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Bladder stones

Workup

• Prevalence: 5% total stone disease, 1.5% urologic hospitalizations
• Primary bladder stones: can be endemic, caused by malnutrition, may present with child pulling/tugging at penis, usually ammonium acid urate, CaOx, urinc acid, and CaPhos
• Secondary bladder stones: caused by underlying outlet obstruction, most often seen with BPH, usually not due to inability to pass upper tract stones
• Spinal cord injury: seen in 15-30% within 10yrs
• Chronic catheters: seen with 0.7-2.2%, can be due to balloon fragments

Management

• Medical management: no proven benefit, takes too long to dissolve stones
• Endoscopic management: cystolitholapaxy (mechanical breakage) vs cystolithotripsy (energy fragmentation), usually via transurethral route
• Cystolithotomy: open approach usually requires overnight stay and catheter drainage
• Urinary diversion: may require percutaneous access and possible revision due to inadequate drainage

Urethral stones

• Prevalence: 0.3-1% total stone disease
• Primary stones: occur from obstruction, urinary stasis, and presence of diverticula
• Urethral strictures: can develop on hair-bearing urethral grafts, hair persists after removal in 3-6% grafts
• Prostatic stones: more common with prostatitis, seen near prostatic capsule during endoscopic resection, can develop from brachytherapy or cryoablation
• Preputial stones: smegma buildup and phimosis, may require circumcision (send for pathology)
• Presentation: acute retention, LUTS, and pelvic/rectal/penile pain

Management

• Lidocaine jelly: can instill and attempt milking out small distal stones
• Surgery: consider ESWL, percutaneous extraction, ventral meatotomy