Small migratory stones may pass spontaneously when there is:
- No bladder outlet obstruction
- Normal bladder function
- Small stone burden
Most primary or secondary bladder stones require active removal.
Transurethral cystolithotripsy
Preferred in most adults.
Fragment using:
- Holmium laser
- Thulium laser
- Pneumatic lithotripsy
- Ultrasonic lithotripsy
Remove fragments completely.
Percutaneous cystolithotripsy
Useful when:
- Transurethral access unsuitable
- Urethral stricture
- Very large stone burden
- Reconstructed lower urinary tract
Open cystolithotomy
Useful for selected very large stones or when another open bladder or prostate operation is being performed.
Uric acid stone
Can sometimes be dissolved by oral urinary alkalinisation.
Aim for urine pH consistently above approximately 6.5 using:
or
with frequent pH monitoring.
Treat the cause
If significant BPH caused the stone, consider simultaneous or staged outlet surgery rather than simply removing the calculus.
