Bladder Stone Management

Initial Evaluation and Management

Urine microscopy and culture should be obtained to exclude or treat urinary tract infection in patients with bladder stones, as recommended by the European Urology guidelines 1, 2
Stone analysis should be performed for all first-time stone formers to guide future prevention strategies, according to the European Urology guidelines 1
Antimicrobial prophylaxis should be administered prior to stone intervention based on prior urine culture results and local antibiogram patterns, as suggested by The Journal of Urology and European Urology guidelines 2, 3
If purulent urine is encountered during endoscopic intervention, the procedure should be aborted, appropriate drainage established, and antibiotic therapy continued, as recommended by The Journal of Urology guidelines 3, 4

Transurethral cystolithotripsy (TUCL) uses laser or pneumatic lithotripsy to fragment stones, with shorter hospital stay and catheterization time compared to open surgery, as reported by The Journal of Urology 5
Percutaneous cystolithotripsy (PCCL) is an alternative endoscopic approach with similar stone-free rates to TUCL, but with longer hospital stays, as noted by The Journal of Urology 5
Open cystolithotomy should not be offered as first-line therapy, but reserved for rare cases with very large or complex stones, or anatomic abnormalities requiring reconstruction, as recommended by The Journal of Urology guidelines 3, 6

Ureteroscopy, including TUCL, should be used as first-line therapy in patients with uncorrected bleeding diatheses or those requiring continuous anticoagulation/antiplatelet therapy, as suggested by The Journal of Urology guidelines 4, 6
Shock wave lithotripsy (SWL) and percutaneous procedures are classified as high-risk procedures for bleeding, according to European Urology guidelines 2

Oral chemolysis with alkalinization using citrate or sodium bicarbonate (pH 7.0-7.2) can dissolve uric acid stones with success rates of 80.5%, as reported by European Urology 1