What is Bladder Stones?
Bladder stones are hard objects found mainly in the urinary bladder. These stones can be hardened, often through a process called calcification, but sometimes they are made of other materials. In developed countries, the occurrence of bladder stones is generally low. On the other hand, in developing regions, such as the Middle East, North Africa, Thailand, Indonesia, and Myanmar, these stones are more common, mainly due to diet differences.
Bladder stones are usually linked to a condition where urine doesn’t exit the body smoothly, often seen in benign prostatic hyperplasia (a non-cancerous prostate enlargement) or neurogenic bladder, a condition where a person cannot control their bladder due to brain, spine, or nerve problems. However, healthy individuals without any structural issues or infections can also develop bladder stones.
It’s important to remember that just because someone has stones in the upper part of the urinary tract, it does not necessarily mean they will develop bladder stones. These bladder stones can cause specific symptoms and are often a major cause of discomfort.
What Causes Bladder Stones?
Bladder stones primarily occur due to urinary stasis, which is a condition where urine remains in one place, often due to disorders like benign prostatic hyperplasia (BPH) or neurogenic bladder disorder. Usually, most of these stones form inside the bladder, but some come from the kidneys in the form of a stone or a discharged papilla tissue. Kidney stones small enough to move through the ureters can go through the urethra unless the bladder is significantly dysfunctional or blocked. Stones left in the bladder will gather further layers of stone-like material, which may or may not be similar to the original stone substance.
Any foreign object left in the bladder that doesn’t get naturally expelled will gradually develop layers of stone-like material and turn into a calculus, or stone. Examples of such objects could be a surgical stapler or permanent thread. That’s why it’s advised to use dissolvable thread whenever urinary surgery is carried out.
A double pigtail stent, if left in the urinary tract for too long, can also turn into a stone. Other examples include fragments from a ruptured Foley catheter balloon left in the bladder. Therefore, it’s critical to check any Foley catheter that has been removed or has accidentally come out to ensure there are no missing fragments that could potentially turn into a stone. If this check isn’t possible, or if it seems a balloon fragment may be missing, a cystoscopy (a procedure to see inside the urinary bladder and urethra) should be performed.
Comparatively, Foley catheters are linked with more bladder stones than intermittent catheterization. In a study that was conducted on patients with spinal cord injuries, it was found that as many as 36% developed bladder stones over an eight-year period. However, better care in urology has managed to bring down this rate to about 10%.
Other factors increasing the predisposition to bladder stone formation include radiation therapy, schistosomiasis (a disease caused by parasitic worms), bladder augmentation surgery (a procedure to increase bladder capacity), urethral strictures (narrowing of the urethra), and presence of bladder diverticula (outpouching of the bladder wall).
Risk Factors and Frequency for Bladder Stones
The number of adults experiencing bladder stones is dropping, largely due to the widespread use of two drugs – alpha-blockers and 5-alpha reductase inhibitors (5-ARIs). Typically, adult males with bladder stones tend to have had kidney stones, gout, low levels of urinary magnesium, and lower urinary pH. They may also have had urinary tract infections and show signs of a condition where the prostate extends into the bladder. These factors increase the likelihood of bladder stone development.
Similarly, the number of children with bladder stones is decreasing, with improvements in pre and post-birth care, as well as improved nutrition for newborns, being the main contributors. However, boys are more susceptible to bladder stones than girls. Unlike kidney stones, which can reoccur frequently, bladder stones in children are relatively rare.
Signs and Symptoms of Bladder Stones
Bladder stones are a health condition that often doesn’t show clear symptoms. Sometimes, a person with bladder stones might not experience any symptoms at all. These stones are typically associated with problems in fully emptying the bladder, and the most common issue of this kind is known as BPH. A person with bladder stones might experience a combination of urinary symptoms such as blood in urine at the end of urination, lower abdominal pain, weak urine flow, and painful urination. In some cases, larger bladder stones can cause noticeable blood in the urine and a sudden interruption in the flow of urine.
Pain can also be felt in various areas including the tip of the penis, scrotum, pelvis, or perineum. A person might also have a swollen bladder that is noticeable upon touch, although the stone itself usually can’t be felt this way. Because the signs and symptoms of bladder stones can be unclear, a surefire diagnosis is typically made using a visual examination of the bladder with a cystoscope or via medical imaging.
In the past, a tool called a Van Buren sound was sometimes used to diagnose bladder stones. This tool would make a clicking “sound” or vibration when it came into contact with a stone in the bladder. However, this method is no longer used because modern imaging technology and flexible cystoscopy have become widely available.
Testing for Bladder Stones
If someone is suspected to have a bladder issue, their urine test might show indications of blood, nitrites, or leukocytes. The test could also show a low pH level indicating acidic urine or reveal a urinary tract infection. To get a clearer picture, doctors often start with a basic x-ray. However, in adult men, the stone may not contain calcium, like a uric acid stone, which means normal x-rays may not show them.
