Bladder Stones Symptom, Diagnosis and Treatment

Bladder stones (also referred to as urolithiasis in sophisticated medical terms) is a fairly common condition that can greatly compromise the overall quality of life. The chemical composition of the stones vary from Calcium phosphate to uric acid and pigment stones.It is imperative to mention that all bladder stones are not symptomatic or discomforting. Research and clinical data indicates that most people who have smaller stones (that are less likely to irritate bladder or ureter walls) experience no symptom at all. In all such cases, diagnosis of bladder stones is incidental (for example during radiological testing for general physical examination or for other indications).In individuals who have larger sized stones (or multiple stones), following signs and symptoms are usually reported:

• Pain in lower abdomen
• Penile discomfort or pain
• Pain during micturition
• Persistent desire to urinate (or feeling of a heavy bladder)
• Problematic urination or interrupted flow of urine
• Presence of blood in the urine
• Hazy or dark-colored urine
• High grade fever
• Pus or bacteria in the urine

Causes of Bladder Stones

The primary etiologic event that favors the formation of bladder stones is urinary retention or ongoing inflammation. Research indicates that any condition that is associated with delayed or incomplete emptying of bladder can give rise to formation of urinary crystals due to stasis of urine. Some statistically significant causes of bladder calculi are:

• Enlargement of Prostate Gland:Also referred to as benign prostatic hyperplasia (BPH), is a benign condition that is fairly common in elderly males. Due to moderate enlargement of prostate gland, the prostatic part of urethra is usually compressed. This not only affects the flow of urine but can also lead to infection or inflammation that further leads to stone formation.
• Damaged Nerves (Neurogenic Bladder):Nerve signals from brain compels the bladder wall to undergo contraction for evacuation of bladder. Damaged nerves due to stroke or injury to spinal cord can lead to incomplete emptying of the bladder.
• Inflammation: Infection of urinary tract and irradiation of pelvis can inflame the bladder wall and thus favor the crystallization of urine.
• Medical Devices.Urinary catheterization can also cause stone formation. Accidental migration of contraceptive devices or a stent can also promotes mineral deposition on the surface thus forming bladder stones.
• Kidney stones.Although kidney stones are different from bladder stones but smaller stones can pass to bladder and if not excreted, can stay and grow top cause inflammation.

Bladder Stones Tests and Diagnosis

Bladder stones produce characteristic symptoms and can be diagnosed by detailed history taking and clinical examination; however, a variety of diagnostic tests can also be used to confirm the diagnosis of bladder stones.

• A Physical Exam:Physicians performs complete abdominal examination to check urinary bladder for distension and tenderness. A rectal examination can also be performed to assess the size of the enlarged prostate gland.
• Analysis of Your Urine (Urinalysis):Urine sample is taken for microscopic detection of blood, presence of bacteria, and mineral crystals. It also rules out the urinary tract infection.
• Spiral Computerized Tomography (CT) Scan:Faster than conventional CT, spiral CT enhances the visualization of internal organs and can sense very small stones. It is deemed sensitive for bladder stone detection.
• Ultrasound: Ultrasound is often considered as gold-standard diagnostic modality for detection of the size and number of bladder stones.
• X-Ray:Though, some types of bladder stones may not be visible on x-ray; the radiological examination of kidneys, ureters and bladder gives an idea about the location of stones.
• Special Imaging of Your Urinary Tract (Intravenous Pyelogram): If your physician is suspecting multiple stones in the urinary tract, he may advise intravenous pyelogram (a specialized procedure that involves injection of contrast media in the veins to improve the visualization of kidneys, ureters and bladder. X-ray images are then taken periodically to assess the exact site and size of stones. Due to high risk of allergic reactions and other adverse effects, this procedure is largely replaced by spiral CT scan in most settings.

Bladder Stones Treatments and Drugs

You can get rid of small, uncomplicated stones by simple home remedies and conservative management (such as flushing your bladder with plenty of water and similar remedies). It is highly recommended to seek some type of management to get rid of bladder stones since bladder stones are a leading cause of other grave issues and health concerns. Other treatment modalities include:

Breaking Stones Apart by ESW Treatment

Cystolitholapaxy is a procedure that is widely used to remove the bladder stones. In this procedure, a cystoscope (a specialized device that comprise of a long tube with a camera at the end) is inserted through the urethra into the bladder to visualize the stone. After detection of stone, appropriate measures are adopted to break the stone. These include; laser, sound waves or mechanical means. Once the larger stone is scrambled into smaller pieces, simple bladder irrigation is sufficient to flush the fragments from the bladder.Complications are uncommon and include urinary tract infection, fever or damage to the urethra wall. Antibiotic may be given before the procedure to reduce the risk of infection. Physician reassess the bladder functioning periodically over the follow up period.

Bladder Stones Surgical Removal

Open surgical intervention is opted when the size of the stone is too big to be taken out with any other method. An incision is introduced in the bladder wall and the stone is then removed. Additionally, appropriate intervention should be sought if bladder stone formation is due to other systemic/ metabolic or organic dysfunction.References:

1. Warren, J. W. (2012). Stones: Do urinary calculi increase risk of bladder pain syndrome?. Nature Reviews Urology, 9(11), 607-608.
2. Krambeck, A. E., Lieske, J. C., Li, X., Bergstralh, E. J., Melton, L. J., & Rule, A. D. (2013). Effect of age on the clinical presentation of incident symptomatic urolithiasis in the general population. The Journal of urology, 189(1), 158-164.
3. Gamal, W., Eldahshoury, M., Hussein, M., & Hammady, A. (2013). Cystoscopically guided percutaneous suprapubic cystolitholapaxy in children. International urology and nephrology, 45(4), 933-937.
4. Sahito, R. A., Awan, M. S., & Baloch, T. A. (2011). A Comparative Study of Percutaneous Suprapubic Cystolitholapaxy Versus Open Cystolithotomy in Children. Journal of Surgery Pakistan (International), 16, 4.