Bladder stones
There are two main causes of bladder stones: stones from the kidneys and ureter enter the bladder, especially stones in the lower part of the ureter. It is important to treat such bladder stones along with stones from the kidneys and ureters. Secondly, stones that originate in the bladder are often accompanied by the presence of lower urinary tract obstruction, and these obstructive lesions should be corrected at the same time as treatment.
Treatment options
The principles of bladder stone treatment: removal of stones; correction of the cause of stone formation.
Surgical treatment of bladder stones includes endoscopic surgery, open surgery and ESWL.
Intracavitary treatment
Intracavitary treatment of transurethral bladder stones is currently the main method of treating bladder stones, which can simultaneously deal with lower urinary tract obstructive lesions, such as urethral stricture and prostatic hyperplasia.
1.Transurethral laser lithotripsy (preferred)
Laser lithotripsy is currently an effective treatment for bladder stones, and holmium laser lithotripsy is currently used more frequently. Holmium laser can also treat other diseases that cause stones, such as prostate enlargement and urethral stricture.
2.Transurethral pneumatic ballistic lithotripsy (recommended)
Pneumatic ballistic equipment is relatively inexpensive and easy for urologists to master. The stones are easy to move in the bladder during pneumatic ballistic lithotripsy, and it takes relatively long time to lithotripsy for larger stones.
3.Transurethral mechanical lithotripsy (optional)
The stone is grasped with a lithotripter and mechanically fragmented under direct cystoscopic view. Transurethral mechanical lithotripsy is suitable for bladder stones of about 2 cm.
4.Transurethral bladder ultrasonic lithotripsy and transurethral electrohydraulic lithotripsy
Because the lithotripsy effect is not as good as laser lithotripsy and pneumatic ballistic lithotripsy, they are less used now.
Extracorporeal shock wave lithotripsy
ESWL can be used for children with primary bladder stones; ESWL can be used for adults with primary bladder stones ≤ 30 mm.
Open surgical treatment of bladder stones
Suprapubic cystotomy for stone extraction should not be the treatment of choice for bladder stones and should only be used in cases where other lesions in the bladder need to be managed at the same time.
Relative indications for open surgical treatment.
(1) More complicated bladder stones in children;
(2) Large stones;
(3) Those with severe prostatic hyperplasia or urethral strictures;
(4) Stones in the bladder diverticulum;
(5) Large stones formed around foreign bodies in the bladder;
(6) Combination of bladder tumors that require open surgery.
Patients with bladder stones in combination with severe medical disease may be catheterized or have suprapubic cystocentesis and then undergo intracavitary or open stone extraction after the medical disease has improved.