To ensure a more accurate diagnosis, doctors could use a CT scan or an ultrasound of the bladder. These imaging techniques can consistently detect potential bladder stones. Bladder stones generally appear as highly reflective areas with a shadow effect on an ultrasound.
It’s interesting to know that ammonium urate, a type of stone, is not naturally visible on x-rays. But over time, it can develop a calcified covering, making it detectable on an x-ray.
In some cases, if the patient’s physical position changes and causes a shift in any abnormalities in the bladder, it might suggest a bladder stone. However, these movements could also be due to a blood clot, a fungal ball, or a specific type of tumor attached to a long stalk. And as these patients often experience pelvic pain, blood in the urine, or issues with urination, doctors often perform a cystoscopy. This procedure provides a definitive answer whether bladder stones are present or not.
Treatment Options for Bladder Stones
Bladder stones, especially those made of uric acid, can sometimes be dissolved with oral medications that make the urine more alkaline. A common medication used for this is potassium citrate. In some cases, sodium bicarbonate might also be necessary to achieve the desired pH level in urine. If you’re on potassium citrate, it’s crucial to have your blood potassium and urine pH levels monitored frequently, and the dose will be adjusted accordingly.
Those who have a history of kidney stones might be directed to take a 24-hour urine test to identify factors that increase their risk of developing stones. This test can help determine proper preventive treatments.
Some types of bladder stones, known as struvite stones, can be dissolved with certain substances such as citric acid, glucono delta-lactone, and magnesium carbonate. However, this process can be slow and requires a special bladder catheter that may not be preferable for all patients.
Calcium phosphate, a common component that blocks urinary stents and catheters, forms in alkaline solutions and can be dissolved by a mild acidic substance. Bladder instillations of acetic acid solution can help dissolve this compound and can also help clear the tubes which may prevent bladder stone formation.
For bladder stones that can’t be dissolved, surgical procedures are available. There’s a type of surgery called cystolitholapaxy that can be used to address most bladder stones. Here, various methods could be used to break down and remove the stones, such as lasers, pneumatic-powered jackhammers, ultrasound, and direct mechanical crushing. One should note though, the electrohydraulic devices are typically avoided in these instances due to the risks involved.
In certain situations, Extracorporeal shockwave lithotripsy (ESWL), a procedure that involves using high-energy sound waves to break down stones, can also be used for bladder stones. Moreover, pediatric bladder stones are usually managed with a method called percutaneous suprapubic cystolitholapaxy, which helps reduce the risk of harming the urinary tract in children.
For adults, if an enlarged prostate is causing the outlet obstruction, a procedure called transurethral resection of the prostate (TURP), is often recommended once the stones are broken down and removed.
Large bladder stones or prostates may require open surgery, which allows for the complete removal of the stone, and possibly an open prostate surgery should the prostate be oversized. The benefit of open surgery is that it can be faster and allow for the removal of large or multiple stones, and it can handle stones that are stuck to the bladder lining. The drawbacks include longer hospital stays, more postoperative pain, and the need for an abdominal incision and draining tubes, which can lead to possible complications and a longer time needed with a Foley catheter.
What else can Bladder Stones be?
When a doctor suspects a person may have a bladder stone, they’ll also consider other possible causes for the symptoms. These could include:
- A fungal infection in the urinary tract
- A blood clot
- Papillary urothelial carcinoma, a type of bladder cancer
- A urinary tract infection
- Benign prostatic hyperplasia, a non-cancerous enlargement of the prostate
These conditions can appear similar to a bladder stone, so it’s important for the doctor to thoroughly investigate to make an accurate diagnosis.
What to expect with Bladder Stones
The outlook for bladder stones is generally positive if they are treated correctly. The method of treatment depends on what caused the bladder stones. Small bladder stones can usually pass out naturally, but larger ones can get stuck at the opening of the bladder, blocking the urine flow. If not addressed, this issue can cause damage to the urinary tract, recurrent formation of stones, or infections.
Possible Complications When Diagnosed with Bladder Stones
Large bladder stones can cause several complications. These include:
- Pain
- Frequent urination
- Obstruction in the urinary tract
- Urinary tract infections
Preventing Bladder Stones
If a person has had bladder stones, they’re more likely to get them again. That’s why it’s essential to find out why they’re occurring and treat that root cause. It’s also important for these individuals to understand that drinking lots of water can actually help reduce the risk of stone formation. This is because drinking more water dilutes the minerals that clump together to create stones in the urinary tract. If a man’s prostate is enlarged, causing a backup of urine in the bladder, it may need to be surgically removed to prevent urine from stagnating and stone formation.
