Urolithiasis (Stones in the bladder)

With urolithiasis, stones form in the kidneys and bladder, which can disrupt the functioning of the urinary system and cause various complications.

5-10% of people suffer from urolithiasis, men — 3 times more often than women. Usually, urolithiasis develops after 40-50 years. However, there are cases in children. Most often, stones are formed in the kidneys, the probability of their formation in the bladder is much lower. More often, stones descend into the bladder from the kidneys through the ureters.

Stones can irritate the walls of the bladder, block the excretion of urine from it, disrupting urination. This contributes to the development of infection and leads to pain in the lower abdomen, impaired urination, the appearance of blood in the urine.

If any of the above symptoms occur, consult a doctor. These signs do not necessarily indicate urolithiasis, but a more thorough examination is necessary.

Most often, the cause of the formation of stones is incomplete emptying of the bladder during urination. If urine stagnates in the bladder for a long time, some of its components precipitate, form crystals, which eventually form stones.

Usually, stones are removed from the bladder surgically. One of the most common types of surgery is cystolitholapaxy.

Usefull Information About Urolithiasis

If the stones are so small that they can easily pass through the urinary tract and stand out with urine, there may be no symptoms. However, in most cases, urolithiasis is accompanied by pronounced complaints, since stones either irritate the walls of the bladder or interfere with normal urination.

Symptoms of urolithiasis include:

  • pain in the penis, scrotum or lower abdomen (in men);
  • pain or difficulty urinating;
  • cloudy or dark urine;
  • blood in the urine.

Additional symptoms found in children include:

  • constant and frequent painful erection, unrelated to sexual desire (the medical term for this condition is priapism) in boys;
  • bedwetting.

It is recommended to seek medical help if the following complaints appear:

  • constant abdominal pain;
  • changing the usual mode of urination;
  • blood in the urine.

These symptoms do not necessarily indicate urolithiasis, but require a more thorough examination.

The most common cause of stone formation is incomplete emptying of the bladder.

Urine is produced by the kidneys. It consists of water mixed with unnecessary metabolic products that are removed from the blood by the kidneys. One of the decay products is urea, consisting of nitrogen and carbon. If the urine in the bladder stagnates for a long time, some chemicals precipitate and crystals form. Over time, these crystals harden and form stones in the bladder.

Some of the most common causes of incomplete emptying of the bladder are described below.

Prostate adenoma (enlargement of the prostate gland). The prostate is a small gland found only in men. It is located in the pelvic area between the penis and the bladder and surrounds the urethra (urethra), through which urine from the bladder is excreted from the body. The main function of the prostate is to participate in the production of seminal fluid. In many men, the prostate increases with age.

In about a third of men aged 50 years and older, the prostate presses on the urethra and interferes with the normal outflow of urine from the bladder. In the treatment of prostate adenoma, urolithiasis in men should not develop. However, in a small number of men who are not helped by treatment, the risk of developing urolithiasis increases.

Neurogenic bladder is a condition caused by damage to the nerves that control the functioning of the bladder, as a result of which a person cannot completely empty it. Neurogenic bladder may have the following causes:

  • severe injury of the spinal cord (a long bundle of nerves passing inside the spine from the brain), leading to paralysis (impaired motor activity of organs and body parts);
  • diseases that cause damage to the nervous system, for example, motor neuron disease or spina bifida (non-infection of the vertebral arches).

Most people with neurogenic bladder require the installation of a catheter to empty it. A catheter is a tube that is inserted into the bladder through the urethra. Through the catheter, urine flows out of the bladder. This is called bladder catheterization.

However, the artificial way of emptying the bladder is not an ideal substitute for the natural one. Therefore, a small amount of urine may remain in the bladder, which eventually causes the formation of stones. According to some estimates, about one in ten people with neurogenic bladder will develop urolithiasis sooner or later.

Bladder prolapse is a disease that occurs in women and develops when the walls of the bladder weaken and begin to hang over the vagina. This may affect the normal outflow of urine from the bladder. Bladder prolapse can develop during heavy loads, for example, during pregnancy, due to chronic constipation or weight lifting.

