Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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The treatment of bladder stones is primarily focused on removal. Unlike kidney stones, which are often left to pass if they are small, bladder stones generally require intervention because they are trapped by the bladder outlet. The method of removal depends on the size of the stone, the hardness of the stone, and the patient’s underlying health conditions.
Modern urology offers a range of minimally invasive options that have largely replaced open surgery. These procedures use natural body openings to access and destroy the stones, resulting in faster recovery times and less pain. However, treating the stone is only half the battle; the underlying cause of the retention must also be addressed to prevent recurrence.
Care plans are customized. A small stone might be managed with increased water intake, while a massive stone might require a robotic or open surgical approach. The ultimate goal is to clear the bladder completely and restore normal voiding function.
For stones that are very small (typically under 5mm), conservative management may be attempted. This involves instructing the patient to drink large amounts of water to increase urine production. The goal is to flush the stone out naturally through the urethra.
This approach is only viable if the patient can pass urine with a strong enough stream and if the pain is manageable. It is rarely successful for stones associated with an enlarged prostate, as the obstruction prevents the stone from exiting.
This is the most common procedure for removing bladder stones. It is minimally invasive and involves no external incisions. A cystoscope (camera) is passed through the urethra into the bladder to visualize the stone.
Once the stone is located, an energy source is used to break it into small fragments. These fragments are then washed out of the bladder. The procedure is typically done under general or spinal anesthesia, and patients often go home the same day.
The energy source used during cystolitholapaxy is often a laser. The Holmium laser is highly effective at dusting stones of any composition. A laser fiber is passed through the scope and placed in contact with the stone.
The laser pulses vaporize the stone material, turning it into fine dust or tiny gravel. This precision allows the surgeon to break up even very hard stones without damaging the surrounding bladder tissue. It is considered a standard of care for endoscopic stone management.
Before lasers, mechanical lithotrites were the primary tool. These are heavy jawed instruments passed through the scope to physically crush the stone. While effective, they can be difficult to use on very large or hard stones.
Ultrasonic lithotripsy uses sound waves to vibrate the stone apart. Often, a combination device is used that delivers both ultrasonic energy to break the stone and suction to remove the pieces simultaneously. This speeds up the procedure for medium sized stones.
For stones that are too large to be broken up quickly through the urethra, or for children whose urethras are too small for standard instruments, a percutaneous approach is used. A small incision is made in the lower abdomen directly into the bladder.
A sheath is passed through this incision, allowing larger instruments to be introduced. This creates a “shortcut” to the stone. It allows for rapid fragmentation and removal of large stone burdens while avoiding trauma to the urethra.
Open surgery is now reserved for specific, complex cases. This involves a larger incision in the lower abdomen to open the bladder and remove the stone intact. It is typically performed if the stone is massive (giant calculus) or if the prostate is also being removed via an open approach.
While it is the most invasive option with a longer recovery, it is the fastest way to remove a very large stone. It also allows the surgeon to repair bladder diverticula or remove a very large prostate at the same time.
Robotic surgery is an evolution of the open or laparoscopic approach. The surgeon uses a robotic system to make small incisions and remove the stone with high precision. This is often utilized when a patient needs a robotic prostatectomy (removal of the prostate) and has concurrent bladder stones.
The robot allows for delicate suturing of the bladder and precise dissection. It offers the benefits of open surgery (removing large stones) with the recovery benefits of minimally invasive surgery.
Removing the stone is only a temporary fix if the obstruction remains. Therefore, stone treatment is often combined with prostate treatment. A Transurethral Resection of the Prostate (TURP) is frequently performed during the same anesthesia as the stone removal.
By coring out the obstructing prostate tissue, the surgeon restores the normal flow of urine. This allows the bladder to empty completely, removing the stasis that caused the stone in the first place.
For patients with neurogenic bladder, treatment involves establishing a better bladder regimen. After the stones are removed, the patient may need to learn Clean Intermittent Catheterization (CIC).
CIC involves passing a catheter several times a day to ensure the bladder is fully empty. This prevents the stagnation that leads to stones. Indwelling catheters (Foley) are generally avoided if possible, as they act as a nidus for new stones.
Post procedure care involves medical management to adjust urine chemistry. If the stones were uric acid, medications like potassium citrate may be prescribed to alkalize the urine (raise the pH), preventing crystals from forming. Allopurinol may be used to lower uric acid levels in the blood.
Dietary counseling is provided based on the stone analysis. This might involve reducing sodium, limiting animal proteins, or increasing citric acid intake (lemonade).
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Yes, laser surgery for bladder stones is considered very safe and effective. The laser energy is focused strictly on the stone, minimizing damage to the surrounding bladder tissue. It also causes very little bleeding.
Most patients will have a urinary catheter for a short period after surgery, usually 1 to 2 days. This allows the bladder to heal and drains any blood or small clots that might form. It is typically removed before you go home or shortly thereafter.
The duration depends on the size and hardness of the stone. A small stone might take 30 minutes to break up and remove. A large or very hard stone could take 1 to 2 hours.
Yes, recurrence is common if the underlying cause is not fixed. If you remove the stone but do not treat the enlarged prostate or emptying problem, new stones can form within months.
If a patient is too frail for anesthesia, doctors might try to manage symptoms with medications and catheters. However, leaving a stone in place can lead to severe infections and pain, so a low stress procedure is usually attempted if at all possible.
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