What happens if gallstones are left untreated

MEN'S HEALTH MATTERS:Left untreated, bladder stones can cause infections and other complications

Q I am 62 years of age have had some abdominal discomfort recently and then developed a urinary tract infection. My doctor arranged for me to have an abdominal scan and it showed that I have a stone in my bladder. I have heard of gallstones but have never heard of bladder stones. My doctor has told me that it will need to be removed, but what will happen if the stone is not removed? Is there any medication I can take to eliminate a bladder stone?

A Bladder stones are hard mineral or protein crystals, which are formed in the urinary bladder and are almost exclusively found in men. They are like grains of sand and can grow up to an inch or larger in diameter. They develop when urine in your bladder becomes concentrated, causing minerals in your urine to crystallise.

The function of your kidneys is to filter your blood, absorbing substances your body needs and removing excess liquid and waste, which is excreted as urine. The urine leaves your kidneys through two tubes (ureters) and enters your bladder, where it’s stored until it passes out of your body. If your bladder doesn’t empty completely, the retained urine can begin to form crystals that eventually become bladder stones. Concentrated, stagnant urine is often the result of an enlarged prostate gland, nerve damage, recurring urinary tract infections or the presence of foreign bodies in the urinary tract. Sometimes small kidney stones travel down the ureter into the bladder and if not expelled can cause bladder stones.

The prostate gland is situated at the bladder neck and surrounds the water passage (urethra). As men get older it enlarges and can compress the urethra and interrupt urine flow, causing urine to remain in your bladder. Normally, nerves carry messages from your brain to your bladder muscles, directing your bladder muscles to contract or relax depending on whether you want to pass urine or not. If these nerves are damaged – from a stroke, spinal cord injury, Parkinson’s disease, diabetes, a herniated disk in your back or other problems – your bladder may not empty completely giving rise to a neurogenic bladder.

Bladder stones can develop if your bladder becomes inflamed. Urinary tract infections and radiation therapy to your pelvic area can both cause bladder inflammation. Occasionally, catheters (tubes inserted through the urethra to help urine drain from your bladder) or objects that accidentally migrate to your bladder, such as a contraceptive device in women or stents, can cause bladder stones.

Stones that form in your kidneys are not the same as bladder stones – they develop in different ways and often for different reasons. Small kidney stones occasionally travel down the ureters into your bladder and if not expelled, can grow into bladder stones.

Bladder stones don’t always give rise to symptoms and are sometimes discovered during tests for other problems. They may, however, block urine flow and may cause severe pain during urination. Since these bladder stones are hard, they sometimes can scratch the lining of the bladder, resulting in bleeding and infection. They may also cause lower abdominal discomfort, painful urination, increased frequency of urination especially at night.

When you visit the hospital, the doctor will take a full history from you followed by a physical examination. Your lower abdomen will be examined to see if your bladder is distended and your prostate gland will be checked, too. A sample of your urine may be collected to see if you have an infection.

Bladder stones are easily diagnosed on plain X-rays – however, a CT scan may be required if there is any suspicion that you may have stones in your kidneys. An ultrasound can help your doctor visualise bladder stones.

Small bladder stones may pass spontaneously, but larger stones will need to be removed during a procedure called a cystolitholapaxy. Using either a spinal or general anaesthetic, a small tube with a camera at the end (cystoscope) is inserted through your urethra and into your bladder to view the stone. A mechanical device, a laser or an ultrasound can be used to break the stone into small pieces and flush these from your bladder. Complications from this procedure are not common, but urinary tract infections, fever, a tear in your bladder and bleeding can occur.

Occasionally, bladder stones which are too large or hard to fragment are removed through open surgery. In these cases, your doctor makes an incision in your bladder and directly removes the stones.

Most bladder stones should be removed because, left untreated, they can cause infections and other complications. If an obstruction from the prostate is the reason for bladder stones, you will almost certainly need to have an operation on your prostate.

This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin

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