Bladder stones are hard lumps of mineral salts that form in the bladder itself or reach it from the kidneys. In adults they mainly affect men over 50–60 and are almost always the result of another condition, most often an enlarged prostate.
A stone can cause no symptoms for a long time and be found by chance on an ultrasound scan, and when symptoms do appear they are often put down to an infection or to the prostate. A timely diagnosis is important, because treatment today is endoscopic and gentle.
What bladder stones are
When urine is left in the bladder after every visit to the toilet, it stagnates and the salts dissolved in it crystallise. Around an initial core – crystals, a blood clot or a foreign body – new layers build up over months until a stone forms, ranging from a few millimetres to several centimetres. In adults the most common type is uric acid, followed by calcium oxalate stones and infection stones.
Symptoms
The most typical symptoms are:
- the stream suddenly stopping, which passes when you change position;
- pain or burning at the end of urination, in men often felt towards the tip of the penis;
- frequent and urgent need to urinate;
- blood in the urine, usually at the end of urination;
- repeated urinary tract infections;
- heaviness and a dull ache low in the abdomen.
Being unable to urinate with a full and painful bladder (a stone stuck at the outlet) and a temperature with shivering need an emergency department or a call to 112 (the European emergency number), not a booked appointment. Painless blood in the urine requires an examination as soon as possible, even if it has stopped, because it can also be caused by a tumour.
Causes and risk factors
The common denominator is incomplete emptying of the bladder. In men the leading cause is an enlarged prostate, which narrows the bladder outlet and leaves residual urine (urine left in the bladder after urinating). Narrowing of the urethra, bladder neck sclerosis (scarring of the bladder outlet) and neurological damage to the bladder, for example in diabetes, lead to the same result.
A separate group are stones that form on a foreign body – a long-term catheter, a forgotten stent or a stitch from an operation; in women bladder stones are rare and are usually linked to exactly these or to a neurological disease. The risk increases with low fluid intake, frequent urinary infections and previous kidney stones.
Diagnosis
A consultation with Dr Penev begins with a conversation about how you urinate and any past infections and operations, followed by a physical examination, which in men includes the prostate. A urine test shows blood, crystals or infection.
Ultrasound is the main method: the stone shows up as a bright structure casting a shadow, which moves when you change position; the residual urine and the size of the prostate are measured at the same time. Cystoscopy confirms the diagnosis and is often the first step of treatment.
Treatment
Endoscopic fragmentation
The standard treatment in adults is transurethral cystolitholapaxy: an endoscope is passed through the urethra into the bladder, with no incision, the stone is broken up with a laser or mechanical energy, and the fragments are removed. The procedure is performed under anaesthesia at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), Plovdiv, with a short hospital stay. For very large stones or a narrowed urethra, access through a small opening above the pubic bone is used, and shock wave lithotripsy from outside the body (ESWL) plays a limited role, because the fragments have to pass through the same narrowed outlet.
Treating the cause
If the prostate stays enlarged, new stones are only a matter of time, so when indicated Dr Penev plans prostate surgery, or medication for milder obstruction. A narrowed urethra and foreign bodies are also dealt with, and any infection is treated according to the urine culture.
When to see a urologist
Book a consultation if your stream stops and starts, if you feel pain at the end of urination, if you notice blood in your urine or if infections keep coming back. Men with an enlarged prostate and residual urine should be followed up with ultrasound, because a stone often grows without clear symptoms.
Prevention
The main prevention is free and complete emptying of the bladder, which means treating an enlarged prostate or any other cause of difficulty urinating in good time. It helps to drink enough fluid, urinate without holding on for long, finish the full course of treatment for urinary infections and, for patients who have a catheter, change it regularly; after a stone has been removed, follow-up ultrasound scans are needed.
Bladder stones are treated successfully when they are found in time and their cause is removed. If you recognise the symptoms described here, book an appointment with Dr Penev for a consultation and ultrasound in Plovdiv or Karlovo.
Frequently asked questions
Can a bladder stone come out on its own?
Very small stones are sometimes passed with the urine, more often in women, whose urethra is short and wide. In men with an enlarged prostate this rarely happens, because difficult emptying is the very reason the stones form, so they usually have to be removed.
How long does recovery take after endoscopic fragmentation of a bladder stone?
The hospital stay is usually short, and the catheter is removed within days. Mild burning and pink urine in the first few days are normal; most patients return to their usual activities within about one to two weeks, and the doctor gives individual instructions.
Why is it important to treat the prostate as well, not just the stone?
The stone is a consequence, not the cause. If the obstruction to the outflow of urine remains, urine will again be retained in the bladder and stones can form again. That is why Dr Penev plans treatment of the cause together with removal of the stone.
Is there a special diet after a bladder stone?
A strict diet is rarely needed. Drinking enough fluid through the day and limiting salt and red meat are helpful; for uric acid stones the doctor may also recommend specific dietary changes or medicines that make the urine less acidic, depending on the stone analysis.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.