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Bladder stones: causes, symptoms, treatment

by Josephine Andrews
Published: Last Updated on 359 views

Bladder stones are urinary stones in the urinary bladder. They usually form in the urinary bladder itself, for example when the urine cannot drain freely when urinating. In addition, urinary stones can be transported from the renal pelvis into the bladder via the ureter. In many cases, bladder stones will go away on their own, but sometimes they need to be removed surgically or using special techniques. Read everything you need to know about bladder stones here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

N21 N20

Bladder stones: description

In general, a urinary stone is a solid, stone-like structure (concretion) in the urinary tract. If there is a urinary stone in the urinary bladder , this calculus is called a bladder stone. The urinary bladder is a reservoir that collects the urine and allows it to be released at will through special muscles. Bladder stones can either form in the bladder itself (primary bladder stones) or they form in the kidneys or ureters and eventually reach the bladder with the constant flow of urine (secondary bladder stones). The urinary stone symptoms are the same in both types.

A bladder stone forms when certain stone-forming salts crystallize in the urine. This usually happens when the salt in question is present in the urine in too high a concentration and thus exceeds the solubility threshold. If the salt forms a solid crystal (concretion), more and more layers are deposited on it over time, so that the initially small concretion becomes an ever larger urinary stone.

Depending on the type of salt from which the stone is made, medical professionals distinguish:

  • Calcium oxalate stones (75 percent of all urinary stones)
  • “Struvite stones” made of magnesium ammonium phosphate (10 percent)
  • Urate stones from uric acid (5 percent)
  • Calcium phosphate stones (5 percent)
  • Cystine stones (rare)
  • Xanthine stones (rare)

The distinction between the different types of stones is not only made for purely scientific reasons. Rather, the various types of stone differ in terms of their causes, diagnosis and treatment. For example, only the calcium-rich, “radiopaque” stones can be recognized on the X-ray image or only certain urinary stones can be dissolved again with an alkalization of the urine.

Bladder stones can occur in people of any age. However, older and overweight people are more prone to bladder stones. Men and women are equally affected. In men, the most common cause of bladder stones is benign enlargement of the prostate (BPH).

In many cases, bladder stones do not cause any symptoms and are flushed out of the body with the urine on their own. However, if the urinary stones block the exit to the urethra or are too large to get through the urethra on their own, medical urinary stone removal is necessary. During a cystoscopy , urinary stones can be broken up with forceps or using what is known as shock wave therapy ( ESWL ). The resulting lumps are then small enough to be flushed out with the urine stream. Proper surgery is only necessary in a few cases of very large bladder stones. In addition to the removal, it is particularly important to eliminate the cause in order to prevent bladder stones from recurring.

Bladder stones: symptoms

People with bladder stones often have no symptoms. Whether bladder stones cause symptoms depends primarily on where the stone is and how big it is. If it lies freely in the urinary bladder, the urine can flow unhindered through the urethra. In this case, there are no special symptoms. If, on the other hand, it attaches itself firmly to the lower bladder wall and blocks the exit of the bladder to the urethra due to its size, symptoms develop. The symptoms are caused on the one hand by the irritation of the mucous membranes, which is caused by the often sharp-edged bladder stone and on the other hand by the urine that often accumulates up to the kidneys. Typical bladder stone symptoms are sudden, colicky lower abdominal pain that can radiate to the flanks. In addition, there is pain when urinating, the stream of urine can suddenly stop and the urine can be bloody. Frequently, there is also a constant urge to urinate, combined with a small amount of urine when urinating (pollakiuria).

The severity of the symptoms depends on the size of the bladder stone. Smaller urinary stones usually only partially block the opening to the urethra and still allow a certain amount of urine to pass through. Larger stones allow progressively less urine to pass out through the urethra, so symptoms tend to worsen as the stone gets larger. If the urethra is completely blocked, urine builds up in the bladder, which can reach the kidneys via the ureters. This situation, in which urination is no longer possible, is referred to by doctors as urinary retention or ischuria.

In addition to these symptoms, many of those affected show increasing restlessness. This is mainly due to the fact that those affected unconsciously search for a body position in which the pain subsides. Thus, they are constantly changing from a lying to a standing position or walking around. The pain can also cause nausea and even vomiting.

If you notice pain when urinating or unusual, cramping pain in the lower abdomen, it is best to consult a doctor immediately and have the cause clarified. If urine backs up to the kidneys, it can permanently damage the kidneys.

Bladder stones: causes and risk factors

Bladder stones are made up of mineral salts that are normally dissolved in the urine and are flushed out of the body with it. Under certain circumstances, these mineral salts can be released from the urine (they “precipitate”) and settle in the urinary bladder. Bladder stones are very small, crystal-like structures when they first develop. Through the accumulation of further salts, they often continue to grow steadily.

