(1) Treatment
The treatment of bladder stones must follow two principles: one is to remove the stones, and the other is to correct the causes and factors of stone formation.
Treatment of stones:
1. Intraluminal surgery, transurethral cystoscopic lithotripsy can be used for stones with smaller diameter and looser texture. Methods of lithotripsy include mechanical, hydraulic, ultrasonic, pneumatic ballistics, laser, etc. You can choose according to the specific equipment conditions of the medical unit and the operator's preferences. Because the diameter of the instrument is too large, it is easy to cause damage to the urethral mucosa, so the so-called "powerful forceps" lithotripsy is rarely used. Currently, pneumatic ballistic lithotripsy and holmium laser lithotripsy are most commonly used clinically. The surgeon needs to improve his proficiency in the surgical operation to avoid unnecessary damage; try to break up the stone and wash away the stone fragments during the operation. Generally, residual stones with a diameter of about 1 to 2 mm can ensure their spontaneous discharge; postoperative anti-infective treatment needs to be strengthened, and patients should be instructed to drink more water to promote stone discharge.
2. Extracorporeal shock wave lithotripsy (ESWL) can treat stones with a diameter of 1 to 2 cm in the prone position. However, due to the large bladder capacity and significantly increased stone activity compared with the upper urinary tract, it is difficult to focus and locate during the operation, and the effect of lithotripsy is difficult to determine, so it is rarely used at present.
3. For open surgery, suprapubic cystolithotomy is feasible for patients with larger stones or those who need to deal with other bladder diseases at the same time. The indications are: ① bladder stones in children; ② stones that are too large; ③ combined with prostatic hyperplasia or urethral stricture that require open surgery; ④ stones in bladder diverticula, especially those with huge bladder diverticula; ⑤ combined cases that require open surgery Bladder tumors to be treated; ⑥ stones that grow on the basis of foreign bodies in the bladder; ⑦ those who cannot undergo laparoscopic surgery due to various reasons, etc.
Correction of the causes of stones: The biggest cause of bladder stones is lower urinary tract obstruction such as prostatic hyperplasia, urethral stenosis, bladder neck elevation, etc. Therefore, those with stones that are clearly caused by obstruction should be treated for obstructive diseases at the same time. Those with stones caused by foreign bodies should remove the foreign bodies at the same time as the stones are removed. Controlling urinary tract infections and strengthening nutrition are also of clear significance in inhibiting the recurrence of stones. For primary diseases that cannot be corrected, such as neurogenic bladder, the decision whether to perform suprapubic cystostomy depends on the specific condition and the patient's own wishes. In addition, using drugs such as alkalinizing urine and inhibiting uric acid based on the analysis results of stone components, and developing lifestyle habits of drinking plenty of water and eating a low-calcium diet can also prevent the recurrence of stones.
(2) Prognosis
Whether bladder stones recur is related to the treatment of urinary tract infection and obstructive lesions.