosing bladder stones may involve:

  • A physical exam. Your doctor will likely feel your lower abdomen to see if your bladder is enlarged (distended) or may perform a rectal exam to determine whether your prostate is enlarged. You’ll also discuss any urinary signs or symptoms that you’re having.
  • Analysis of your urine (urinalysis). A sample of your urine may be collected and examined for microscopic amounts of blood, bacteria and crystallized minerals. A urinalysis also helps determine whether you have a urinary tract infection, which can cause or be the result of bladder stones.
  • Computerized tomography (CT). CT uses X-rays and computers to quickly scan and provide clear images of the inside of your body. CT can detect even very small stones and is considered one of the most sensitive tests for identifying all types of bladder stones.
  • Ultrasound. An ultrasound, which bounces sound waves off organs and structures in your body to create pictures, can help your doctor detect bladder stones.
  • X-ray. An X-ray of your kidneys, ureters and bladder helps your doctor determine whether stones are present in your urinary system. But some types of stones aren’t visible on conventional X-rays.

 

TREATMENT/RECOMMENDED MEDICATIONS

Bladder stones generally need to be removed. Your doctor may recommend drinking a lot of water each day to help a small stone pass naturally. However, because bladder stones are often caused by the inability to empty the bladder completely, this may not be enough to make the stone pass. Most cases require removal of the stones.

Breaking stones apart

Bladder stones are often removed during a procedure called a cystolitholapaxy (sis-toe-lih-THOL-uh-pak-see). A small tube with a camera at the end (cystoscope) is inserted through your urethra and into your bladder to view the stone. Your doctor then uses a laser, ultrasound or mechanical device to break the stone into small pieces and flushes the pieces from your bladder.

Hand-held lithotripters use ultrasonic energy to break up the stone into pieces small enough to pass in the urine. Holmium laser lithotripsy uses a laser to break up the stone.

Before the procedure, you’ll likely be given an anesthetic that numbs the lower part of your body (regional anesthesia) or that makes you unconscious and unable to feel pain (general anesthesia). Complications from a cystolitholapaxy aren’t common, but urinary tract infections, fever, a tear in your bladder or bleeding can occur. Your doctor may give you antibiotics before and after the procedure to reduce the risk of infections.

About a month after the cystolitholapaxy, your doctor will likely confirm that there are no remaining stone fragments in your bladder.

Surgical removal

Occasionally, bladder stones that are large or too hard to break up are removed through surgery. In these cases, your doctor makes an incision in your bladder and directly removes the stones.

Alternative medicine

No studies have confirmed that herbal remedies can break up bladder stones, which are extremely hard and usually require a laser, ultrasound or other procedure for removal.

Always check with your doctor before taking any alternative medicine therapy to be sure it’s safe and that it won’t adversely interact with other medications you’re taking.

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