Doctors differentiate between primary and secondary bladder stones . Primary bladder stones form in the bladder itself, secondary bladder stones form in the upper urinary organs such as the kidneys or in the ureters and are flushed into the bladder with the urine. However, primary bladder stones are much more common than secondary bladder stones. If the urinary stones come loose from the kidneys or ureters, they are usually so small that they can be easily excreted and do not get stuck in the bladder.

Bladder stones usually form when there is an obstruction in the flow of urine from the bladder (primary bladder stones). As a result, the urine stays in the bladder for an excessively long time, which leads to the precipitation of mineral salts and thus to urinary stones. This often results in an additional inflammation of the urinary tract, which in turn promotes the formation of bladder stones.

The typical causes of urinary outflow disorders include an enlarged prostate or a neurogenic bladder emptying disorder: benign enlargement of the prostate (BPH) is a very common finding in older men. In the case of neurological diseases such as multiple sclerosis or paraplegia , bladder stones can also form due to outflow disorders. In these diseases, the contraction of the bladder muscles and thus urination (micturition) is often impaired.

With a urinary tract infection , the bacteria can change the chemical composition of the urine and increase the risk of certain substances precipitating out. The formation of struvite stones consisting of magnesium ammonium phosphate is attributed to urinary tract infections with certain bacteria.

In Germany, an unfavorable diet with a lot of animal fats, proteins and foods containing oxalic acid is considered a risk factor for the development of bladder stones. Oxalic acid is found, for example, in nuts, coffee, cocoa, rhubarb , beetroot and spinach. Stone-forming substances such as oxalate, calcium , phosphate , ammonium and uric acid (urate) can only be dissolved in the urine and transported out of the body in a certain amount. If the amount taken in with food exceeds a certain limit, this can also lead to the precipitation of certain substances.

Foreign bodies in the bladder, such as urinary catheters or surgical sutures, are also risk factors for bladder stones. Bacteria can adhere particularly easily to foreign bodies and thus trigger a urinary tract infection. The infection, in turn, increases the risk of bladder stones.

Other risk factors for bladder stones include:

  • insufficient fluid intake (concentrated urine)
  • unbalanced diet with too much meat and dairy products
  • increased intake of vitamin D3 (e.g. vitamin capsules)
  • Deficiency of vitamin B6 and vitamin A
  • Osteoporosis with an increased release of calcium from the bones into the blood
  • Overactive parathyroid glands (hyperparathyroidism) due to the high levels of calcium in the blood associated with this condition
  • too much magnesium intake

Bladder Stones: Examinations and Diagnosis

If bladder stones are suspected, a specialist in diseases of the urinary tract (urologist) is the right contact person. In large cities there are also established urologists with their own practices, in rural areas urologists are usually only found in hospitals. First, the doctor treating you will collect the medical history ( anamnesis ). You describe your current symptoms and any previous illnesses to the doctor. The doctor then asks further questions in order to be able to go into more detail about your personal case. These can be questions like:

  • Where exactly is your pain?
  • Are you currently having trouble urinating?
  • Did you already have problems urinating before the symptoms appeared?
  • Do you (men) have an enlarged prostate?
  • Have you noticed blood in your urine ?
  • Do you take any medicine?

After the anamnesis, the physical examination follows . The doctor listens to the abdomen with the stethoscope, for example, and then carefully feels it. The physical examination enables the doctor to better assess the possible causes of the abdominal pain and which further examinations are necessary for the clarification.

Further investigations:

If bladder stones are suspected, further tests are usually necessary. If the patient is able to urinate despite the bladder stone, the urine is examined in the laboratory for crystals, blood and bacteria. In addition, a blood sample is taken to assess kidney function and determine the uric acid level. A blood count and blood clotting provide indications of possible accompanying inflammation in the urinary bladder. When there is inflammation in the body, the value of the white blood cells ( leukocytes ) and the so-called C-reactive protein ( CRP ) in the blood are greatly increased.

An X-ray or ultrasound examination (sonography) can make urinary stones visible. In the X-ray image, however, only the so-called “radiopaque” (calcium-containing) stones are clearly visible. Another option that can also be used to visualize radiolucent stones is urography . A contrast medium is injected into a vein. This is distributed in the body and makes it possible to visualize the kidneys and the urinary tract with any stones. In the meantime, however, urography has been largely superseded by computed tomography (CT). With a computed tomography, all types of stones and any urinary obstruction can be detected quickly and reliably.

