» Bladder lithiasis
 » Ureterolithiasis
 
Bladder lithiasis
The bladder calculi or stones are small, hard and they are generally formed of calcium or of uric acid. Often they are formed when the urine suffers stasis in the bladder.

The risk factors for the formation of bladder calculi are:


Men are more prone than women to form bladder calculi
Mature age  
Insufficient consumption of liquid
Incomplete emptying of the bladder - especially in men with benign growth of the prostate, causing difficulties with the run of the urine, or of men and women with a condition known as neurogenic bladder
Frequent or recurrent urinary infections 
Other medical conditions that cause an increase in the formation of bladder calculi


 

Symptoms
Most of symptoms are due to the irritation of the bladder mucous due to the presence of calculi, or when the flow of the urine of the bladder is obstructed. You can have bladder calculi and not present any symptom at all. However, if they are big or if they are in the urethra, they can show symptoms.
Bleed in the urine
Pain when urinating
Difficulty to urinate
To frequently urinate
Urgency of urinating
Interruption of the urine flow
Abdominal pain
Dark urine
Frequent urinary infections
The urine escape with urgency (urge incontinence)
Inability to urinate (urinary retention)

Diagnosis

Your doctor can order some tests to confirm the diagnosis. 
These include: General urine test, urine culturing, blood tests, pelvic scan and even urotac.  
 
Your doctor can even carry out a cystoscopy, to examine the interior of the bladder and, if there are calculi, to know the number and size of the same ones. A cystoscopy is a procedure where an optic fiber is introduced by the urethra reaching the bladder.

The treatments of minimal invasion to treat bladder calculi include, laser, special waves of high energy sound (ultrasound) or of electric power. Then, fragments are eliminated from the bladder. The minimally invasive surgery is either carried out through the urethra or inclination of a very small abdominal incision. 
 
If the calculi are too big or too numerous to be eliminated by these methods, the conventional surgical extirpation may be necessary. This incision is carried out below the umbilical scar.

There are three different surgical methods for the treatment of bladder calculi. Two approaches are minimally invasive and the third is the traditional surgery. The advantages of the minimally invasive methods are: less pain, there are not incisions or a small incision, shorter stay at the hospital and shorter catherization. Or we can apply the use of probes.


Minimal invasive surgery for bladder calculi

Lithotrity and Transurethral litholapaxy
The cystoscopy is carried out to visualize the stones. Later on, an energy source, as the pneumatic or high energy sound waves (ultrasound) or the electric power (shock wave lithotripsy), or laser, is used to crush the stones until the fragments are enough small to be removed through the cystoscope. There is no incision made in this treatment. A catheter can be necessary at the end this procedure.

Litotricia y litolapaxia suprapúbica percutánea
This is often applied for the stones that are too big for the transurethral treatment and in children. In this treatment, a small incision is made in the inferior abdominal wall. This allows the urologist to use instruments for the fragmentation of the stones in a quicker and more effective way. A catheter can be necessary at the end of its procedure. It is required a suprapubic catheter for some days in the tap place.

Additional procedures:
If your bladder stones were caused by the obstruction of a growth of the prostate, your doctor can decide to carry out a transurethral resection of the prostate (TURP) after the extraction of the stones.


Preparations for the surgery
If you have a record of heart problems, it is possible to request your cardiologist's additional authorization.

Preparations for the surgery

Only drink clear liquids during a period of 24 hours before the date of your surgery

Don't eat neither drink anything at least 8 hrs before the surgery
The aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, E Vitamin, Ticlid, Coumadin, Lovenox, Plavix and some medications for the arthritis can cause hemorrhage and should be avoided one week before the date of the surgery

Previous to the surgery
All procedures are very safe but there are risks that, although they are minimal, you should know them:
Hemorrhage:
The blood loss during this procedure is minimum and only in strange occasions it is necessary a blood transfusion.

Infection:
All patients are treated with antibiotics intravenous via before the surgery to reduce the probability of infection, which is strange to occur after the surgery.

Hernia on the incision area is not very common
Tissue / organs lesion:
Although they are not very frequent, there is a possible damage for the surrounding tissue and organs, including the intestine, the blood vessels.

Switch to open surgery:
The minimal invasive surgery may require the switch to standard open surgery if there are difficulties. This implies a bigger incision and possibly a longer recovery period.

Mistake:
Your bladder calculi may be too numerous to be extracted in a single minimal invasive surgery. If this happens, an additional surgery will be necessary

Other complications:
These are not very common and they include: low sodium concentration (hyponatremia) and bladder perforation which could require open surgical repair of the bladder and long term catheterize.

After the surgery

Immediately after the surgery, you will be taken to the recovery room. You will be transferred to your room at the hospital once you are totally awake and your vital signs are stable. If you will return home the same day, you will be discharged from the recovery room after you are totally awake and your conditions are stable.

Post operatory pain:
The pain is controlled with medication that will be prescribed in the hospital or at your home.

Nausea:
It is probable to experience some nausea related to the anesthesia or medication for the pain. There are available medications for the control of the nausea.

Urinary catheter:
  You can expect to have a urinal catheter, same that will be placed through your urethra to drain the bladder. This will be placed in the surgery room while you sleep. It is not strange to have the urine with a blood color, to present smarting when urinating during some few days after the surgery, but this is temporary. It is possible you will go back home with a catheter, in which case the same one will be removed by the doctor.

Diet:
You can expect to have an intravenous catheter (iv) during 1-2 days. (an intravenous line is a small tube placed in the vein so that you can receive necessary fluids and remain well hydrated, and it also offers an easy way to receive medication). Most of the patients are able to tolerate liquids the following day after the surgery and a regular diet little time later. Once in a regular diet, you will take oral medication for the pain or injections instead intravenous line.

Strolling:
It is very important to stroll the same day of the surgery or one day later; this helps your recovery and avoids complications like thrombosis, constipation and infections in the lungs. The strolling should be carried out with the supervision of a nurse or a relative.

Hospital stay:
The duration of the hospital stay in most of the patients is of approximately 1-3 days, depending on the complication of the surgery.

Constipation:

You can experience lazy intestine during several weeks. Suppositories and laxatives are in general the treatment of this problem.


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