My clinical approach
Bladder stones are not simply a “mechanical problem” solved by removing them. In 95% of cases, bladder lithiasis is a symptom of a deeper problem: nearly always there is an underlying cause leading to inefficient bladder emptying — and if untreated, the stones will return.
Holmium:YAG laser bladder stone lithotripsy is the method of choice — with proven efficacy for stones of all types and sizes, minimal injury risk, and rapid recovery.
What is laser bladder stone lithotripsy?
Laser bladder stone lithotripsy is an endoscopic technique in which a cystoscope is introduced through the urethra, the stone is located in the bladder, and a laser fibre inserted through the cystoscope’s working channel delivers Holmium:YAG laser energy to fragment the stone into small pieces, which are then irrigated out or passed via the urethra.
Causes of bladder stones
Benign Prostatic Hyperplasia (BPH)
Bladder outlet obstruction due to BPH leads to residual urine, salt precipitation, and stone formation.
Neurogenic bladder dysfunction
Incomplete bladder emptying due to neurological disease (e.g. multiple sclerosis, spinal cord injury).
Foreign body
Catheters, sutures or other materials can serve as a nidus for stone formation.
Urethral stricture
Difficulty voiding due to urethral narrowing, mainly in men.
Dehydration / diet
Insufficient fluid intake, excessive salt or oxalate consumption.
When is treatment needed?
Pre-operative preparation
Tests
Full blood count, biochemistry, urinalysis, bladder ultrasound to assess stone size and number, ECG.
Anticoagulants
Discontinue anticoagulants/antiplatelets as per guidelines, typically 5–7 days prior.
Fasting
Fast from midnight before the procedure.
Antibiotics
Prophylactic antibiotics given before the procedure.
How the procedure is performed
Recovery
Contact your urologist immediately if:
- Fever > 38°C
- Inability to urinate
- Heavy haematuria with clots
- Severe abdominal or pelvic pain
Preventing recurrence
Treat BPH
Medical (alpha-blockers, 5-alpha reductase inhibitors) or surgical (TURP, laser prostatectomy) treatment to restore bladder emptying.
Manage neurogenic bladder
Clean intermittent catheterisation (CIC) or other urodynamic management for complete bladder emptying.
Increased fluid intake
Target 2–2.5 litres/day to dilute urine and reduce crystallisation.
Regular urological follow-up
Annual ultrasound for early detection of new stones.
Comparison of lithotripsy methods
| Method | Advantages | Disadvantages |
|---|---|---|
| Holmium:YAG Laser ✓ | Effective for all stone types, minimal wall injury risk, fine fragments/dust | Equipment cost |
| Mechanical lithotripsy | Simple equipment, lower cost | Less effective for hard stones |
| Electrohydraulic lithotripsy | Effective, widely available | Higher risk of bladder wall injury |
| Open cystolithotomy | Large or multiple stones | Skin incisions, longer recovery — reserved for failed endoscopic approaches |
Frequently Asked Questions (FAQ)
Do bladder stones always require surgery?
Yes. Bladder stones do not pass spontaneously like some small kidney stones. Endoscopic laser lithotripsy is the recommended treatment — it avoids external incisions, produces excellent results, and recovery is minimal.
What anaesthesia is used?
Usually spinal (regional) or general anaesthesia. For very small stones and selected patients, local anaesthesia with anaesthetic gel may be used if the procedure is performed in the office.
How long does the procedure take?
Duration depends on the number, size and hardness of the stones. Usually 20–60 minutes. Very large or hard stones may require longer.
When can I go home?
For straightforward cases, the same day or after one overnight stay. If a catheter is placed after the procedure, it is usually removed the following day. Return to normal activities in 1–3 days.
Why do bladder stones form?
Common causes: enlarged prostate (BPH) causing urinary retention, neurogenic bladder dysfunction, urethral stricture, foreign bodies (e.g. catheter), inadequate fluid intake, recurrent UTIs, and metabolic disorders.
Can bladder stones recur?
Yes, if the underlying cause is not addressed. If, for example, BPH is not treated, urinary stasis continues and stone recurrence is likely. We always treat the cause, not just the stones.
Book your appointment in Rhodes
If you have bladder stones or symptoms of bladder lithiasis, early endoscopic treatment prevents complications and allows a rapid return to normal activities.
References
- EAU Guidelines on Urolithiasis 2024 — uroweb.org
- AUA Surgical Management of Stones Guideline 2016 (Amended 2019) — auanet.org
- EAU Guidelines on Non-Neurogenic Male LUTS 2024 — uroweb.org
Medical review
Dr. Marinos Vasilas, Urologist – Andrologist
Dr. Vasilas performs Holmium:YAG laser bladder stone lithotripsy, focusing both on stone clearance and addressing the underlying cause — for optimal long-term outcomes.
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