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 Bladder stones

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PostSubject: Bladder stones   Bladder stones EmptyTue Jan 04, 2011 5:36 am

Bladder stones are small masses of
minerals that form in your bladder. Bladder stones develop when urine in
your bladder becomes concentrated, causing minerals in your urine to
crystallize. Concentrated, stagnant urine is often the result of an
enlarged prostate, nerve damage or recurring urinary tract infections.

Bladder stones don't always cause signs or symptoms and are sometimes
discovered during tests for other problems. When symptoms do occur, they
can range from abdominal pain to blood in your urine.

Small bladder stones sometimes pass on their own, but you may need to
have others removed by your doctor. Left untreated, bladder stones can
cause infections and other complications.

Symptoms

Some people with bladder stones have no problems — even when their
stones are large. But if a stone irritates the bladder wall or blocks
the flow of urine, signs and symptoms can develop. These include:

* Lower abdominal pain
* In men, pain or discomfort in the penis
* Painful urination
* Frequent urination, especially during the night
* Difficulty urinating or interruption of urine flow
* Urine leakage (incontinence)
* Blood in your urine
* Abnormally dark-colored urine

Bladder stones come in a variety of characteristics:

* They can be small, or large enough to fill your entire bladder.
* They can be soft or hard.
* They can be smooth, or jagged and spiked.
* You can have a single bladder stone or several.


Causes

Your kidneys 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 slender 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. In most cases,
an underlying condition affects your bladder's ability to empty
completely. The most common of these conditions include:

* Prostate gland enlargement. An enlarged prostate, or benign
prostatic hyperplasia (BPH), is one of the most common causes of bladder
stones in men. As the prostate enlarges, it can compress the urethra
and interrupt urine flow, causing urine to remain in your bladder.
* Neurogenic bladder. Normally, nerves carry messages from your
brain to your bladder muscles, directing your bladder muscles to tighten
or release. If these nerves are damaged — from a stroke, spinal cord
injury or other health problem — your bladder may not empty completely.
* Bladder diverticula. These are weakened areas in the bladder wall
that bulge outward in pouches. Bladder diverticula may be present at
birth or develop later as a result of benign prostatic hyperplasia or
other conditions that cause poor bladder drainage.

Other conditions that can cause bladder stones include:

* Inflammation. Bladder stones can develop if your bladder becomes
inflamed. Urinary tract infections and radiation therapy to your pelvic
area can both cause bladder inflammation.
* Medical devices. Occasionally, catheters — slender tubes inserted
through the urethra to help urine drain from your bladder — can cause
bladder stones. So can objects that accidentally migrate to your
bladder, such as a contraceptive device or stent. Mineral crystals,
which later become stones, tend to form on the surface of these devices.
* Kidney stones. Stones that form in your kidneys are not the same
as bladder stones — they develop in different ways and often for
different reasons. But small kidney stones occasionally travel down the
ureters into your bladder and if not expelled, can grow into bladder
stones.


Risk factors

In developing nations, bladder stones are common in children — often
because of dehydration and a low-protein diet — but in other parts of
the world, bladder stones occur primarily in older men. If you live in
an industrialized country, these factors increase your risk:

* Your sex. Bladder stones occur primarily in men.
* Your age. In wealthy countries, bladder stones tend to occur in
people age 50 and older, although younger men who have urinary retention
may also develop stones.
* Bladder outlet obstruction. The most common cause of bladder
stones in men, bladder outlet obstruction refers to any condition that
blocks the flow of urine from your bladder to the urethra, the tube that
carries urine out of your body. Bladder outlet obstruction has many
causes, but the most common is an enlarged prostate. Other possible
causes include prostate cancer, narrowing of the urethra from infection
or surgery — even certain medications.
* Neurogenic bladder. Stroke, spinal cord injuries, Parkinson's
disease, diabetes, a herniated disk and a number of other problems can
damage the nerves that control bladder function. Some people with
neurogenic bladder may also have an enlarged prostate or other type of
bladder outlet obstruction, which further increases the risk of stones.
* Frequent bladder infections. Inflammation from chronic bladder infections can lead to the formation of bladder stones.

Complications

Bladder stones that aren't removed — even those that don't cause symptoms — can lead to complications, such as:

* Chronic bladder dysfunction. Left untreated, bladder stones can
cause long-term urinary problems, such as pain or frequent urination.
Bladder stones can also lodge in the opening where urine exits the
bladder into the urethra, and block the passage of urine from your body.
* Urinary tract infections. Recurring bacterial infections in your urinary tract may be caused by bladder stones.
* Bladder cancer. Chemicals or objects that cause chronic irritation
of the bladder wall, including bladder stones, increase your risk of
bladder cancer.


Preparing for your appointment

You're likely to have one or more tests to help diagnose bladder stones.
Be sure to ask your doctor whether you need to avoid eating, drinking
or taking certain medications before the test. You might also find it
helpful to prepare a list of other questions for your doctor, such as:

* Do bladder stones pass on their own?
* If not, should they be removed and what is the best method?
* What are the risks of the treatment you're proposing?
* What will happen if the stones aren't removed?
* Is there any medication I can take to eliminate bladder stones?
* How can I keep them from coming back?

