What is a Bladder Stone?
The bladder is a muscular organ that stores urine from the kidneys. Under normal conditions, the bladder should empty completely during urination. However, if the bladder cannot empty completely for various reasons, the remaining urine (‘residual urine’) accumulates over time. These deposits combine and crystallise, forming bladder stones.
These stones can sometimes be as small as a grain of sand, but in neglected cases, they can grow to the size of an orange and completely fill the bladder.
Causes: What Causes Bladder Stones?
95 per cent of bladder stones occur in men. The main reasons for this are anatomical and hormonal factors.
1. Benign Prostatic Hyperplasia (BPH) – The Most Common Cause
The primary cause of bladder stones is benign prostatic hyperplasia. When the prostate enlarges, it compresses the urinary tract and prevents the bladder from emptying completely. Over time, the urine remaining at the bottom of the bladder forms sediment and turns into stones.
Important: If a man has bladder stones, he must also have his prostate checked. The two conditions are usually treated at the same time.
2. Neurogenic Bladder
In conditions affecting the nervous system, such as spinal cord injury, diabetes or stroke, the bladder muscles cannot find the strength to expel urine. As urine remains inside continuously, stone formation may become inevitable.
3. Urinary Tract Infections
Frequent infections disrupt the chemical composition of urine, creating conditions conducive to stone formation.
4. Insufficient Fluid Intake
Not drinking enough water causes urine to become very concentrated (dark) and minerals to precipitate.
5. Kidney Stones
Sometimes a small stone that falls from the kidney cannot be passed in the urine and remains in the bladder, where it continues to grow.
What are the symptoms of bladder stones?
Bladder stones cause very typical symptoms as a result of rubbing against the bladder wall or blocking the urinary outlet:
- Sudden Interruption of Urination: This is the most characteristic symptom. As the patient urinates, the stone moves and blocks the outlet like a ‘plug’. Urination suddenly stops. When the patient moves, the stone rolls and urination resumes.
- Lower Abdominal Pain: A constant feeling of discomfort and heaviness below the navel.
- Pain at the Tip of the Penis: Especially in men, a severe stinging pain at the tip of the penis at the end of urination.
- Haematuria (Blood in the Urine): Urine may appear bloody or tea-coloured as a result of the stone scratching the bladder wall.
- Frequent and Difficult Urination: Frequent waking at night and the need to strain to start urination.
- In Children: Children may pull on their penis to relieve pain or hold it constantly with their hands.
Diagnostic Methods
Diagnosis is usually straightforward and quick.
- Ultrasound: Stones are clearly visible as white, bright masses on an ultrasound performed with a full bladder. The size of the prostate and the amount of urine remaining in the bladder are also measured.
- X-ray (DÜSG): Stones containing calcium can be seen directly on an X-ray.
- Cystoscopy (Camera Examination): In suspicious cases or for differential diagnosis of tumours, a camera-equipped device is inserted through the urinary tract to look directly inside the bladder. This is the definitive diagnostic method.
Treatment Methods for Bladder Stones
Treatment is planned according to the size of the stone and the underlying cause (usually the prostate).
A. Drink Plenty of Water (For Very Small Stones)
If the stones are very small (like sand) and there is no prostate obstruction, it is possible to expect the stones to pass naturally by drinking plenty of water. However, this possibility is lower for bladder stones than for kidney stones because there is usually an obstruction (the prostate) in the passageway.
B. Endoscopic (Closed) Bladder Stone Surgery: Cystolithotripsy
Today, the Gold Standard treatment is used. No incisions are made in the body.
- How is it done? While the patient is under anaesthesia, a thin tube with a camera called a ‘cystoscope’ is inserted through the urethra.
- Stone Fragmentation: The stone in the bladder is visible on the camera. The stone is pulverised inside using laser, pneumatic (air-powered) or ultrasonic energy sources.
- Cleaning: The small fragments are removed by suction or flushing.
- Advantages:
No incision or stitches.
Minimal risk of bleeding.
The patient returns home the same day or the next day.
Very little pain.
C. Percutaneous Lithotripsy (PCC-L)
It is used when the stones are too large to be broken using the closed method or when the urinary tract is too narrow in paediatric patients.
- Method: A small 1 cm incision is made below the navel into the bladder. The stone is broken up and removed through this incision. This is also considered a closed method.
D. Open Lithotomy (Open Surgery)
It is rarely used nowadays. It is only preferred for stones that have reached enormous sizes (fist-sized) or if open prostate surgery is to be performed at the same time. An incision of approximately 10 cm is made in the lower abdomen.
Critical Point: Breaking the Stone Is Not Enough, You Must Solve the Cause!
The biggest mistake made in the treatment of bladder stones is simply breaking the stone and sending the patient home. If the underlying cause of the stone formation, Benign Prostatic Hyperplasia (BPH), is not treated, it is inevitable that stones will recur within 1-2 years.
For this reason, urologists generally apply the ‘One Session, Two Procedures’ principle:
- During the same operation, the bladder stone is first broken using a closed method.
- Immediately afterwards, in the same session, the prostate obstruction is opened using the TURP (Transurethral Resection of the Prostate) or HoLEP method.
This way, the patient is rid of the stone and also achieves comfortable urination by removing the obstruction blocking the urinary tract.
Post-Treatment Process and Recovery
- Catheter: A urinary catheter is usually inserted for 1-2 days after surgery to allow the bladder to heal and expel any small fragments inside.
- Hospitalisation: For closed surgeries, one night’s stay is usually sufficient.
- Daily Life: After the catheter is removed, the patient can immediately return to their daily routine. Mild burning during urination and pink-coloured discharge in the urine are normal for the first few days.
- Sexual activity: Depending on your doctor’s advice, you can usually resume sexual activity after 2-3 weeks.
Ways to Prevent Bladder Stones
Lifestyle changes are important to prevent stones from recurring after treatment:
- 2.5 Litres of Water per Day: This dilutes the urine and prevents minerals from precipitating.
- Do Not Hold Urine: Do not delay when you feel the urge to urinate. Urine that remains in the bladder can crystallise.
- Double Voiding: After using the toilet, wait 10-15 seconds and then strain again to try to empty the bladder completely.
- Prostate Check: It is vital for all men over the age of 50 to have an annual prostate examination for the early detection of blockages.