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Bladder Stones

Overview

Bladder stones refer to the condition in which stones are formed in your urinary bladder. The urinary tract includes a pair of kidneys and ureters (tubes that carry urine from the kidneys to the bladder), a urinary bladder, and a urethra (a small tube that empties to the outside). The function of the kidneys is the filtration of the blood and the production of urine. During the process, large amounts of minerals like calcium, uric acid, oxalates, etc., tend to accumulate in the urine, resulting in the formation of stones. These stones start as small but can grow larger, obstructing urine flow and damaging the urinary bladder. They are treated with medications and increased fluid intake that causes the expulsion of the stone. If the stone doesn’t make its way out of the urethra, surgery or lithotripsy may be required.

Types

Stones may be of different sizes and types:

·         Calcium Oxalate monohydrate and dihydrate

·         Calcium Phosphate

·         Magnesium Phosphate

·         Ammonium Phosphate

·         Ammonium Magnesium Phosphate

·         Uric acid

·         Cystine

 

·         Xanthine

Causes

The most common etiology behind stone formation is concentrated urine which may result from either low fluid intake or urinary stasis in the bladder for any reason. Urinary stasis can predispose to urinary infections that may cause stones. Low urine volumes result in the supersaturation of urine with stone-forming constituents like calcium, oxalate, and uric acid. Crystals can act as a cradle on which more and more ions and minerals are fostered, thus forming a stone. Some of the causative factors for stone formation are;

 

  • Dehydration: Water functions to dilute the minerals in the urine and help them be removed from the body through urine. Low fluid intake can cause a decreased amount of water concentration in the body and hence urine. This may cause an accumulation of minerals in the concentrated urine, thus causing stone formation.
  • Obstruction to the flow of urine: The prostate gland lies around the urethra in men and increases in size as the men age, which may result in the pressing of the urethra obstructing the urinary flow. The urine tends to stay in the bladder, can become concentrated, or may predispose to urinary infection.
  • Kidney stones: Stones can also form in the kidneys and travel down through the ureters into the bladder.
  • Neurogenic bladder: Some diseases or trauma to the spinal cord can damage the urinary bladder's nerve supply, affecting its functions to work properly. This can lead to stasis of the urine. To enable the urinary exit, a tube called a catheter is placed in the bladder. Improper care or the long duration of the catheters can lead to urinary infections. 

Risk Factors

The following risk factors can predispose you to the formation of bladder stones.

Fluid intake: Low fluid, especially for people living in temperate climates.

Lifestyle: Obesity, lack of exercise, sedentary lifestyle.

Diet: Consuming food rich in proteins, sugars, sodium, and fruit juices.

Family history: A family member with a history of renal and bladder calculi also increases your chances of getting one.

 

Medications: The use of some drugs can predispose to stone formation—for example, diuretics, calcium, vitamin D supplements, antibiotics like ciprofloxacin, ceftriaxone, etc.

Epidemiology

Bladder stones are more common in developing countries where people have limited access to good nutrition and water and suffer recurrent infections due to improper hygiene.

Signs And Symptoms

Signs and symptoms of a bladder stone depend upon its size and position. Small stones do not cause any symptoms and may be found incidentally on radiographs. Bigger stones may cause the following symptoms;

·         Severe pain in the back and lower abdomen

·         Increased frequency of urine

·         Pain or difficulty in passing urine

·         Nausea vomiting

·         Burning pee

·         Pink, red, or brown urine

 

·         Urgent desire to urinate

Diagnosis

If you experience the symptoms of a bladder stone, contact your healthcare provider. They would take the history of pain and associated symptoms, perform a physical examination, and may advise some tests;

Blood tests: They may show the number of minerals and salts in your blood. Also, they can determine your kidney functions or if you have an infection.

Urine tests: These can tell the urinary infection and the passage of blood and other cells. The collection of 24-hour urine can tell which mineral is in more amount in your urine.

Imaging: These can be used to diagnose a stone. They can show the stone’s exact position and include X-ray KUB, ultrasound, CT scan, and MRI.

Cystoscopy: This test involves the insertion of a small flexible tube with a camera at the tip to visualize the inside of the bladder

 

Stone lab test: You may be asked to keep the stone safe that you will pass to be checked in the lab for recurrent stones and find out the minerals responsible for it.

Differential Diagnosis

There are some other conditions that may have the same symptoms as the bladder stone:

·         Bladder carcinoma

·         A blood clot

·         Acute glomerulonephritis

·         Urinary tract infection

 

·         Pyonephrosis

Treatment

The bladder stones are treated with medications and interventional procedures like lithotripsy, surgery, etc.

Medications

·         Pain medicines: Your doctor may prescribe you paracetamol or other pain-relieving medicines (NSAIDs) for the pain.

·         Stone expulsive medicines: Some medicines relax the sphincter of the urethra and thus result in the passage of the stone. They include alpha-adrenergic blockers (tamsulosin), and calcium channel blockers (nifedipine). You would need to increase fluid intake to flush the stones out.

·         Stone prevention medicines: These medicines are given to people with recurrent stones of a specific type to prevent further formation. They include thiazide diuretic for calcium stones, allopurinol for uric acid stones, alkaline preparations to keep the urine alkaline, and antibiotics to prevent struvite stones.

 

Surgical procedures

Lithotropsy:

In this procedure, a cystoscope is inserted into the bladder to visualize the stone and with the help of laser or ultrasonic energy, the stone is broken down into small pieces that can easily be flushed. 

Cystolithotomy:

 

It is an open surgical procedure using an incision in the lower abdomen to remove the bigger stones that can not be treated with medication or lithotripsy. 

Prognosis

The overall prognosis of bladder stones is good. Small stones may pass by themselves. Medications and other procedures are usually effective for larger stones. In cases of recurrent stones, the doctor may advise more tests to find out the composition and cause of the stone and may give you medicines to avoid further stone formation.

Lifestyle Modifications

You can adopt the following habits to avoid the formation of stones,

·         Drink plenty of water. Around 6-8 glasses per day are recommended.

·         Try to maintain an optimum weight by following a healthy meal plan and performing exercises. Avoid high intake of food rich in proteins (meat, legumes), salts, sugars, and oxalates (spinach, sweet potato, nuts, tea, chocolates)

 

·         Incorporate fruits and vegetables into your diet. 

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