Another examination method is the bladder reflection (cystoscopy). A rod or catheter-like instrument with an integrated camera (endoscope) is inserted into the bladder. Stones can thus be recognized directly on the transmitted live images. The advantage of cystoscopy is that smaller stones can be removed nicely during the examination. In addition, other causes of a blockage in the flow of urine from the bladder, such as tumors, can also be detected in this way.

Bladder stones: treatment

If there is pain, the first step in treatment is a pain reliever. In many cases, a thorough examination is only possible with prior pain relief. Even asymptomatic bladder stones that are incidentally discovered during a routine ultrasound should be treated, as they can increase in size over time and then cause symptoms.

It depends primarily on the size and location of the bladder stone whether you have to remove it or whether you can wait for it to pass spontaneously. In most cases, a bladder stone does not require any special treatment. Small stones (≤ 5 mm) lying freely in the urinary bladder are flushed out of their own accord via the urethra in about 90 percent of cases. The flushing out can be facilitated by certain drugs ( e.g. tamsulosin ) if, for example, an enlarged prostate narrows the urethra. In the case of some stones (urate stones, cystine stones), an attempt can also be made to dissolve or reduce the size of the urinary stones through a chemical reaction (chemolitholysis).

In any case, it is important that you drink a lot to make it easier to pass the stone. If pain occurs (which often happens when the urinary stone slides through the urinary tract), painkillers such as diclofenac can help.

If the stone is too large to pass spontaneously, if the stone is blocking the urethra and there is urinary retention, or if there is evidence of a severe infection (urosepsis), the stone must be surgically removed. During a cystoscopy, the doctor can crush smaller stones with forceps or remove them directly. Only a local anesthetic is required for adult cystoscopy, so that you can follow the procedure yourself on a monitor. In children, the procedure is performed under general anesthesia. After a bladder examination, you can go home either on the same day or within the next two to three days.

The length of time you need to stay in the hospital after the treatment depends on the size of the stone removed and whether there were any complications from the procedure. As with any surgical procedure, there are risks associated with cystoscopy. In general, there is a risk that the instruments will introduce germs into the bladder and inflame it. In addition, organ walls can be injured or even punctured with the instrument. However, such incidents are very rare.

For several years, crushing of the stones by pressure waves has been used in the majority of all interventions. This procedure is called extracorporeal shock wave lithotripsy (ESWL). In ESWL, larger stones are destroyed by shock waves so that the debris (now much smaller) can be easily excreted in the urine. If pain persists even after the bladder stone has been removed, this may be an indication of inflammation of the bladder (cystitis). If necessary, this is treated with antibiotics.

An open surgical method is only used in very rare cases today. It is necessary, for example, if the doctor cannot get into the bladder with the endoscope during the cystoscopy because the stone or another structure is blocking the urethra or the entrance to the bladder. For example, tumors can sometimes also look like urinary stones in the computed tomography image. However, tumors require a completely different treatment method, so that in case of doubt, open surgery is more common.

If the bladder stones were caused by a bladder emptying disorder, the treatment of the cause is the priority after the stone has been removed. In men, an enlarged prostate often leads to drainage problems in the urethra and subsequent stone formation. In such a case, one can first try to treat the prostate enlargement with medication. In the case of a severely enlarged prostate or recurring urinary stones, however, surgical intervention is recommended in order to eliminate the cause of the stone formation. A so-called transurethral prostate resection ( TURP ) is usually recommended. In this procedure, the prostate is removed through the urethra.

Bladder stones: disease course and prognosis

About 90 percent of bladder stones that are ≤ 5 millimeters are flushed out with the urine on their own. During this time, however, severe pain can occur if the bladder stone “wanders” through the urethra. As a rule, all urinary stones that do not pass on their own can be removed with an interventional or surgical procedure. In principle, one tries to wait for a spontaneous stone to pass before considering an intervention.

Consequential damage from bladder stones is rare, for example when a sharp-edged bladder stone injures the bladder wall or the urethra. If the stone travels through the urethra, it can literally “slit open” the wall of the urethra. This can lead to scarring of the urethra and permanent problems with urination.

Successful bladder stone removal does not guarantee that urinary stones will never appear again. Doctors repeatedly point out that urinary stones have a high recurrence rate. This means that people who have had bladder stones are at risk of developing them again.

You can reduce the risk of bladder stones by getting regular exercise and eating a balanced diet that is high in fiber and low in animal protein. Especially if you have ever had bladder stones, you should only eat small amounts of foods containing purine and oxalic acid. These foods include, for example, meat (especially offal), fish and seafood, legumes (beans, lentils, peas), black tea and coffee, rhubarb, spinach and chard. You should also make sure that you drink at least 2.5 liters a day, as this will ensure that the urinary tract is well flushed and the risk of mineral salts being able to settle is reduced. A safe method, bladder stonesHowever, there is no such thing as generally avoidable.

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