Secondary prevention against recurring bladder stones

dr. Dyandra Parikesit, Sp.U, B.Med.Sc.
dr. Dyandra Parikesit, Sp.U, B.Med.Sc. Photo: RS UI

Depok, IO – Bladder stones are the third more common urological problem suffered, after urinary tract infections and prostate enlargement. The stones are formed when minerals accrete and crystallize in the urinary tract. When sufficient amounts stick together, a stone matrix will be formed. Minerals can accrete anywhere: within the kidneys’ chambers, sliding down the urinary tract, or sticking on the tract’s wall. When the stone is big enough to obstruct the urinary flow, complaints such as difficulty to urinate, painful urination, and even bleeding urination (hematuria) may occur. 

“Patients usually complain of pains going on and off somewhere down below, from the waist to the lower stomach to the genitals. They must be especially alert for reinfection, which is generally indicated by fever, nausea, and vomiting. As we are geographically located in a tropical region with a humid climate and high temperatures, an environment which promotes sweating and dehydration, the incidence of bladder stones in Indonesia is higher than that in other countries. According to medical literature, Indonesia is even nicknamed the ‘bladder stone belt’ region,” said dr. Dyandra Parikesit, Sp.U, B.Med.Sc., an urologist from the University of Indonesia Hospital, Depok, West Java, in the webinar “When Do We Need to Treat Bladder Stones?” held on Tuesday (15/03/2022). 

He went on to say that bladder stones are not like tonsillitis or appendicitis, which require only a single operation to get rid of once and for all. “I prefer to use the term ‘treatment’ that ‘operation’ because nowadays we usually don’t perform major operations anymore. We prefer to use shockwaves, laser, or other minimally-invasive treatments. Bladder stones have a tendency to return after treatment. Therefore, I always urge my patients to take secondary prevention measures, which is generally a lifestyle change: drinking more plain water, and avoiding sodas and other foods that are high in uric acid.” 

Personalized Stone Approach 

When treating a patient with a bladder stone, the urologist will do their best to get as much of the stone out of the patient’s body. “If the stone is less than 0.5 centimeter in diameter and located in the urinary tract, the patient’s therapy is a simple drug-and-lots-of-plain-water regime. This is usually sufficient to get the stone out by itself, as it is already in the tract. Stones located within the kidney’s chambers are harder to take out. Therefore, we need a personalized stone approach by evaluating the stone’s characteristics: is it soft or hard? Where is it located? Does the patient suffer from any co-morbidity?” dr. Dyandra said. 

He further reminds everyone that the stone does not suddenly appear as a large 1.5-2 centimeter pebble. “The stone is formed from the tiniest size – 1 millimeter, 2 millimeters – and growing. This is why it is important to get routine health checks – the earlier the stone is found, the earlier it is treated, the better the chances of full recovery. This is especially important as genetics strongly affect the formation of bladder stones. Children of parents who have bladder stones run a higher risk of developing them all their lives. Therefore, as I tirelessly remind everyone, we need to avoid this by implementing a healthy lifestyle of sufficient hydration, routine exercise, and no alcohol. Most importantly, make sure that we produce 2-2.5 liters of urine a day. That’s about 3-4 medium flow urinations a day,” he added. (est)