Introduction
Cystolithiasis is the presence of stones in the urinary bladder. These stones are small hard masses made up of minerals and salts from the urine. They are commonly found in men above fifty years of age. Cystolithiasis usually develops when some urine stays back in the bladder after one urinates. Most of the time, cystoliths do not cause symptoms and pass out of the body independently. But at times, they might cause pain requiring medical or surgical treatment.
What Causes Cystolithiasis?
Cystoliths can develop when the bladder does not empty fully. This makes the urine concentrated. This concentrated urine crystallizes and forms stones. Certain infections also lead to the formation of these stones. The common causes of cystolithiasis are:
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Benign Prostatic Hyperplasia- An enlarged prostate gland can lead to the formation of bladder stones in men. The enlarged prostate obstructs the urine flow, thus preventing the bladder from emptying.
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Neurogenic Bladder- Nerves carry messages from the brain to the bladder muscles signaling them to tighten or loosen. If these nerves are damaged during a stroke, spinal cord injury, or any other health issues, the bladder might not empty. This is called the neurogenic bladder.
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Inflammation- Urinary tract infections or radiation therapies to the pelvic area can cause bladder inflammation leading to the formation of bladder stones.
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Medical Devices- Bladder catheters or tubes inserted through the urethra (the small tube through which urine passes out of the body) to help urine drain from the bladder may cause bladder stones. In addition, crystals can form on objects that accidentally migrate to the bladder, such as contraceptive devices or urinary stents. These crystals can later form stones.
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Kidney Stones- Kidney and bladder stones are two different entities altogether. However, small kidney stones might travel down the bladder and lodge themselves if not expelled from the urinary flow. These stones then grow into bladder stones.
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Bladder Augmentation Surgery- Bladder augmentation surgery helps people with urinary incontinence or inability to control urination. However, this surgery can make an individual prone to develop cystolithiasis.
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Bladder Diverticula- Bladder diverticula are tiny sacs in the urinary bladder. These are present in some individuals since birth, while in others, it develops due to infections or a prostate issue.
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Cystocele- This is a condition where the bladder drops from its original position in the pelvic area pushing on the vaginal wall, blocking the urinary flow.
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Diet- A diet high in fat, sugar, and salt and lacking in vitamins A and B can increase the chance of getting cystolithiasis.
What Are the Symptoms of Cystolithiasis?
Small bladder stones can pass out of the body through urine and are usually asymptomatic. However, large bladder stones can irritate the bladder and cause symptoms like:
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Pain- Cystolithiasis causes pain or burning while passing urine. The pain in the lower part of the abdomen comes and goes. Men might complain of pain in the penis or testicles.
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Bleeding.
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Changes in the Urine Color- The color of urine varies from cloudy, dark, or reddish (due to the presence of blood).
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Frequent Urination- There is always a frequent urge to urinate even after passing the urine.
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Urine Intermittency- This is a condition in which the urinary stream is discontinuous. Sometimes it is difficult for the individual to start urination.
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Urinary Tract Infections- Cystolithiasis can also lead to an infection in the urinary tract causing frequent, painful, cloudy, and smelly urine.
How Is Cystolithiasis Diagnosed?
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Physical Examination- The lower abdomen is usually palpated, or performs a rectal examination to evaluate whether the prostate is enlarged or not. Any particular sign or symptoms is also discussed.
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Urine Test- A urine test is carried out to determine the presence of blood, bacteria, and crystallized minerals and salts. It is also helpful to detect a urinary tract infection.
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CT (Computed Tomography) Scan- CT scan uses combined effects of sound waves and computer technology to make images of the internal organs. A CT scan is used to detect tiny stones as well. It is one of the sensitive tests to identify all kinds of bladder stones.
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Ultrasound- This test uses sound waves to form an image of the internal organ. The sound waves bounce off the organs to create pictures of the urinary bladder, thus helping detect any stones.
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X-ray- An X-ray of the kidneys, ureters, and urinary bladder helps the doctor identify cystolithiasis. However, X-rays cannot detect all types of stones.
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Cystoscopy- A cystoscope (a small tube with an attached camera) is inserted into the urethra and pushed up to the bladder to detect any stone.
How Is Cystolithiasis Treated?
Cystolithiasis is treated by removing the stones present in the bladder via surgery. Sometimes the smaller stones drain out with the urine flow on their own and do not need any specific treatment. However, rarely can the stones be dissolved, depending on the stone type.
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Cystolitholapaxy: During the process of cystolitholapaxy, the surgeon uses a small tube with a camera through the urethra inside the urinary bladder to locate the stones. A crushing device, lasers, or ultrasound waves transmitted from the cystoscope can be used to break the stones into smaller particles, which are then washed out of the bladder with fluids. This procedure is carried out under local or general anesthesia. There is a risk of infection during the procedure, so antibiotics are given as a precaution.
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Surgery: If the bladder stones are large, one might need to undergo open surgery to remove those. Surgical correction can also be carried out if the bladder stones are due to any anatomical obstruction or an enlarged prostate.
Can Cystolithiasis Be Prevented?
It might not be possible to prevent cystolithiasis; however, the risk of developing the condition can be minimized by -
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Drinking plenty of water to flush out smaller stones, if any, with urine. Water helps dilute the minerals and salts in the urine, thus making it unlikely for the minerals to accumulate together to form a stone.
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Surgical treatments of an enlarged prostate or any other anatomical anomalies.
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Changing the diet or using specific medicines based on the type of stone might help reduce future cystolithiasis for certain types of stones.
Conclusion
Cystolithiasis is the presence of bladder stones. The signs and symptoms differ from individual to individual. It is not a life-threatening condition. Effective treatments are there for all kinds of stone removal. It is advised to get diagnosed and treated early and address any condition causing cystolithiasis. Prompt treatment can relieve the symptoms and help one to avoid long-term complications. Making a few lifestyle modifications would also keep cystolithiasis from developing again.