Diverticula of the bladder are sac-like protrusions on the walls of the bladder. If the diverticula grow to a certain size, it may be difficult for a person to completely empty the bladder. Diverticula of the bladder can be a birth defect or develop as a complication of infection or prostate adenoma.

Surgery to enlarge the bladder. There is an operation to enlarge the bladder, during which a part of the intestine is sewn to the bladder. This technique is used, for example, for the treatment of urgent (urgent) urinary incontinence. Research results have shown that approximately one in twenty people who have undergone this operation will face urolithiasis.

A monotonous diet, saturated with fats, sugar and salt, with a lack of vitamin A and B, can increase the predisposition to urolithiasis, especially if a person consumes insufficient fluids. These factors can change the chemical composition of urine, which will increase the likelihood of formation of stones in the bladder.

Small stones can leave the body on their own, for this it is recommended to increase the amount of liquid consumed to 6-8 glasses per day (about 1.2-1.5 liters) In other cases, medical assistance will be required.

The most common operations to extract stones from the bladder include:

  • transurethral cystolitholapaxy is the most common procedure for the treatment of urolithiasis in adults;
  • subcutaneous suprapubic cystolitholapaxy is more often used to treat children to avoid damage to the urethra, but sometimes it can also be used in adults to extract very large stones;
  • open cystotomy is often used for men whose prostate is so enlarged that it interferes with other procedures, or if the stone is very large.

Transurethral cystolitholapaxy. During the operation, the surgeon will insert a cystoscope into your bladder through the urethra — a small solid tube inside which a camera is located. The camera will help to detect the stones. Then, the stones are crushed into pieces using laser energy or sound waves emitted by a cystoscope. Small pieces of stones are washed out of the bladder with liquid.

Transurethral cystolitholapaxy is performed under local or general anesthesia, so you will not feel pain. There is a risk that an infection will be introduced during the procedure, so you will be given antibiotics as a precaution. There is also a small risk of bladder damage.

Subcutaneous suprapubic cystolitholapaxia. During the operation, the surgeon makes a small incision on the skin in the lower abdomen. Then an incision is made on the bladder and stones are extracted through it. The procedure is performed under general anesthesia.

Open cystotomy is similar to subcutaneous suprapubic cystolitholapaxy, but the surgeon makes a larger incision on the skin and bladder. An open cystotomy can be combined with another type of surgery, for example, removal of the prostate or part of it or removal of diverticula of the bladder (sacs formed on the walls of the bladder).

The operation is performed under general anesthesia. The disadvantage of open cystotomy is more pronounced pain after surgery, a longer recovery period. But this procedure is necessary if the stone reaches a large size. For 1-2 days after the operation, you will also need to install a catheter.

The most common complication during surgery to remove stones from the bladder is the development of an infection of the bladder or urethra. These infections are known collectively as urinary tract infections.

Urinary tract infections occur in about one in ten people who have undergone surgery. As a rule, they are treated with antibiotics.

After removing stones from the bladder, you will need to stay in the hospital for several days so that the doctor can monitor your condition in the postoperative period. The duration of hospitalization may vary depending on the type of surgery, the presence of complications and your individual characteristics. You will be scheduled for a second examination, during which an X-ray or CT scan will be taken to make sure that all the stone particles have been removed from your bladder.

Treatment of the cause of urolithiasis

After removing the stones from the bladder, it is necessary to cure the cause of the disease so that it does not happen again in the future.

Prostate adenoma can be treated with drugs that simultaneously shrink the prostate and relax the bladder, making it easier to urinate. If medications do not help, you may need surgery to remove the prostate or part of it.

If you have a neurogenic bladder (inability to control the work of the bladder due to nerve damage), and you have developed urolithiasis, correction of the process of removing urine from the bladder is required. This may require the installation of a catheter or replacement of an old one to improve bladder control.

Mild and moderate cases of bladder prolapse (when the walls of the bladder weaken and begin to hang down into the vagina) can be cured by installing a pessary. This device is in the form of a ring that is inserted into the vagina and holds the bladder in place In more severe cases, surgery may be required to strengthen and support the walls of the bladder.

Diverticula of the bladder (sac-like protrusions) can be surgically removed.

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