Tests and diagnosis

Making a diagnosis of bladder stones begins with a physical exam. Your
doctor will likely feel your lower abdomen to see if your bladder is
distended and, in some cases, perform a rectal exam to determine whether
your prostate is enlarged. You may also discuss any urinary signs or
symptoms that you've been having.

Other tests used to make a diagnosis of bladder stones may include:

* Urinalysis. A sample of your urine may be collected and examined
for microscopic amounts of blood, bacteria and crystallized minerals. A
urinalysis is also helpful for determining whether you have a urinary
tract infection, which can cause bladder stones.
* Cystoscopy. During cystoscopy, your doctor inserts a tube with a
small camera at the end (cystoscope) through your urethra and into your
bladder. After the cystoscope is in place, your doctor fills the
cystoscope with water, which flows into your bladder. As fluid fills
your bladder, it stretches the bladder wall, allowing your doctor to
view the bladder interior. Cystoscopy is the most sensitive test for
diagnosing bladder stones because it helps your doctor see the number,
size and location of the stones in your bladder.
* Spiral computerized tomography (CT) scan. A conventional CT scan
combines multiple X-rays with computer technology to create
cross-sectional images of your body rather than the overlapping images
produced by regular X-rays. A spiral CT speeds up this process, scanning
more quickly and with greater definition of internal structures. Spiral
CTs can detect even very small stones and are considered one of the
most sensitive tests for identifying bladder stones of all types.
* Ultrasound. An ultrasound, which bounces sound waves off organs
and structures in your body to create pictures, can help your doctor
visualize bladder stones.
* X-ray. An X-ray of your kidneys, ureters and bladder helps your
doctor determine whether stones are present in your urinary system. This
is an inexpensive and easy test to obtain, but some types of stones
aren't visible on conventional X-rays.
* Intravenous pyelogram. An intravenous pyelogram is a test that
uses a contrast material to visualize organs in your urinary tract. The
material is injected into a vein in your arm and flows into your
kidneys, ureters and bladder, outlining each of these organs. X-ray
pictures are taken at specific time points during the procedure to check
for stones. In many cases, helical CT scans have now replaced this
test.

Treatments and drugs

Most bladder stones should be removed. If the stone is small, your
doctor may recommend that you drink an increased amount of water each
day to help the stone pass. If the stone is large or doesn't pass on its
own, your doctor may need to remove the stone.

Breaking stones apart
Bladder stones are often removed during a procedure called a
cystolitholapaxy. A small tube with a camera at the end (cystoscope) is
inserted through your urethra and into your bladder to view the stone.
Your doctor then uses a laser, ultrasound or mechanical device to break
the stone into small pieces and flushes the pieces from your bladder.

You'll likely have regional or general anesthesia prior to the procedure
to make you comfortable. Complications from a cystolitholapaxy aren't
common, but urinary tract infections, fever, a tear in your bladder and
bleeding can occur. Your doctor may give you antibiotics before the
procedure to reduce the risk of infections. About a month after the
cystolitholapaxy, your doctor will likely check to make sure that no
stone fragments remain in your bladder.

Occasionally, bladder stones that are large or too hard to fragment are
removed through open surgery. In these cases, your doctor makes an
incision in your bladder and directly removes the stones. Any underlying
condition causing the stones, such as an enlarged prostate, may be
corrected at the same time.


Alternative medicine

For centuries, some people have tried to use herbs to treat and prevent
stones that form in the kidneys and bladder. Traditional herbs for
bladder stones include gravel root (also called kidney root, queen of
the meadow and Joe Pye), stone root (also called citronella and
colinsonia) and hydrangea (wild or mountain hydrangea).

These herbs are used alone or in various combinations and drunk as tea
or taken in tincture form. Some herbal formulas add marshmallow, which
is said to coat the fragments so that they can be eliminated painlessly.
No studies, however, have confirmed that herbs can break up bladder
stones, which are extremely hard and usually require a laser, ultrasound
or other procedure for removal.


Prevention

Bladder stones usually result from an underlying condition that's hard
to prevent, but you can decrease your chance of developing bladder
stones by following these tips:

* Ask about unusual urinary symptoms. Early diagnosis and treatment
of an enlarged prostate or another urological condition may reduce your
risk of developing bladder stones.
* Drink plenty of fluids. Drinking lots of fluids, especially water,
may help prevent bladder stones because fluids dilute the concentration
of minerals in your bladder. How much water you should drink depends on
your age, size, health and level of activity. Ask your doctor what's an
appropriate amount of fluid for you.
* Try cranberry juice. Chronic bladder infections can lead to the
formation of bladder stones. Cranberry juice may help prevent these
infections by slowing bacterial growth and preventing bacteria from
adhering to the lining of your bladder.
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