Bladder stones - Treating bladder stones

It may be possible to flush small bladder stones out of your bladder by drinking lots of water (try around 1.2 litres or 6-8 glasses a day).

However, as most people with bladder stones have problems completely emptying urine from their bladder, it is unlikely that the stones will pass out using this method.

Types of surgery

The main types of surgery used to treat bladder stones include:

• a transurethal cysolitholapaxy - the most common procedure used to treat adults with bladder stones
• a percutaneous suprapubic cystolitholapaxy - mainly used to treat children to avoid damaging their urethra but sometimes used for adults with very large bladder stones
• an open cystotomy - often used in men where the prostate has grown so large that it obstructs other procedures, or if the stone is very large

These are explained in more detail below.

Transurethral cystolitholapaxy

During the procedure the surgeon will insert a small, rigid tube that contains a camera at the end (a cystoscope) into your urethra and up into your bladder.

The camera is then used to locate any stones. A 'crushing' device can be used, or lasers or ultrasound waves transmitted from the cystoscope to break up the stones into smaller fragments, which can be washed out of your bladder with fluids.

A transurethral cystolitholapaxy is carried out under regional or general anaesthetic, so you should not feel any pain.

During the cystolitholapaxy procedure, there is a risk that you will develop an infection, so you may be given antibiotics as a precaution. There is also a small risk of injury to the bladder.

Percutaneous suprapubic cystolitholapaxy

During the procedure the surgeon makes a small incision in the skin, in the lower abdomen. A further incision is made in the bladder and the stones are removed.

A percutaneous suprapubic cystolitholapaxy is carried out under general anaesthetic.

Open cystostomy

Open cystostomy is similar to a percutaneous suprapubic cystolitholapaxy except the surgeon makes a much larger incision in the abdomen and bladder.

Alternatively, an open cystostomy may be combined with other types of surgery, such as removing some or all of the prostate or bladder diverticula (pouches that develop in the lining of the bladder).

An open cystostomy is carried out under general anaesthetic.

The disadvantage of an open cystostomy is that it causes more post-operative pain and has a longer recovery time, but this procedure is required if the stone is large.

A urethral catheter is also required for a day or two after the surgery.

Complications of surgery

The most common complication of bladder stone surgery is an infection of the bladder or urethra. These are collectively known as urinary tract infections or UTIs.

UTIs affect around 1 in 10 people who have undergone bladder surgery and they can normally be treated with antibiotics.

Recovery and follow-up

If you have transurethral cystolitholapaxy or percutaneous suprapubic cystolitholapaxy you will normally need to stay in hospital for a few days to recover.

In open cystostomy it may take several days before you are well enough to go home.

You will probably be asked to attend a follow-up appointment where X-rays or a CT scan can be used to check that all the fragments of the bladder stones have been removed from your bladder.

Treating the underlying cause

Once the bladder stones have been removed it is necessary to treat the underlying cause to avoid new bladder stones forming.

Prostate enlargement

Prostate enlargement can be treated using medication that can both help reduce the size of the prostate and relax the bladder, making it easier to pass urine.

If medication fails to work then surgery may be required to remove some or all of the prostate.

Read more about the treatment of prostate enlargement.

Neurogenic bladder

If you have a neurogenic bladder (inability to control the bladder due to nerve damage) and you develop bladder stones it is often a sign that you need to change the way in which you are draining your bladder.

You may need further training in fitting your catheter or you may need to change the type of catheter you are using and use medication to help control the bladder.

Read more about urinary catheterisation.

Cystocele

Mild to moderate cases of cystocele (where the walls of the bladder weaken and begin to drop down into the vagina) can be treated using a device called a pessary.

A pessary is designed to fit inside the vagina and hold the bladder in its correct location.

More severe cases may require surgery to strengthen and support the walls of the bladder.

Bladder diverticula

Bladder diverticula (pouches that develop in the wall of the bladder) may require surgery to remove any pouches.