Bladder stones are a manifestation of urolithiasis characterized by the presence of saline or calcified concretions in the bladder cavity. Pathology is characterized by pain syndrome, urination disorders, the presence of blood in the urine. The disease is diagnosed according to the results of ultrasound of the urinary tract, general urinalysis, cystoscopy, cystography. The main treatment is fragmentation and removal of stones by contact method (lithotripsy) or operationally (during open cystolithotomy).
ICD 10
N21.0 Bladder stones
Meaning
Bladder stones (cystolithiasis), along with kidney stones, ureters and urethra, are one of the manifestations of urolithiasis. Their formation may be due to both a violation of the physico-chemical properties of urine (solubility of organic and inorganic compounds contained in it) and physiological factors (congenital or acquired metabolic disorders: metabolic, inflammatory, medicinal, etc.).
Depending on the place and mechanism of formation, stones vary in size, quantity, consistency, surface type, shape, color and chemical composition. Pathology is observed mainly in the male population in childhood (in the first 6 years of life) and the elderly (over 50 years old). In adult patients, bladder stones consist mainly of uric acid, and in children they include uric acid crystals, phosphates and calcium oxalates.
Causes
The most common cause of the formation of stones in adult patients is infravesical obstruction – a violation of the free flow of urine due to an obstacle in the neck of the bladder or urethra. Blockage of the lower urinary tract can be caused by:
- bladder neck stenosis (Marion’s disease),
- prostate hyperplasia or prostate cancer in men,
- urethral strictures (after injury, surgery),
- inflammatory changes in urogenital infections,
- parasitic diseases (genitourinary schistosomatosis),
- radiation therapy.
The mechanism of stone formation is associated with the impossibility of complete emptying of the bladder, stagnation and concentration of residual urine, leading to the loss of salt crystals. Stone formation is promoted by neurogenic bladder, its omission in women with cystothelium, existing defects of the inner muscular membrane, including diverticula.
Sometimes, in the presence of concretions in the kidneys and upper urinary tract, there is a migration of small stones through the ureter with their further appearance and persistence in the bladder. The presence of foreign bodies (stents, ligatures, catheters and other foreign objects) in the bladder can cause the deposition of salts on them and the formation of stones. In children, the appearance of stones in the bladder is often caused by existing balanoposthitis, complicated by phimosis and narrowing of the external opening of the urethra.
Classification
Bladder stones can be single (solitary) and multiple, small (microliths) and large (macroliths), smooth, rough and faceted, soft and very hard; contain uric acid, uric acid salts, phosphates or calcium oxalates. In practical urology, primary stones are distinguished (formed directly in the organ cavity) and secondary (formed in the kidneys and ureters, then migrate to the bladder). Secondary stones, being in the bladder, can further increase in size.
Bladder stones symptoms
In some cases, the presence of bladder stones, even quite large, does not manifest any signs. Clinical symptoms occur with constant contact of the stone with the walls of the bladder, the development of irritation of the mucous membrane or blocking the outflow of urine. The symptoms of pathology are diverse, but not pathognomonic. It can be a pain syndrome in the lower abdomen, above the pubis, in men – discomfort, acute or dull pain in the penis. Minor at rest, the pain becomes unbearable when moving, changing the position of the patient’s body and urinating, can radiate into the perineum and external genitals, the hip area.
Concretions cause a violation of urination with frequent, sharp urges during movement, interruption of the urine stream or acute delay in its outflow in case of migration of the stone into the urethra, as well as urinary incontinence when the internal sphincter of the bladder is not closed due to a stone stuck in its narrowed neck. In the case of large stones, some patients may empty the bladder only in a supine position.
Complications
Due to the addition of microbial infection, bladder stones can be complicated by cystitis and pyelonephritis. Hematuria and pyuria develop as a result of traumatization and inflammation of the bladder mucosa by stones. When a stone is pinched in the neck of the bladder, blood may appear in the last portion of urine; with trauma to the dilated venous vessels of the neck, profuse total hematuria may develop.
Diagnostics
Diagnosis of bladder stones includes analysis of the patient’s medical history and complaints, the results of instrumental and laboratory examination. It is necessary to clarify the nature of pain, the degree of manifestations of dysuria and hematuria, to identify cases of sand and stones, the presence of concomitant diseases: hyperplasia and prostate cancer, urethral stricture, diverticulum, bladder tumors, neurogenic dysfunction.Only very large concretions can be detected during vaginal (bimanual) or rectal examination. Rectal palpation of the prostate gland in men allows you to identify its increase. Informative in diagnostics:
- Urine examination. In patients with stones in the bladder cavity, a general urine analysis can reveal leukocytes and erythrocytes, bacteria, salts. Urine back-up allows you to identify the microflora and its sensitivity for the selection of antibacterial therapy.
- Sonography. With ultrasound of the bladder, stones can be seen as hyperechoic formations with an acoustic shadow that move into the bladder cavity when the patient’s position changes.
- Endoscopic diagnostics. Cystoscopy is one of the main methods to study the internal structure of the bladder (the state of the mucous membrane, the presence of diverticula, tumors, strictures), to determine the presence of stones in its cavity, their number and magnitude.
- X-ray diagnostics. With the help of cystography and excretory urography, it is possible to assess the state of the urinary tract, identify urolithiasis, the presence of X-ray positive concretions, prostate hyperplasia, bladder diverticula. The X-ray contrast of stones depends on their chemical composition, first of all, the presence and percentage of the calcium component in them. With multispiral CT, very small and X-ray negative concretions can be distinguished, as well as concomitant pathology.
Bladder stones treatment
Sometimes small stones leave on their own through the urethra with urine. In the absence of complications with a small size of concretions, conservative treatment is carried out, which consists in following a special diet (depending on the mineral composition of the stones) and taking medications to maintain the alkaline balance of urine.
In the surgical removal of stones from the bladder, endoscopic lithoextraction, stone crushing (contact transurethral cystolithotripsy, percutaneous suprapubic litolapaxy) and stone cutting (open suprapubic cystolithotomy) are used. Transurethral lithotripsy is performed in adult patients during cystoscopy, while the detected stones are crushed under visual control by a special device (ultrasonic, pneumatic, electrohydraulic or laser lithotripter), and their fragments are removed by washing and suction through a cystoscope.
Transurethral cystolithotripsy can be an independent procedure or performed in conjunction with other endoscopic operations, such as transurethral resection of the prostate. The technique is contraindicated with a small volume of the bladder, during pregnancy.
In the absence of a result from drug therapy and stone crushing, with acute urinary retention, persistent pain syndrome, hematuria, relapses of cystitis and with large concretions, an open extraperitoneal suprapubic cystolithotomy is performed. For the postoperative period, a catheter is inserted into the bladder, antibacterial drugs are prescribed. In the future, it is necessary to observe a urologist, metabolic examination and ultrasound of the kidneys and bladder once every six months.
Prognosis and prevention
When the background disease is eliminated, the prognosis after treatment of bladder stones is favorable. With unresolved causes of stone formation, a recurrence of the formation of concretions in the bladder and kidneys is possible. Complications of surgical treatment can be urinary tract infection, fever, injury to the walls of the bladder, hyponatremia, bleeding. Prevention includes timely diagnosis and treatment of diseases that provoke the formation of stones in the bladder.