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Abstract: Bladder stones often cause difficulty in urination and interruption of urine flow with symptoms such as painful urination. This patient came to our hospital with clinical manifestations such as long-term interruption of urination, the need to change position to continue urination, and radiating pain at the urethral orifice, and was diagnosed with bladder stones, which are common lower urinary tract stones. The patient was treated with holmium laser lithotripsy of the transurethral bladder, after which the patient’s pain was relieved and he was able to urinate freely.
Basic information】Male, 66 years old
Disease Type】Bladder stones
Hospital】Associated Hospital of Fujian Medical University
Date of Consultation】May 2021
Treatment Plan】 Holmium laser lithotripsy of the transurethral bladder
Treatment Period】3 days of inpatient treatment, 1 month of outpatient follow-up
Results】Bladder stones were crushed and removed, pain was relieved, and urination was unobstructed.
I. Initial consultation
The patient was a 66-year-old man with a long history of prostate enlargement with difficulty in urination, pain during urination, and interruption of urination. The patient underwent CT examination and the results showed bladder stones. Since the patient had large bladder stones that could not be expelled on their own, surgery was considered. After communication with the patient, the patient expressed his cooperation with the treatment and was admitted to the hospital.
II. Treatment history
There are two clinical options for bladder stone surgery, namely minimally invasive surgery and open surgery. Minimally invasive surgery can avoid incision, fast recovery and less trauma, but the operation time is correspondingly longer, while open surgery can remove the stone completely, but it is traumatic and slow recovery. After fully informing the patient of the advantages and disadvantages, the final decision was made to opt for minimally invasive surgery, namely holmium laser lithotripsy treatment of the transurethral bladder. During the surgical treatment, it was confirmed that the stones were located in the bladder, nearly 5 cm in diameter, with local mucosal grossness in the bladder, and no obvious bladder mass was detected. Holmium laser was placed to target the stones and break up most of them to restore the patency of the urethra, and some of the stones were removed and sent for examination for stone composition analysis.
III. Treatment effect
Holmium laser lithotripsy is a minimally invasive procedure that avoids the scars and pain associated with bladder incision and shatters and removes stones through the body’s natural cavity, the urethra, restoring urethral patency and relieving obstruction and pain. After the surgery, the patient’s painful urination symptoms were improved in a short period of time, and the patient was discharged from the hospital 3 days after the surgery.
IV. Notes
We are glad that the patient’s symptoms of painful urination improved after the treatment and he was discharged from the hospital successfully. However, the patient still needs to pay attention to the following conditions after discharge.
1. Although the patient was able to pass urine and relieve pain after treatment, he still needs to pay attention to regular review and daily monitoring of his own urination. Patients themselves have a history of prostate enlargement and laborious urination, and have a higher probability of acute urinary retention. Therefore, patients need to go to the urology clinic promptly once they have urination disorders or symptoms of acute urinary retention.
2. Patients should pay attention to drinking more water and urinating more after discharge, while avoiding spicy and irritating food and avoiding sedentary behavior that can easily cause prostatitis or prostate-related diseases.
3, because the patient himself has prostatic hyperplasia, and this time did not treat it, so the patient often has residual urine when urinating, can be appropriate to carry out the second urination or three urination, that is, feel to urinate after resting for a few minutes and then urinate, can reduce the amount of residual urine, to avoid the accumulation of impurities to form stones again.
V. Personal insight
Lower urinary tract stones are the most common complication in patients with prostatic hyperplasia. The reason for the interruption of urination and painful urination symptoms in this patient is due to the narrowing of the urinary channel caused by prostatic hyperplasia and the accumulation of impurities in the residual urine during daily urination to form stones, which often cannot be discharged due to the relatively small posterior urethral channel when passing through the enlarged prostatic part of the urethra, which then leads to difficulty in urination and painful urination. Patients often have concerns and doubts because of the privacy of the surgical site and the variety of surgical procedures. It is very important to patiently explain to patients and their families the treatment options for urinary stones and the advantages and disadvantages of each surgical procedure.