Bladder Stones

Bladder stones are relatively uncommon formations of complex mass structures within the bladder due to bladder dysfunction that allows urine to stagnate within the bladder or mechanical blockage of the urethra, like BPH, known as an enlarged prostate, that may slow voiding. These masses differ from the far more common kidney stones found in the kidneys and ureters further up the urinary tract. Bladder stones can vary in size and may or may not cause symptoms. They are often signs of an underlying condition, disorder, or injury.

How Do Bladder Stones Form?

Bladder stones are simply the accumulation of urine crystals in stagnant, concentrated urine. The bladder usually fills with urine and triggers the brain to urinate. At this point, urine is expelled from the body, and the cycle begins again. However, in patients with diseases or conditions that cause the bladder to retain extra urine, this cycle is broken. This is often the case in patients with bladder decompensation, which involves the weakening of the bladder’s detrusor muscle or when the neurological pathways between the brain and the bladder have been compromised.

In patients with an enlarged prostate or BPH, when the prostate squeezes the urethra and makes the channel narrower, blockage is more likely and only requires a smaller bladder stone to create symptoms. In the most severe cases, a bladder stone can completely block the urethra, causing urinary retention, which needs to be relieved emergently to avoid permanent bladder and kidney damage.

Urine accumulation within the bladder and resultant bladder stones can also be caused by UTIs, catheter placement, and rarely, passed kidney stones can become trapped in the bladder to which urine crystals attach and form a bladder stone.

When Do Bladder Stones Become Symptomatic?

Symptomatic bladder stones in patients with healthy bladder function are relatively uncommon because the urethra, the channel that brings urine from the bladder out of the body, is relatively large in diameter, unlike the ureters further up, which, being far smaller, are often the source of trapped kidney stones. As such, bladder stones tend to be extremely large before becoming symptomatic.

Often, patients with bladder stones experience chronic urinary tract infections as the stagnant urine may not only cause a buildup of material but also allow bacteria to breed and increase. Typically, treating the underlying cause handles both concerns.

If BPH is causing the blockage of urine and its retention in the bladder, patients may experience a wide range of lower urinary tract symptoms ranging from mild to severe. While these symptoms are unrelated to the bladder stone, they can be exacerbated by occlusion due to the bladder stone.

Treatment for Bladder Stones

Treatment for a typical bladder stone is similar to how we treat kidney stones. Using a minimally invasive camera-tipped scope threaded through the urethra and into the bladder, we can visualize the bladder stones and effectively pulverize them so they can be passed quickly through the urine naturally or with assistance. We use high-intensity laser (light) to break up the stones, giving them a gravelly consistency that can easily be flushed out. Since we can see the stones, we can get almost all patients stone-free using this treatment method.

Patients presenting to us with urinary obstruction may require, depending on the severity and length of time since the obstruction, a catheter to open the urethra and flush the urine out of the body.

For patients experiencing neurological bladder dysfunction stemming from improper brain-bladder signaling, we have an excellent treatment in the form of sacral neuromodulation that essentially works as a pacemaker for the bladder. These therapies are known by their tradenames: Axonics and Interstim

There are several possible treatments for patients with BPH that allow for normal urination. These procedures range from in-office to minimally invasive therapies performed in an outpatient surgery center or surgical procedures at the hospital. The patient’s anatomy will determine the best course of BPH treatment. Typically, however, once the BPH is successfully treated if a patient has normal bladder function, bladder stones will not be a significant concern.

The Bottom Line

Bladder stones are a relatively uncommon but very treatable concern. They are usually reflective of an underlying condition affecting the bladder or the prostate, and as such, treating both the stones themselves and the cause is very important. Depending on the severity of the blockage of urine up to including urinary retention, the patient should see their urologist at the earliest signs of any urinary tract issues. To avoid the potential for long-term bladder damage